Peer Review Report For: Efficacy of Heated Humidified High-Flow Nasal Cannula versus Standard Oxygen Delivery for Management of Transient Tachypnea of Newborn- A Randomized Controlled Trial [version 1; peer review: 2 approved with reservations]

Background Transient tachypnea of the newborn (TTNB) is a frequently encountered respiratory condition that affects term and late preterm infants. While standard oxygen therapy (SOT) remains the first-line intervention, emerging modalities, such as heated humidified high-flow nasal cannula (HHHFNC), may be more efficacious with fewer complications. However, evidence from randomized trials is scarce. Methods This was an open-label, non-blinded, randomized controlled trial conducted in a tertiary-care neonatal unit. Neonates with gestational age (GA) ≥ 34 weeks who were diagnosed with TTNB and satisfied the inclusion criteria were randomized to receive either HHHFNC or SOT. The primary outcomes included the duration of respiratory support and respiratory distress score (Downe Score). Secondary outcomes included the need for escalation of respiratory support, need for higher modes of respiratory support, length of hospital stay, and incidence of complications. Results Sixty neonates were randomized equally to HHHFNC (GA: 36.79 ± 2.46 weeks; BW: 2.50 ± 0.71 kg) and SOT (GA: 37.68 ± 1.04 weeks; BW: 2.79 ± 0.53 kg) groups. The need for escalation of respiratory support was significantly lower in the HHHFNC arm (46.7% vs. 96.7%, p=0.001), with a significant improvement in the Downe score at one hour (1.97±1.42 vs. 2.73±1.14, p=0.03). Neonates on HHHFNC required a shorter duration of respiratory support and had notably reduced length of hospital stay as compared to the SOT group (2.77±6.32 hours vs 3.87±7.20 hours, p=0.53 and 4.67±1.65 days vs 5.83±3.42 days, p=0.10, respectively). Nasal crusting occurred exclusively in the standard oxygen group (20% vs. 0%; p=0.011). Conclusions HHHFNC is an effective early treatment modality for TTNB, offering greater comfort and fewer complications than the standard oxygen therapy.