Data from large randomized controlled trials and a Cochrane Review suggest three possible pathways to introduce NHF for neonates 28 weeks of gestational age or older1-7:
Clinical judgement is necessary to assess the apropriate treatment for an individual patient.
For stable neonatal patients who are 28 weeks gestational age or older, there is well-established evidence supporting the use of NHF for postextubation support as a suitable alternative to CPAP.4–6,8
A Cochrane Review by Wilkinson et al. indicates that the use of NHF instead of CPAP is associated with significantly lower rates of nasal trauma, with no additional risk of treatment failure, reintubation, or adverse events such as death, pneumothorax or bronchopulmonary dysplasia (BPD).5 A clinical pathway involving an escalation step to CPAP if required may also be appropriate8.
For neonates under 28 weeks’ gestational age, there is insufficient evidence to change clinical practice and CPAP continues to be the gold standard of care for postextubation support.5 Once the patient is stable, NHF can be considered to help facilitate developmental care and reduce nasal trauma.7,9
This information collates data from published literature. It does not overrule expert clinical judgement. Gestational age alone should not determine individual patient management.
Expert consensus suggests that NHF may be a suitable alternative to CPAP, for neonates who require prolonged periods of noninvasive support.1,2
Once neonatal patients are stable on CPAP, NHF may be considered as an alternative noninvasive therapy at the clinician’s discretion.1,2
Comparing the safety and efficacy of NHF and CPAP for initial respiratory support, several studies from around the globe indicate that neonates who are 28 weeks gestational age or older can be treated with either NHF or CPAP first, with no significant difference in intubation rates.3,4,10-12
If NHF is used first, a clinical pathway involving an escalation step to CPAP if required may also be appropriate.8
For neonates of a gestational age of under 28 weeks, there is insufficient evidence to change clinical practice and CPAP should be used as primary support.7,9 Once the patient is stable, NHF can be considered to help facilitate developmental care and reduce nasal trauma.7,9
NHF is a mode of noninvasive respiratory support that delivers high flows of blended air and oxygen through a nasal cannula. Guidance from the neonatal literature and from expert consensus indicates that flow rates should be initiated between 4 and 6 L/min.4,6-8,10
Discover the hospital’s journey of successfully implementing NHF therapy
Explore the research behind the decision to implement NHF at the Rosie Hospital.
Delivering respiratory support for spontaneously breathing patients
Full face masks designed for comfort and care
Providing Optimal Humidity for intubated patients
Establish effective spontaneous breathing or assist ventilation of the lungs
Respiratory support that replaces spontaneous breathing
Noninvasive respiratory support that provides a continuous distending pressure
Noninvasive respiratory support that delivers high flows of blended air and oxygen
Delivering warm, humidified carbon dioxide in laparoscopic and open surgery
Designed to work in harmony with the way patients naturally breathe while they sleep
F&P SleepStyle - designed to strike the balance between comfort and effective treatment