Background: Nasal High-flow Therapy (NHFT) has gained popularity over Low-flow Oxygen Therapy (LFOT) as respiratory support post-discharge in infants with chronic respiratory disease.

Objective: To compare NHFT as respiratory support post-discharge with LFOT in infants with bronchopulmonary dysplasia (BPD) on respiratory morbidity in the first four years of life.

Method: We conducted a monocentric, retrospective analysis of infants of gestational age (GA) <32 weeks and birth weight (BW) <1500gr with a diagnosis of BPD and requiring respiratory support post-discharge.

Results: we included 26 infants discharged with LFOT and 47 with NHFT. The two groups were homogenous for baseline features, including GA, BW, sex, main risk factors for prematurity, duration of respiratory support and oxygen therapy in the NICU, and BPD grade (p>0.05). The NHFT group had a significantly lower incidence of lower respiratory tract infections (p=0.018), need for antibiotics (p=0.020) and bronchodilators (p=0.019). Infants with NHFT were weaned earlier from respiratory support than those with LFOT (median 8.0 vs 14.5 months, p=0.046). Even after applying a mixed model correcting for mechanical ventilation, the overall duration of respiratory support, pulmonary hypertension, oxygen therapy and smocking exposure, the NHFT group presented a lower rate of wheezing (p 0.003),  use of bronchodilators (p 0.024) and systemic steroids (p<0.001), upper and lower (p 0.003) respiratory tract infections (p 0.031) in the first four years.

Conclusions: NHFT may be a valid alternative to LFOT in infants with BPD requiring respiratory support post-discharge.