Mesenteric blood flow is equally compromised in preterm neonates receiving CPAP or high-flow respiratory support

Non-invasive ventilation (NIV) is preferred to intubation and mechanical ventilation as a means of managing respiratory distress syndrome (RDS) in preterm infants to help prevent ventilation induced lung injury. Nasal continuous positive airway pressure (CPAP) has been shown to decrease the incidence of bronchopulmonary dysplasia (BPD) when compared with mechanical ventilation. 1 However, CPAP is increasingly being associated with multiple adverse effects. These include nasal trauma which can be external (columellar necrosis) or internal trauma (ulceration, granulation, vestibular necrosis), pneumothorax, feed intolerance, and abdominal distension progressing to necrotizing enterocolitis (NEC). 2 , 3 Haemodynamic concerns regarding CPAP have also been raised with over-distention of the lungs possibly leading to a compromise of venous return to the heart resulting in altered organ perfusion. There is also increasing evidence that CPAP may adversely affect gut perfusion and cause significant haemodynamic changes in the superior mesenteric artery (SMA) flow. 4 Humidified high-flow nasal cannula (HHHFNC) is a relatively new modality of NIV in the management of RDS and is increasingly used as an alternative to CPAP. 5 It is thought that HHHFNC may be associated with less adverse effects compared with CPAP, especially regarding nasal trauma and lung overdistention. 6 , 7