Nasal High Flow for Neonates

Evidence-based applications of NHF for neonates

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 older^1-7:

• Post extubation
• An alternative to prolonged continuous positive airway pressure (CPAP)
• Primary support.

NHF as postextubation support

 

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.

NHF as primary support

 

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  

This information collates data from published literature. It does not overrule expert clinical judgement. Gestational age alone should not determine individual patient management.