Background High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) for treating respiratory distress in a variety of clinical situations, including post-extubation support, primary therapy from birth, and to ‘wean’ from NCPAP.

Objectives To present and discuss the available evidence for the use of HFNC in various roles in the preterm population.

Methods We performed an internet-based literature search for relevant, original research articles (both randomised and not) on the use of HFNC in preterm infants.

Results 18 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size, and may vary according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but perhaps only at flow rates >2 Litres per minute. Based on available published evidence, the efficacy and safety of HFNC in preterm infants remain to be determined.

Conclusions There is increasing evidence from clinical trials to support the use of HFNC treatment of preterm infants with respiratory failure, however uncertainty remains about efficacy, safety and optimal flow rates. Until the results of randomised trials in progress are known, widespread use of HFNC to treat preterm infants cannot be recommended.