[High flow nasal cannula: is it a risk factor of bronchopulmonary dysplasia and retinopathy of premature?]

Abstract

Observational studies have described an increase in the duration of oxygen therapy, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) in relation to the use of high-flow nasal cannula (HFNC, 2013-2016).

Objective: to analyze changes in the evolution of very preterm newborns with the use of HFNC.

Patients and method: The incidence of neonatal pathologies between 2013 and 2021 was analyzed with a statistical process control. An analysis of cases (with HFNC, 2017-2021) and controls (without HFNC, 2013-2016) was performed, 1:2, matched by weight and gestational age, comparing the main neonatal morbidities and respiratory support. Univariate analysis and logistic regression were performed with the variables associated with BPD and ROP.

Results: 59 cases and 116 controls. The statistical process control revealed an increase in BPD and ROP over time, which coincides with the incorporation of the HFNC and with the increase in days of oxygen therapy. The case-control analysis showed an increase in respiratory support and oxygen therapy measures and greater severity at birth, according to the Apgar and Neocosur score, in the group with HFNC. Logistic regression showed a significant association between the use of the HFNC and the risk of BPD and ROP. In addition, a longer duration of mechanical ventilation, lower birth weight, and more late sepsis were associated with BPD, and lower weight and gestational age at birth and longer duration of mechanical ventilation were associated with ROP.

Conclusions: These findings require a quality improvement program to reduce BPD and ROP, seeking an adequate use of HFNC.