High Flow Nasal Cannula Versus Bubble Nasal CPAP for the Treatment of Transient Tachypnea of the Newborn in Infants ≥ 35 Weeks Gestation
High Flow Nasal Cannula Versus Bubble Nasal CPAP for the Treatment of Transient Tachypnea of the Newborn in Infants ≥ 35 Weeks Gestation
The primary objective is to determine whether High Flow Nasal Cannula (HFNC) is a superior
 respiratory modality for neonates ≥36 weeks with transient tachypnea of the newborn (TTN)
 when compared to the standard of care modality (NCPAP).
Transient Tachypnea of the Newborn, fetal lung fluid retention causing poor lung compliance
 and atelectasis, is a common entity in neonates ≥ 36 weeks in our unit. Currently our
 standard of care includes using the respiratory modality of bubble nasal continuous positive
 airway pressure (BNCPAP) to support these neonates during this illness. BNCPAP provides
 positive distending pressure to recruit alveoli and prevent atelectasis, however, it is
 associated with air leak (pneumothorax, pneumomediastinum), nasal irritation and necrosis,
 and intolerance. HFNC is another respiratory modality that uses high flow gas that also
 provides positive distending pressure and thus prevents atelectasis. This modality does not
 cause nasal irritation or necrosis and has a minimal risk of air leak. We postulate that HFNC
 is a superior modality to BNCPAP in treating neonates ≥ 36 weeks with TTN. This will be
 determined by comparing the duration of respiratory support (in hours) for newborns ≥ 36
 weeks gestation with a diagnosis to TTN randomized to receive either NCPAP or HFNC for
 respiratory care.
Inclusion Criteria:

 -  gestational age ≥ 35 weeks

 -  diagnosis of TTN, defined as respiratory rate >60, presence of subcostal and /or
 intercostal retractions, nasal flaring, grunting, oxygen saturations 70-93% on room
 air, and radiological evidence of perihilar streaking and patchy infiltrates

 -  admission to the NICU at Mount Sinai hospital within first 24 hours of life

 Exclusion Criteria:

 -  gestational age < 35 weeks

 -  history of thick meconium stained fluid and/or diagnosis of meconium aspiration
 syndrome

 -  diagnosis of major congenital pulmonary or cardiac anomalies

 -  initial CXR demonstrating air leak

 -  respiratory distress first occurring after 24 hours of life

 -  presumptive diagnosis of RDS as indicated by the need for FiO2 > 40%, severe
 retractions and grunting with poor air entry, and diffuse alveolar consolidation on
 chest radiograph