Nasal High-Flow Therapy Versus Low-Flow Oxygen Therapy Post-Discharge in Infants With Bronchopulmonary Dysplasia: A Retrospective Observational Study

Introduction: Low-flow oxygen therapy (LFOT) has been the only option for infants with bronchopulmonary dysplasia (BPD) requiring supplemental oxygen after discharge for years. Nasal high-flow therapy (NHFT) has more recently become available as a home device. We compared the impact of NHFT and LFOT on respiratory morbidity and lung function over the first 4 years in infants with BPD requiring respiratory support post-discharge.

Method: We retrospectively analyzed data on respiratory morbidity and lung function assessed by tidal breathing flow-volume loop (TBFVL) analysis available from follow-up visits of infants with BPD discharged home with LFOT or NHFT up to 4 years. We compared long-term respiratory outcomes by applying a mixed model, adjusting for mechanical ventilation, overall respiratory support duration, pulmonary hypertension, oxygen therapy, caffeine therapy, and smoking exposure.

Results: We included 26 infants discharged with LFOT and 47 with NHFT. The two groups were homogeneous for baseline demographics and BPD severity. Infants in the NHFT group were weaned from respiratory support earlier compared to the LFOT group (median [IQR] 8.0 [4.0; 12.0] vs 14.5 [6.0; 21.5] months, p 0.046). After applying a mixed model, the NHFT group showed a lower incidence of upper (p = 0.025) and lower respiratory tract infections (p = 0.003), wheezing (p: 0.001), and need for bronchodilator (p = 0.028) and systemic steroids (p < 0.001) during the initial 4 years. Lung function testing did not highlight between-group differences.

Conclusions: NHFT as an alternative to LFOT may positively impact long-term clinical outcomes of infants with BPD requiring noninvasive respiratory support post-discharge.