Name: Anna Lavizzari, MD
Job Title: Attending Physician,

Neonatal Intensive Care Unit,
Department of Clinical Sciences and Community Health, University of Milan
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico – Milan, Italy

Title of talk: High Flow Therapy as primary treatment for respiratory distress of preterm infants: the Italian experience.
Biographical Sketch: I earned my medical degree in General Medicine and Surgery in 2006 from the University of Florence. I am board certified in Paediatrics since 2012 (University of Milan). I completed my training in Pediatrics and Neonatology at the Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico – University of Milan, directed by Professor Fabio Mosca. During my training, I developed a strong interest in neonatal respiratory physiology, neonatal respiratory support and neonatal resuscitation.

I did a research fellowship at the Murdoch Children’s Research Institute in Melbourne in 2013-2014, investigating different strategies for neonatal resuscitation in preterm lambs and less invasive methods of delivering surfactant, under the supervision of Dr David Tingay and Prof Peter Dargaville. I have and continue to participate in experimental research on the long-term complications of preterm birth and prolonged mechanical ventilation in former preterm lambs under the guidance of both Dr. Jane Pillow in Perth (University of Western Australia) and Dr. Kurt Albertine in Salt lake City (University of Utah).

I have been working as an attending physician in the Neonatal Intensive Care Unit at Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico – University of Milan since December 2014. My clinical research projects have been focused up to now on neonatal non-invasive respiratory support, Forced Oscillation Technique for assessing respiratory mechanics, Sustained Lung Inflation, and minimally invasive surfactant administration.

I have been a member of the Pulmonology Board of the Italian Neonatal Society and a young member of the Pulmonology section of the ESPR.

Lecture Abstract: Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasingpopularity as respiratory support for newborn infants in recent years. We conducted an unblinded, monocentric, randomized clinical noninferiority trial at our tertiary neonatal intensive care unit aiming to o determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach

to RDS in infants older than 28 weeks’ gestational age (GA).

Inborn infants at 29 weeks 0 days to 36 weeks 6 days of GA were eligible if presenting with mild to moderate RDS requiring non-invasive respiratory support. Criteria for starting non-invasive respiratory support were a

Silverman score of 5 or higher or a fraction of inspired oxygen higher than 0.3 for a target saturation of peripheral oxygen of 88%to 93%. Infants were ineligible if they had major congenital anomalies or severe RDS requiring early intubation. Intervention: they were randomized to either HHHFNC at 4 to 6 L/min or nCPAP/BiPAP at 4 to 6 cmH2O. The primary outcome was the need for mechanical ventilation within 72 hours from the beginning of respiratory support. The absolute risk difference in the primary outcome and its 95% confidence interval were calculated to determine noninferiority (noninferiority margin, 10%). An intention-to-treat analysis was performed.

A total of 316 infants were enrolled in the study: 158 in the HHHFNC group (mean [SD] GA, 33.1 [1.9] weeks; 52.5%female) and 158 in the nCPAP/BiPAP group (mean [SD] GA, 33.0 [2.1] weeks; 47.5%female). The use of HHHFNC was noninferior to nCPAP with regard to the primary outcome: failure occurred in 10.8% vs 9.5%of infants, respectively (95%CI of risk difference, −6.0% to 8.6% [within the noninferiority margin]; P = .71). Significant

between-group differences in secondary outcomes were not found between the HHHFNC and nCPAP/BiPAP groups, including duration of respiratory support (median [interquartile range], 4.0 [2.0 to 6.0] vs 4.0 [2.0 to 7.0] days; 95% CI of difference in medians, −1.0 to 0.5; P = .45), need for surfactant(44.3% vs 46.2%; 95% CI of risk difference, −9.8 to 13.5; P = .73), air leaks (1.9% vs 2.5%; 95% CI of risk difference, −3.3 to 4.5; P = .70), and

bronchopulmonary dysplasia (4.4% vs 5.1%; 95% CI of risk difference, −3.9 to 7.2; P = .79). In this study, HHHFNC showed efficacy and safety similar to

those of nCPAP/BiPAP when applied as a primary approach to mild to moderate RDS in preterm infants older than 28 weeks’ GA.

References: 1.     Lavizzari A, Colnaghi M, Ciuffini F, Veneroni C, Musumeci S, Cortinovis I, Mosca F. Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial. JAMA Pediatr. 2016 Aug 8.   PMID:27532363

2.     Yoder BA, Manley B, Collins C, Ives K, Kugelman A, Lavizzari A, McQueen M. Consensus approach to nasal high-flow therapy in neonates.J Perinatol. 2017 Mar 23. PMID:28333157

Lavizzari A, Veneroni C, Colnaghi M, Ciuffini F, Zannin E, Fumagalli M, Mosca F, Dellacà RL. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures. Arch Dis Child Fetal Neonatal Ed. 2014 Jul;99(4):F315-20. PMID:24786469