Discussion
fatigue, NRS
SECONDARY
To our knowledge, this multicenter randomized clinical trial was the first to investigate the effects on feeding intolerance of the 2 most common techniques of NRS (NCPAP and HHHFNC) in preterm infants at high risk for feeding problems. We found no differences in time to reach FEF between the NCPAP and HHHFNC groups, and the population was not analyzed by different gestational age classes.These findings disproved our hypothesis that HHHFNC might affect feeding intolerance to a lesser extent than NCPAP, but they are in agreement with the results reported by Amendolia et al,We based the study hypothesis on the premise that infants with HHHFNC rather than NCPAP treatment experience less feeding intolerance that is secondary to less gastric distension from high positive pressure, discomfort from nasal prongs and nasopharyngeal tube, stress and fatigue from overhandling, and hesitation in increasing volume of enteral feeding. The results of this trial disproved this hypothesis. To explain this disagreement, we can argue that the high flow of oxygen or air delivered by HHHFNC devices increases the pharyngeal pressure by 0.8 cm HConcerning the respiratory outcomes, NCPAP and HHHFNC had similar rates of failure and change in NRS. However, the change from NCPAP to HHHFNC was mainly due to poor compliance with the interface, and HHHFNC was used as a weaning technique from NCPAP. The switch from HHHFNC to NCPAP was mainly due to lower respiratory efficacy of HHHFNC. The SpO