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.