Article Text

  1. D J Wilkinson1,2,
  2. C P F O’Donnell3,4,5,
  3. C C Andersen6
  1. 1The Ethox Centre, University of Oxford, Oxford, UK
  2. 2Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  3. 3National Maternity Hospital, Dublin, Ireland
  4. 4Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
  5. 5University College, Dublin, Ireland
  6. 6Neonatal Unit, Women’s and Children’s Hospital, Adelaide, SA, Australia


Objective Preterm infants frequently receive respiratory support. The association between endotracheal ventilation and chronic lung disease (CLD) has prompted increasing interest in non-invasive respiratory support. Humidified oxygen or blended oxygen/air administered via nasal cannulae at flow rates >1 l/minute (high flow nasal cannulae, HFNC) may provide continuous positive airways pressure (CPAP). We wished to compare the efficacy of HFNC with other methods of support for preterm infants.

Methods The standard search strategy of the Cochrane Neonatal Group was used. PubMed, CINAHL, EMBASE and the Cochrane Central register of controlled trials were searched for randomised clinical trials. The primary outcomes were death at latest follow-up and CLD. Secondary outcomes included duration of respiratory support and neurosensory outcome.

Results We identified 7 studies; we excluded 4 short-term crossover studies. The remaining three randomised studies enrolled 98 infants. These studies compared HFNC with variable flow nasal CPAP, constant flow CPAP and non-humidified oxygen via nasal cannulae respectively. None of these studies reported death, chronic lung disease or duration of respiratory support as outcomes. Meta-analysis was thus not performed.

Conclusions There is insufficient evidence to support or refute the efficacy of HFNC for respiratory support. There is a need for further adequately powered randomised trials. Such trials should ideally compare HFNC with other means of respiratory support, include appropriate outcome measures, and follow-up infants at least until discharge from hospital.

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