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A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). One-hundred late-moderate-preterm infants were randomly assigned to either NHFOV-group (<jats:italic>n<\/jats:italic>\u2009=\u200950) or NCPAP-group (<jats:italic>n<\/jats:italic>\u2009=\u200950). For both groups, functional echocardiography was performed in the first 24\u00a0h to detect hemodynamic changes and respiratory outcome was monitored throughout the hospital stay. The main outcomes were hemodynamic measurements and myocardial function using functional echocardiography of those infants along with the respiratory outcome and complications. Kaplan\u2013Meier survival plot was used representing time course of NCPAP and NHFOV failure. Left ventricular output values were not significantly different in both groups with median 202\u00a0ml\/kg \/min and IQR (176\u2013275) in NCPAP-group and 226\u00a0ml\/kg\/min with IQR (181\u2013286) in NHFOV group. Nevertheless, ejection fraction and fractional shortening were significantly higher in NHFOV-group with <jats:italic>P<\/jats:italic> 0.001. The time to weaning, the time to reach 30%-FIO2, the need for invasive ventilation, oxygen support duration, and maximal-FIO2 were significantly more in NCAPAP group.<\/jats:p><jats:p><jats:italic>\u00a0 \u00a0 \u00a0Conclusion<\/jats:italic>: NHFOV is an effective and promising tool of non-invasive-ventilation which can be used as a primary modality of respiratory support in preterm infants with variable forms of respiratory distress syndrome without causing detrimental effect on hemodynamics or significant respiratory complications.<\/jats:p><jats:p><jats:italic>\u00a0 \u00a0 \u00a0Trial registration<\/jats:italic>: NCT05706428 (registered on January 21, 2023).\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-024-05515-5","type":"journal-article","created":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T06:01:26Z","timestamp":1714802486000},"page":"3263-3275","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The effect of NHFOV on hemodynamics in mild and moderately preterm neonates: a randomized clinical trial"],"prefix":"10.1007","volume":"183","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-9018","authenticated-orcid":false,"given":"Marwa Mohamed","family":"Farag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ahmed Amen","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader Abd EL Moneim","family":"Fasseeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham Abd EL Rahim","family":"Ghazal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,4]]},"reference":[{"issue":"7","key":"5515_CR1","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1007\/s12098-021-03755-z","volume":"88","author":"RP Anne","year":"2021","unstructured":"Anne RP, Murki S (2021) Noninvasive respiratory support in neonates: a review of current evidence and practices. 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IRB no. is 00012098 and FWA no. is 00018699.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"NHFOV can be used as an initial mode of ventilation in moderate and late preterm infants with moderate to severe RDS.\u00a0NHFOV can provide CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor an adverse hemodynamic effect.\u00a0Except for increased respiratory secretion, NHFOV causes no significant respiratory adverse events.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Impact"}},{"value":"Written informed consent was obtained from parents or authorized legal representatives of all newborns who participated in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent was obtained from parents or authorized legal representatives of all newborns who participated in the study for publication of anonymous patients\u2019 data.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}