Nasal High Flow for Neonates

Nasal high flow (NHF) can be used to support the neonatal patient pathway through the hospital.1-7
 
 

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 older1-7:

  • Post extubation
  • An alternative to prolonged continuous positive airway pressure (CPAP)
  • Primary support.
This information collates data from published literature. It does not overrule expert clinical judgement. Gestational age alone should not determine individual patient management.

 
 

NHF for postextubation support

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NHF as an alternative to prolonged CPAP

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NHF as primary support

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Clinical judgement is necessary to assess the apropriate treatment for an individual patient.

NHF as postextubation 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.46,8

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).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 an alternative to prolonged CPAP

NHF as an alternative to prolonged CPAP
 

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 

NHF as primary support

NHF as primary treatment
 

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.

Setting flow rates for neonates

NHF is a mode of noninvasive respiratory support that delivers high flows of blended air and oxygen through a nasal cannula.13 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

Setting flow rates for neonates

The Rosie Hospital NHF Documentary Series

The reason, the rollout and the results: The Rosie Hospital, a Cambridge University Hospital, shares its successful implementation of NHF therapy for neonatal patients.
A new therapy in practice at the Rosie

NHF in practice at the Rosie Hospital

Learn how the Rosie Hospital in the UK uses NHF therapy in the unit
 
The impact of a new therapy at the Rosie

The impact of NHF therapy at the Rosie Hospital

Discover the hospital’s journey of successfully implementing NHF therapy


 
The implementation of a new therapy at the Rosie

Implementation of NHF at the Rosie Hospital

Explore the research behind the decision to implement NHF at the Rosie Hospital.

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