Comparative efficacy of High-Flow Nasal Cannula (HFNC) versus Continuous Positive Airway Pressure (CPAP) in Preventing Bronchopulmonary Dysplasia (BPD) among Preterm Neonates

HFNC versus CPAP in Preventing BPD among Preterm Neonates

Abstract

Bronchopulmonary dysplasia (BPD) remains a major cause of respiratory morbidity in preterm infants requiring respiratory support. Non-invasive ventilation strategies such as nasal continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) are commonly used, but evidence comparing their effectiveness in preventing BPD remains limited, particularly in low- and middle-income settings. Objectives: To compare HFNC and CPAP as primary non-invasive respiratory support in preterm neonates <34 weeks’ gestation, with BPD at 36 weeks postmenstrual age as the primary outcome. Methods: This cohort study was conducted in a tertiary-care neonatal intensive care unit in Peshawar, Pakistan. Preterm neonates <34 weeks who received HFNC or CPAP as initial respiratory support between April 2024 and March 2025 were included. Multivariable logistic regression was performed to identify predictors of BPD. Results: A total of 189 neonates were analyzed (HFNC n=95; CPAP n=94). The incidence of BPD was similar between HFNC and CPAP groups (25.3% vs 27.7%; p=0.709). Mortality and major neonatal complications were also comparable. Respiratory modality was not independently associated with BPD (aOR 1.41; 95% CI 0.69–2.90; p=0.348). Intubation was strongly associated with BPD (aOR 19.30; p=0.005), while complete antenatal steroid exposure was protective (aOR 0.24; p=0.016). Conclusions: HFNC and CPAP showed similar outcomes in preterm neonates <34 weeks. However, due to the observational design, further prospective studies are needed to confirm these findings.