***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Treatment with nasal high-flow therapy has efficacy similar to that of nasal continuous positive airway pressure ( CPAP ) when used as postextubation support in neonates . The efficacy of high-flow therapy as the primary means of respiratory support for preterm infants with respiratory distress has not been proved . METHODS In this international , multicenter , r and omized , noninferiority trial , we assigned 564 preterm infants ( gestational age , ≥28 weeks 0 days ) with early respiratory distress who had not received surfactant replacement to treatment with either nasal high-flow therapy or nasal CPAP . The primary outcome was treatment failure within 72 hours after r and omization . Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome ; the chosen margin of noninferiority was 10 percentage points . Infants in whom high-flow therapy failed could receive rescue CPAP ; infants in whom CPAP failed were intubated and mechanically ventilated . RESULTS Trial recruitment stopped early at the recommendation of the independent data and safety monitoring committee because of a significant difference in the primary outcome between treatment groups . Treatment failure occurred in 71 of 278 infants ( 25.5 % ) in the high-flow group and in 38 of 286 infants ( 13.3 % ) in the CPAP group ( risk difference , 12.3 percentage points ; 95 % confidence interval [ CI ] , 5.8 to 18.7 ; P<0.001 ) . The rate of intubation within 72 hours did not differ significantly between the high-flow and CPAP groups ( 15.5 % and 11.5 % , respectively ; risk difference , 3.9 percentage points ; 95 % CI , -1.7 to 9.6 ; P=0.17 ) , nor did the rate of adverse events . CONCLUSIONS When used as primary support for preterm infants with respiratory distress  , high-flow therapy result ed in a significantly higher rate of treatment failure  than did CPAP . ( Funded by the National Health and Medical Research Council and others ; Australian New Zeal and Clinical Trials Registry number , ACTRN12613000303741 . ) Heated , humidified , high-flow nasal cannula ( HHFNC ) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress . But there are limited studies that compares HHFNC with nasal continuous positive airway pressure ( nCPAP ) only as the initial treatment of respiratory distress in preterm infants immediately after birth . The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress . Preterm infants at between 30 and 35 weeks of gestational age were r and omized to HHFNC or nCPAP  when they showed respiratory distress in less than 24 hours of age postnatally . Preterm infants who needed invasive respiratory supports were excluded . Primary outcome was the incidence of treatment failure ( defined as need for the intubation or mechanical ventilation ) . Eighty-five infants were analyzed . Sixteen of 42 infants r and omized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP ( Risk difference 17.17 [ −1.90–36.23 ] ; P = 0.099 ) . In terms of the reason for treatment failure , the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group ( P = 0.020 ) . There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications . Although HHFNC is safe compared to nCPAP , it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress Objective To compare patient comfort in preterm infants treated with heated humidified high flow nasal cannulae ( HHHFNC )  versus nasal continuous positive airway pressure ( NCPAP ) . Design R and omised cross-over trial ( 2 × 24 h ) . Setting Single tertiary neonatal unit . Patients 20 infants less than 34 weeks postmenstrual age treated with NCPAP due to mild respiratory illness . Interventions After parental consent , infants were r and omised to 24 h of treatment with NCPAP or HHHFNC followed by 24 h of the alternate therapy . Main outcome measures Primary outcome was patient comfort assessed by the EDIN ( neonatal pain and discomfort ) scale . Secondary outcomes were respiratory parameters ( respiratory rate , FiO2 , SpO2 , TcPCO2 ) , ambient noise , salivary cortisol and parental assessment s of their child . Results We found no differences between HHHFNC and NCPAP  in mean cumulative EDIN score ( 10.7 vs 11.1 , p=0.25 ) or ambient noise ( 70 vs 74 dBa , p=0.18 ) . Parents assessed HHHFNC treatment as significantly better in the three domains , 1 ) child satisfied , 2 ) parental contact and interaction and 3 ) possibility to take part in care . Mean respiratory rate over 24 h was lower during HHHFNC than CPAP ( 41 vs 46 , p=0.001 ) . Other respiratory parameters were similar . Conclusions Using EDIN scale , we found no difference in patient comfort with HHHFNC versus NCPAP . However , parents preferred HHHFNC , and during HHHFNC respiratory rate was lower than during NCPAP . Clinical Trials.gov , number NCT01526226 OBJECTIVES To conduct an in vitro evaluation of a humidified high-flow nasal cannula ( HFNC ) system at different flows , cannula sizes , and air leaks and also an in vivo analysis of mean end-expiratory esophageal pressure ( EEEP ) from nasal continuous positive airway pressure at 6 cm H(2)O ( NCPAP+6 ) versus HFNC . STUDY DESIGN In the in vitro study , we measured HFNC system pressure and flow , with varying degrees of leak and with and without the use of a pressure-limiting valve . In the in vivo study , we measured  EEEP  in 15 newborns on NCPAP+6 and then on HFNC at 6 L/minute , with flow decreased by 1 L/minute every 30 minutes . Heart rate , respiratory rate , fraction of inspired oxygen , arterial oxygen saturation , respiratory distress syndrome score , and EEEP were recorded for each intervention . Data analysis was done using repeated- measures analysis of variance and linear regression . RESULTS In the in vitro study , in the absence of leaks , the pressures were limited by the pressure-limiting valve only at flows > or = 2 L/minute . With leaks of 30 % and 50 % , delivered pressures were always < 3 cm H(2)O. In the in vivo study , respiratory rate increased from baseline ( NCPAP+6 ) as flow decreased ( P < .02 ) . Intrapatient and