Explore Outcomes of High-Flow Nasal Cannula Versus Classical Oxygen Therapy in Infants with Acute Bronchiolitis: A Comparative Clinical Study

Abstract

Background: Acute bronchiolitis is a major cause of hospitalization in infancy and supportive oxygen therapy forms an important part of management in hypoxemic patients. High flow nasal cannula (HFNC) therapy has been increasingly used as an alternative to conventional low flow oxygen, particularly in infants with respiratory distress. Objective: To compare the clinical outcomes of HFNC therapy with standard oxygen therapy in infants hospitalized with acute bronchiolitis. Methods: A comparative clinical study was performed in the general pediatric ward of Karbala Teaching Hospital for Children from January 1 to February 29, 2024 on 100 infants (aged 2–12 months) clinically diagnosed bronchiolitis; standard oxygen therapy (50) and HFNC therapy (50). Standard oxygen was administered through nasal cannula at 1–2 L/min and HFNC at 1–2 L/kg/min with fraction of inspired oxygen adjusted according to oxygen saturation. Clinical severity was assessed by Modified Tal score. The main outcomes were treatment failure, clinical severity after 24 hours and hospital stay length. Results: Baseline demographics were similar between the two groups. Initial Modified Tal scores did not differ significantly between standard oxygen and HFNC groups (7.00 ± 1.37 vs. 7.58 ± 2.02; p=0.090). At 24 hours, clinical severity score was lower in HFNC group than standard oxygen group (5.08 ± 2.28 vs. 6.96 ± 2.09; mean difference 1.88; 95% CI 1.03–2.74; p<0.001). Mean hospital stay was shorter in HFNC group (3.58 ± 1.26 vs. 4.68 ± 2.76 days; mean difference 1.10 days; 95% CI 0.25–1.95; p=0.011). Treatment failure occurred in 19 (38%) infants on standard oxygen but none among infants receiving HFNC. Conclusion: In infants hospitalized with acute bronchiolitis HFNC therapy was associated with greater improvement in clinical severity at 24 hours, fewer treatment failures and shorter hospital stay than standard oxygen therapy. Further multicenter studies are needed to confirm these results.