Predicting nasal high-flow treatment success in newborn infants with respiratory distress cared for in nontertiary hospitals

McKimmie-Doherty, Megan, Arnolda, Gaston R.B., Buckmaster, Adam G., Owen, Louise S., Hodgson, Kate A., Wright, Ian M.R., Roberts, Calum T., Davis, Peter G., Manley, Brett J., and For the HUNTER trial investigators, (2020) Predicting nasal high-flow treatment success in newborn infants with respiratory distress cared for in nontertiary hospitals. Journal of Pediatrics, 227. pp. 135-141.

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Objective: To evaluate demographic and clinical variables as predictors of nasal high-flow treatment success in newborn infants with respiratory distress cared for in Australian nontertiary special care nurseries.

Study design: A secondary analysis of the HUNTER trial, a multicenter, randomized controlled trial evaluating nasal high-flow as primary respiratory support for newborn infants with respiratory distress who were born >= 31 weeks of gestation and with birth weight >= 1200 g, and cared for in Australian nontertiary special care nurseries. Treatment success within 72 hours after randomization to nasal high-flow was determined using objective criteria. Univariable screening and multivariable analysis was used to determine predictors of nasal high-flow treatment success.

Results: Infants (n = 363) randomized to nasal high-flow in HUNTER were included in the analysis; the mean gestational age was 36.9 +/- 2.7 weeks and birth weight 2928 +/- 782 g. Of these infants, 290 (80%) experienced nasal high-flow treatment success. On multivariable analysis, nasal high-flow treatment success was predicted by higher gestational age and lower fraction of inspired oxygen immediately before randomization, but not strongly. The final model was found to have an area under the curve of 0.65, which after adjustment for optimism was found to be 0.63 (95% CI, 0.57-0.70).

Conclusions: Gestational age and supplemental oxygen requirement may be used to guide decisions regarding the most appropriate initial respiratory support for newborn infants in nontertiary special care nurseries. Further prospective research is required to better identify which infants are most likely to be successfully treated with nasal high-flow.

Item ID: 66195
Item Type: Article (Research - C1)
ISSN: 1097-6833
Copyright Information: ©2020 Published by Elsevier Inc.
Additional Information:

We thank the HUNTER trial investigators: The Royal Women's Hospital, Parkville: Amy Tagliante Saracino, RN, Bernice Mills, RN; Sunshine Hospital (Western Health), St Albans: Rosalynn J. Pszczola, MBChB, Haidee J. Murnane, RN; The Northern Hospital (Northern Health), Epping: Wei Qi Fan, PhD, Amanda J. Freeman, RN, Gloria J. Pegler, RN, Barbara Rischitelli, RN; Geelong University Hospital (Barwon Health), Geelong: Isaac R. Marshall, MPH, Melissa Blake, RN; Box Hill Hospital, Box Hill, and The Angliss Hospital, Upper Ferntree Gully (Eastern Health): Alice Y. W. Fang, MBBS, Elizabeth L. Thomas, MBBS, Nancy Yuen, RN, Tracy Huang, RN; Dandenong Hospital, Dande-nong, and Casey Hospital, Berwick (Monash Health): Tracey L. Clark, RN; Christine M. Monagle, RN; The University of Melbourne, Parkville: Li Huang, PhD, Kim M. Dalziel, PhD; Mr Alex Ades, Life's Little Treasures and NICU parent. New South Wales, Australia Gosford Hospital, Gosford: Jane Wardle, RN, Ahmed Khan, MB BS; Wollongong Hospital, Wollongong: Ashley N Blood, RN, Patrice Nolan, RN; Western Sydney University, Penrith: Jann P. Foster, PhD. We also thank the participating centers for their involvement in the trial and the parents of the infants.

Funders: Medical Research Future Fund (MRFF), National Health and Medical Research Council (NHMRC)
Projects and Grants: MRFF Next Generation Clinical Researchers Career Development Fellowship 1159225, NHMRC Career Development Fellowship 1159444, NHMRC Emerging Leadership Grant 1175634, NHMRC Practitioner Fellowship 1157782
Date Deposited: 06 Jan 2021 07:45
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3213 Paediatrics > 321302 Infant and child health @ 100%
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