The work of breathing (WOB) in preterm infants - Is there a difference in the electrical activity in the diaphragm (Edi signals) and cardiorespiratory parameters during heated humidified nasal cannula (HHHNNC) vs. nasal continuous positive airway pressure (NCPAP)? - A Randomised Crossover Pilot Study
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Background: Nasal Continuous Positive Airway Pressure (NCPAP) has recognised benefits as noninvasive respiratory support in preterm infants. There is now a widespread use of heated humidified high flow nasal cannula (HHHFNC) as a noninvasive respiratory support in this population in Newborn Intensive Care Units both nationally and global. There is still a lack of knowledge of short and long-term clinical effects in the use of HHHFNC, and especially because it delivers unregulated end expiratory pressure. Purpose: To test feasibility of a method to measure the work of breathing (WOB) in preterm infants treated with HHHFNC versus NCPAP. Material and methods: Electrical activity in the diaphragm (Edi signals) in a randomised crossover pilot study (2 X 4 hours) with HHHHFNC 6 l/min and NCPAP 2-3cm H2O. Ten preterm infants with mild to moderate respiratory distress syndrome requiring NCPAP within 48 hours after birth participated. Outcome: Electrical activity in the diaphragm (Edi peak and Edi min) r espiratory rate and heart rate. Results: We found no difference in Edi peak, Edi min or heart rate between the HHHFNC and NCPAP interventions. Mean respiratory rate was lower during HHHFNC than NCPAP. No adverse effects. Conclusion: This randomised crossover pilot study was feasible concerning process, resources and management. The use of a new and standardised method measuring the neural drive of the respiration (Edi peak and Edi min) by electromyography is safe and efficient.