Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants

Objective:to assess pain and compare its severity in preterm infants during application of nasal-continuous positive airway pressure (ncpap) and heated, humidified high-flow nasal cannulae (hhhfnc).study design:an observational cross-sectional study. sixty preterm infants, categorized into ncpap (n=37) and hhhfnc groups (n=23). pain response was assessed using premature infant pain profile (pipp), duration of first cry and salivary-cortisol concentrations.result:the pipp scores were significantly higher in the ncpap compared with hhhfnc group (10 (7–12) vs 4 (2–6), p<0.01). none of the infants in the hhhfnc group had severe pain defined as a pipp score >12, compared with 5 (13.5%) infants in the ncpap group. salivary-cortisol concentrations were significantly higher in ncpap group compared with the hhhfnc group (5.0 (3.6–5.9) vs 1.6 (1.0–2.3) nmol l−1, p<0.01). a lower incidence of cry was observed for infants in the hhhfnc group compared with the ncpap group (11 (47.8%) vs 30 (81.1%), p<0.001), however, the duration of first cry was not significantly different between groups. the respiratory rate was significantly lower after application of hhhfnc compared with ncpap (p<0.001). there were no significant differences between groups with regard to fraction of inspired oxygen (fio2), oxygen saturation by pulse oximeter (spo2) and heart rate.conclusion:the application of hhhfnc in preterm infants is associated with less pain compared with ncpap, as it is associated with less pipp scores and lower salivary-cortisol concentrations.