Use of heated humidified high-flow nasal cannula oxygen in neonates: a UK wide survey

Aim: Heated humidified high-flow nasal cannula (HHHFNC) oxygen is a relatively new form of respiratory support and is increasing in popularity despite lack of supportive evidence and amid safety concerns. We investigated the prevalence of its use in tertiary neonatal units in the UK.

Method: Electronic survey.

Results: A total of 57 units were contacted and replies received from 44 (77%). HHHFNC was used in 34/44 (77%) units. Vapotherm 2000i and Fisher and Paykel RT329 were the most popular devices. 39% units used HHHFNC without policies. Most reported use in infants of any gestation (24/34, 71%) and weight (26/34, 77%) and for a variety of indications including as an alternative to CPAP (26/34, 77%), weaning off CPAP (24/34, 71%) and postextubation (18/34, 53%). The flow rates, cannula size and mouth position varied widely. The popularity of HHHFNC appeared to be its perceived ease of use and improved access to the baby.

Conclusion: This survey demonstrates that HHHFNC is a widely used modality in UK neonatal units. Its current use appears to be without clear criteria and mostly based on individual preference. In view of doubts about its efficacy and concerns regarding safety, this study highlights the urgent need for research to evaluate its use in newborns.