interpatient coefficients of variation were always high . CONCLUSIONS A pressure-limiting valve is necessary in a HFNC system . Although mean EEEP levels were similar in NCPAP+6 and HFNC , tachypnea developed as flow diminished . This system apparently can not predict EEEP , because of interpatient and intrapatient variation BACKGROUND AND OBJECTIVE : Heated , humidified high-flow nasal cannula ( HHHFNC ) is commonly used as a noninvasive mode of respiratory support in the NICU . The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large r and omized trials . The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure ( nCPAP ) for noninvasive respiratory support in the NICU . METHODS : R and omized , controlled , unblinded noncrossover trial in 432 infants ranging from 28 to 42 weeks ’ gestational age with planned nCPAP support , as either primary therapy or postextubation . The primary outcome was defined as a need for intubation within 72 hours of applied noninvasive therapy . RESULTS : There was no difference in early failure for HHHFNC ( 23/212 [ 10.8 % ] ) versus nCPAP ( 18/220 [ 8.2 % ] ; P = .344 ) , subsequent need for any intubation ( 32/212 [ 15.1 % ] vs 25/220 [ 11.4 % ] ; P = .252 ) , or in any of several adverse outcomes analyzed , including air leak . HHHFNC infants remained on the study mode significantly longer than nCPAP infants ( median : 4 vs 2 days , respectively ; P < .01 ) , but there were no differences between study groups for days on supplemental oxygen ( median : 10 vs 8 days ) , bronchopulmonary dysplasia ( 20 % vs 16 % ) , or discharge from the hospital on oxygen ( 19 % vs 18 % ) . CONCLUSIONS : Among infants ≥28 weeks ’ gestational age , HHHFNC appears to have similar efficacy and safety to nCPAP when applied immediately postextubation or early as initial noninvasive support for respiratory dysfunction BACKGROUND AND OBJECTIVE To conduct a pilot study to compare the frequency of errors that accompany single vs. double data extraction , compare the estimate of treatment effect derived from these methods , and compare the time requirements for these methods . METHODS Review ers were r and omized to the role of data extractor or data verifier , and were blind to the study hypothesis . The frequency of errors associated with each method of data extraction was compared using the McNemar test . The data set for each method was used to calculate an efficacy estimate by each method , using st and ard meta-analytic techniques . The time requirement for each method was compared using a paired t-test . RESULTS Single data extraction result ed in more errors than double data extraction ( relative difference : 21.7 % , P = .019 ) . There was no substantial difference between methods in effect estimates for most outcomes . The average time spent for single data extraction  was less than the average time for double data extraction ( relative difference : 36.1 % , P = .003 ) . CONCLUSION In the case that single data extraction is used in systematic review s , review ers and readers need to be mindful of the possibility for more errors and the potential impact these errors may have on effect estimates OBJECTIVE To compare the requirement for endotracheal ventilation  in preterm infants treated with heated , humidified high-flow nasal cannula ( HHHFNC )  with those treated with nasal intermittent positive pressure ventilation ( NIPPV ) for the primary treatment of respiratory distress syndrome ( RDS ) . STUDY DESIGN R and omized , controlled , prospect i ve , single-center pilot study . Infants ( gestational age [ GA ] < 35 weeks , birth weight [ BW ] > 1,000 g ) with RDS were r and omly assigned to receive  HHHFNC ( 38 infants ) delivered by Vapotherm ® device ( Precision Flow ™ or 2000 i , Vapotherm Inc. , Stevensville , MD ) , at flows between 1.0 and 5.0 L/min , or NIPPV ( 38 infants ) delivered by the SLE 2000 or 5000 . Surfactant was administered as rescue therapy . Analysis was done by intention-to-treat . RESULTS Infant 's characteristics ( [ mean ± SD ] GA 31.8 ± 2.3 vs. 32.0 ± 2.3 weeks )  and cardio-respiratory status at study entry ( FiO2 0.25 ± 0.05 vs. 0.26 ± 0.07 ; SpO2 90 ± 6 % vs. 87 ± 12 ; PCO2 54.4 ± 10.4 vs. 52.6 ± 8.0 mmHg ) were comparable for the HHHFNC and NIPPV groups . There was no significant difference in the need for endotracheal ventilation ( 28.9 % vs. 34.2 % ) between HHHFNC and NIPPV groups . One infant failed HHHFNC and succeeded on NIPPV . The rate of neonatal morbidities ( pneumothorax , bronchopulmonary dysplasia , intra-ventricular hemorrhage , necrotizing enterocolitis , patent ductus arteriosus , and nasal trauma ) was comparable in both groups . Duration of nasal support was longer with HHHFNC compared with NIPPV ( 5.4 ± 4.0 vs. 2.6 ± 1.9 days , P = 0.006 ) but the duration of endotracheal ventilation , time to full feeds , and length of stay were comparable . CONCLUSIONS Our pilot study suggests that HHHFNC maybe as effective as NIPPV in preventing endotracheal ventilation in the primary treatment of RDS in premature infants ( < 35 weeks GA and BW > 1,000 g ) Objective : Nasal high-flow therapy ( nHFT ) is commonly used for noninvasive respiratory support in the neonatal intensive care unit . Our objective was to determine which aspects of neonatal nHFT  have achieved adequate evidence base to support consensus among experienced clinical investigators , and to document areas lacking consensus to promote future investigations . Study Design : Prospect i ve , modified Delphi collation of tabular queries related to specific aspects of neonatal nHFT . Seven international nHFT clinical research ers were queried regarding approaches to initiation , escalation , we 
    Output:
    
Low- quality evidence showed no significant differences between HFNC and NCPAP in the need for intubation and bronchopulmonary dysplasia rate .
When HFNC failed , intubation was avoided in some neonates by switching them to NCPAP .
CONCLUSION HFNC had higher failure rates than NCPAP when used as first-line support .
Subsequently switching to NCPAP sometimes avoided intubation .