Editor—As the manufacturer of the device featured in the paper by Robertson et al, 1 we would like to make several points. Although we understand that the article was written in good faith, and that St George’s is committed to the use of the Infant Flow device, we remain concerned about the effect of the study on practitioners not yet familiar with the unique benefits of the device.

We do not in any way consider that the prong is wrongly designed. In any event, the design was not the cause of the problems identified by Robertson et al.

We do not understand the basis for the allegation that the prong is wrongly designed, and we are not aware of any research that could justify this conclusion.

It is incorrect to state that “we are working together to modify the design of the prong,” and we are surprised that this was written without any reference to us.1

The cause of the difficulties at St George’s was the manner of the fixation of the device.

We confirmed on our visits to the hospital that babies will sustain injury if an inappropriate (small) size prong is used. If the device is fitted too tightly, in a misguided attempt to prevent leaks, the subsequent pressure may cause tissue damage. This can be avoided if a larger prong is used. The choice of correct hat/bonnet size will also determine pressures on the nose.

We have provided guidelines and comprehensive training on the use of our device since its release: we have always emphasised the need for proper fixation and the proper choice of prong size.

The Infant Flow has been used for several years in the Karolinska University Hospital in Sweden for several years, and in the County Hospital in Östersund, Sweden, and has not resulted in any of the difficulties reported in Robertson et al’s article.

Our anecdotal monitoring in the UK has indicated that the device is regularly used without incurring the damage described at St George’s. With proper training and understanding, the Infant Flow can be used with confidence.

We regret that the study by Robertson et al may have deterred some practitioners from using the Infant Flow, meaning that some babies who would otherwise have safely been able to benefit from the device will not have done so.

All at EME are very much concerned about the damage caused to patients for whatever reason. We will always endeavour to improve the design and performance of our equipment whenever the opportunity presents itself.