Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries

Manley, Brett J.; Arnolda, Gaston; Wright, Ian; Owen, Louise; Foster, Jann P; Huang, Li; Roberts, Calum T.; Clark, Tracey L.; Fan, Wei; Fang, Alice Y.W.; Marshall, Isaac R.; Pszczola, Rosalynn J.; Davis, Peter G; Buckmaster, Adam

doi:10.1056/nejmoa1812077

Cited by 66 publications

(74 citation statements)

References 23 publications

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“…Noninvasive oxygen delivery using nasal high‐flow (NHF) cannula is an alternative to continuous positive airway pressure (CPAP) in preterm infants because the care of the patient is simplified when compared to other forms of oxygen delivery . Although large RCTs have shown the efficacy of NHF to be similar to CPAP when used as postextubation respiratory support, when used as primary support in newborn infants with respiratory distress, NHF has resulted in higher rates of treatment failure …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Although large RCTs have shown the efficacy of NHF to be similar to CPAP when used as postextubation respiratory support, 4 when used as primary support in newborn infants with respiratory distress, NHF has resulted in higher rates of treatment failure. 5,6 Despite its increasing popularity, data on the physiological effects of NHF remains limited. A number of studies have investigated the potential continuous distending pressure that NHF may deliver and its effect on work of breathing (WOB).…”

Section: Introductionmentioning

confidence: 99%

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Nasal high flow in preterm infants: A dose‐finding study

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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Objective To investigate the relationship between applied flows of nasal high flow (NHF) and physiological outcomes and work of breathing (WOB), to identify an optimal delivery flow which results in reduced WOB in preterm infants. Design A prospective observational clinical study with randomly applied NHF rates. Patients and Setting Preterm infants within 72 hours of commencement of NHF respiratory support. Interventions Infants were initially placed on 8 L/min of NHF and flows of 2, 4, and 6 L/min were then applied in random order. Measurements and Results WOB was measured using transcutaneous electromyography and respiratory inductance plethysmography. Physiological variables were also recorded. Measurements taken 10 minutes after each flow change were compared with 8 L/min. Sixteen infants with a median gestational age of 28 (range 24‐31) weeks and postnatal age of 14 (2‐55) days were included in the study. The median flow rate before the study was 6 (4‐8) L/min and a fraction of inspired oxygen (FiO2) was 0.21 (0.21‐0.26). Changes in flow resulted in changes in activity in the front diaphragm (P = .027) and intercostals (P = .034). The electrical activity of the front diaphragm at 8 L/min was significantly lower than that at 2 L/min (P = .016). Respiratory rate was lowest at 6 L/min (P = .002) and SpO2/FiO2 was highest at 8 L/min (P < .04). Conclusion In preterm infants, changes in WOB resulting from randomly applied levels of NHF can be demonstrated by measuring the electrical activity of the diaphragm and intercostal muscles with transcutaneous electromyography. In combination with physiological measurements, the similarities in electrical activity between 4, 6, and 8 L/min suggest that these three flows may be equally as effective.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasal high flow in preterm infants: A dose‐finding study

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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“…Most babies in the NICU can be managed with noninvasive respiratory strategies such as CPAP (continuous positive airway pressure) or HFNC (high flow nasal cannula) without the need for a ventilator. (Manley et al 2019). Those modalities should always be tried first, and that rule should be especially important during the pandemic.…”

Section: Ventilatorsmentioning

confidence: 99%

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

Haward

Janvier

Moore

et al. 2020

The American Journal of Bioethics

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In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing lifeyears. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.

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“…The majority of neonates requiring respiratory support at any given time can be managed with continuous positive airway pressure, delivered as a bubble CPAP (using tubing and water), ventilator-delivered CPAP (when available) or High Flow Nasal Canula. 4 Fourth, factors helpful for triaging adults (length of time on ventilator, pre-existing conditions, co-morbidities) do not apply to premature babies. For premature babies, who succumb to their disease, most die within the first few days and many have no baseline co-morbidities when the initial decision is taken.…”

Section: B Roadening Our Vie W Of Sc Arce Re Source S: An E X Amplementioning

confidence: 99%