Objective To investigate the effect and predictors of failure of high-flow nasal cannula(HFNC)as the primary respiratory support therapy for non-invasive ventilation in severe neonatal pneumonia(NSP).Methods This study retrospec-tively analyzed 85 neonates with NSP admitted to the neonatal intensive care unit of our hospital from January 2019 to De-cember 2021.All patients received HFNC as primary supportive care.HFNC failure was defined as the need for escalation to noninvasive ventilation or invasive mechanical ventilation.Based on clinical data obtained before HFNC treatment and at 30,60,120,and 720 min after treatment,HFNC success(responders)and HFNC failure groups(non-responders)were compared.Results Among 85 neonatal infants,13 patients(15.29%,13/85)experienced HFNC failure,and 72 patients(84.71%,72/85)were successfully ventilated.Compared with the failed HFNC group,the gestational age,birth weight,and duration of HFNC in the successful HFNC group were significantly increased,as well as the respiratory distress score and the length of hospital stay were significantly decreased.The comparison of baseline gas and blood parameters showed that the RS of the successful HFNC group was significantly lower than that of the failed HFNC group,and the SpO2/FiO2(S/F),SpO2 and pH were significantly in-creased.Gestational age,severity of respiratory distress,RS and S/F predicted HFNC failure according to logistic regression analysis.After HFNC treatment,RR,HR,RS and FiO2 were significantly decreased in both groups,and SpO2 and S/F ratio were increased.Compared with the successful HFNC group,the HFNC failure group had significantly lower RS and FiO2 after HFNC treatment,and increased SpO2 and S/F ratio.The achievement rate of S/F goals at 30 min and 60 minutes,RR goals at 30 min-utes,and RS goals at 30 minutes was higher in the HFNC success group compared with the HFNC failure group.In logistic re-gression analysis,the 60-min S/F target significantly predicted successful HFNC treatment(OR=8.035,95%CI 2.980-21.658).Conclusions HFNC is suitable for the treatment of respiratory distress/failure of NSP newborns,and S/F ratio can be used as an early warning index to monitor the failure of treatment before or 60 minutes after HFNC treatment.
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