الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Heated humidified high flow nasal cannula is a noninvasive respiratory support strategy that is widely used in preterm infants. It delivers heated and humidified blended oxygen and air via nasal cannulas at high flow rates greater than 2 L/min. The advantages of HHHFNC include ease of use, less nasal trauma, and improved patient comfort compared to NCPAP. Our study is a prospective quasi-experimental study conducted in the NICU, Mansoura University Children’s Hospital in the period from July 2017 to August 2018. We tested the hypothesis that applying a protocol of weaning from HHHFNC will be safe, decreased weaning failure, duration of therapy, risk for sepsis, pulmonary air leak, nasal trauma, hospitalization costs and helped early discharge from NICUs. Of the 136 infants screened, 104 preterm infants less than 37 weeks gestation received respiratory support via HHHFNC for any indication were enrolled in the study. They were categorized into two groups; 51 preterm infants in the protocol group and 53 in the usual care group. The first group received HHHFNC and weaned according to the use of a pre-specified protocol. The second group received HHHFNC and weaned as usual care. We excluded infants with HHHFNC for < 24 h, inborn error of metabolism, congenital abnormalities and more than grade 2 IVH. Our study showed a lower failure rate in weaning of HHHFNC in protocol group (P=0.007). Fifteen infants (28.3%) in the non-protocol group failed weaning from HHHFNC versus 4 infants (7.8%) in the protocol group.In our study, there was no difference in the duration of weaning failure from HHHFNC occurred after 48h (24-60) in the protocol group versus 24h (3-60) in the non-protocol group. Similarly, we have found no difference in the duration of HHHFNC between groups. As it was 5 (3-20) days in protocol group versus 5 (3-28) days in non-protocol group (P=0.32). We found no difference in secondary outcomes between two groups as regard duration of hospital stay, cost of hospitalization, duration of oxygen, and total duration of respiratory support, nasal trauma, IVH, PDA and sepsis. In our study, the duration to full enteral feeding was lower in protocol than non-protocol group with 7 days (4-26) vs 8 days (5-23).Regarding ROP, we found three patients had ROP requiring intravitreal injection in non-protocol group with no infants in protocol group, although there was no difference in duration of oxygen therapy or total duration of respiratory support.