Publication:

High-flow nasal cannula versus standard oxygen therapy for acute bronchiolitis in infants: a retrospective analytical study

Background Acute Bronchiolitis is a highly prevalent lower respiratory tract infectious diseases among infants. Despite accounting for most hospitalizations in children under 5 years, all pharmaceutical treatments have not demonstrated clear efficacy. Thus, management is mostly by oxygen support. High-flow nasal cannula (HFNC) therapy was recently incorporated as an alternative to standard oxygen therapy (SOT). Given the conflicting results, its efficacy in the treatment of acute bronchiolitis remains unclear. Our study aimed to assess the efficacy of HFNC compared with SOT in terms of length of hospital stay, child discomfort and early discharge.

Methods This retrospective analytical study was conducted at Ghayathi-AlDhafra hospitals, Abu Dhabi, United Arab Emirates, between January 2023 and December 2024. Data were extracted from electronic health records of infants admitted with acute bronchiolitis. All statistical analyses were performed using R version 4.4.1 in RStudio. Between-group comparisons used Fisher’s exact and Mann-Whitney U tests, with multivariable linear and logistic regression models employing bootstrap confidence intervals to assess length of stay and early discharge.

Results A total of 81 infants (HFNC: n=15; SOT: n=66) were included in the analysis. Median length of stay was significantly longer in the HFNC group compared with SOT (4 (IQR 3-5) vs 3 (IQR 2-3) days; p=0.002) and HFNC use remained independently associated with prolonged hospitalization after adjustment (β=1.31 days; 95% CI 0.41-2.18). Early discharge within 48 hours was less frequent among infants receiving HFNC (13.33% vs 37.88%), although this difference did not reach statistical significance.

Conclusions Use of HFNC is associated with longer hospital stays, suggesting that early HFNC use does not alter the course of disease in moderate bronchiolitis. Large-scale studies with standardized protocols are needed to accurately assess the efficacy of HFNC in the treatment of bronchiolitis to identify patients who would benefit most.