High‐flow nasal cannulae (
HFNC) are increasingly used for respiratory management of preterm infants. However, their ability to provide support compared to nasal continuous positive airway pressure ( CPAP) has been questioned. We compared the effect of HFNCversus nasal CPAPon diaphragm electrical activity ( EAdi) in preterm infants. Methods
Preterm infants ≤1500 g were randomised in a crossover design to receive 2 hours of either Infant Flow®
CPAP( IF‐ CPAP) at 5–6 cmH2O or HFNCwith the flow rate adjusted to achieve an equivalent pharyngeal pressure. A feeding catheter with miniaturised sensors was inserted for continuous EAdi measurement. Results
The study comprised ten infants. Physiologic parameters and oxygen requirements were not different between the two modes. However, seven infants demonstrated a higher
EAdi peak and six showed a higher EAdi tonic on HFNC, even though the mean group data showed no difference between HFNCand IF‐ CPAP. Neural inspiratory time was significantly longer with HFNCthan IF‐ CPAP(0.55 ± 0.11 versus 0.48 ± 0.06 seconds, p = 0.018). Conclusion
In this cohort of preterm infants, the majority exhibited greater diaphragm activation, as assessed by neural breathing patterns, when supported with
HFNCthan IF‐ CPAP, suggesting that nasal CPAPmay provide more effective respiratory support.