Efficacy and Safety of Nasal High-Frequency Oscillation in Preventing Intubation in Very-Low-Birth-Weight Infants with Respiratory Distress Syndrome

Background Invasive mechanical ventilation in very-low-birth-weight infants (VLBWI) was associated with immediate and long-term complications. Nasal high-frequency oscillation (nHFO) has recently become a new non-invasive ventilation (NIV) mode for treating respiratory failure in VLBWI. This study aimed to investigate the safety and efficacy of nHFO as an alternative respiratory support to prevent intubation in VLBWI. Methods A retrospective analysis was conducted using the clinical data of 42 VLBWIs with respiratory distress syndrome (RDS) who were treated in our department from August 2018 to August 2020 and met the selection criteria. Results nHFO was used as a rescue strategy in 32 infants and a prophylactic strategy in 10 infants. It was observed that out of 42 cases, 30 cases (71.4%) were able to avoid intubation within 72 hours, while 23 cases (54.8%) were successfully switched to another NIV mode from nHFO. There was a significant decrease in pCO2 and an increase in pH one hour after using nHFO in the success group. Two cases (4.8%) of feeding intolerance associated with nHFO were noted. Conclusion This study showed that nHFO as alternative respiratory support for preterm infants with RDS might be safe and effective in reducing the need for intubation. Highlights Invasive mechanical ventilation in very low-birth-weight infants (VLBWI) was associated with immediate and long-term complications. As a result, there is an increasing focus on researching and applying non-invasive ventilation (NIV). In this study, Nasal high-frequency oscillation (nHFO) in VLBWI with respiratory distress syndrome showed promising efficacy and safety, with 71.4% of cases avoiding intubation within 72 hours. Further, 54.8% of cases were successfully transitioned to another NIV mode from nHFO. Further randomized controlled trials with adequately powered sample sizes are warranted to assess the overall safety and efficacy of nHFO.