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J Pulm Respir Med. 2014 Dec;4(6). pii: 216.

Safety and Long Term Outcomes with High Flow Nasal Cannula Therapy in Neonatology: A Large Retrospective Cohort Study.

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Division of Neonatology, Banner Estrella, Thunderbird, and Del E. Webb Medical Centers, Phoenix, AZ, USA.
Pediatrix, Baptist Hospital, Nashville, TN, USA.
Saint Barnabas Medical Center, Livingston, NJ, USA.
Oxford University Hospitals, Oxford, UK.
UMass Memorial, Worcester, MA, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Vapotherm, Inc., Stevensville, USA ; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Sydney, Australia.
Nemours, Wilmington, USA ; Temple University School of Medicine, Philadelphia, PA, USA ; Department of Pediatrics, Jefferson Medical College, Philadelphia, PA, USA.
Vapotherm, Inc., Stevensville, USA ; Department of Pediatrics, Jefferson Medical College, Philadelphia, PA, USA.



High flow nasal cannula therapy (HFT) has been shown to be similar to nasal continuous positive airway pressure (nCPAP) in neonates with respect to avoiding intubation. The objective of the current study is to determine if there are trends for adverse safety and long-term respiratory outcomes in very low birth weight infants (<1500 g) from centers using HFT as their primary mode of non-invasive respiratory support compared to data from the largest neonatal outcomes database (Vermont Oxford Network; VON).


A multicenter, retrospective analysis of pulmonary outcomes data was performed for the calendar years 2009, 2010 and 2011. Performance of five HFT centers was compared with population outcomes from the VON database. The five HFT centers routinely use flow rates between 4-8 L/min as described by the mechanistic literature. Weighted average percentages from the five HFT centers were calculated, along with the 95% confidence intervals (CI) to allow for comparison to the VON means.


Patient characteristics between the HFT centers and the VON were not different in any meaningful way, despite the HFT having a greater percentage of smaller infants. The average VON center primarily used nCPAP (69% of all infants) whereas the HFT centers primarily used HFT (73%). A lesser percentage of VLBW infants in the HFT cohort experienced mortality and nosocomial infection. Compared to VON data, an appreciably lesser percent of the HFT cohort were receiving oxygen at 36 weeks and less went home on oxygen.


Considering there was no trend for adverse events, and there was a trend for better outcomes pertaining to long-term oxygen use, these data support claims of safety for HFT as a routine respiratory management strategy in the NICU.


High flow nasal cannula; High flow therapy; Neonatal respiratory distress; Oxygen therapy; Respiratory Dead space; Ventilatory efficiency; Work of breathing

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