title: Safety and Long Term Outcomes with High Flow Nasal Cannula Therapy in Neonatology: A Large Retrospective Cohort Study.
abstract: OBJECTIVE
  High flow nasal cannula therapy (HFT) has been shown to be similar to nasal continuous positive airway pressure (nCPAP) in neonates with respect to avoiding intubation. The objective of the current study is to determine if there are trends for adverse safety and long-term respiratory outcomes in very low birth weight infants (<1500 g) from centers using HFT as their primary mode of non-invasive respiratory support compared to data from the largest neonatal outcomes database (Vermont Oxford Network; VON).
  
  
  METHODS
  A multicenter, retrospective analysis of pulmonary outcomes data was performed for the calendar years 2009, 2010 and 2011. Performance of five HFT centers was compared with population outcomes from the VON database. The five HFT centers routinely use flow rates between 4-8 L/min as described by the mechanistic literature. Weighted average percentages from the five HFT centers were calculated, along with the 95% confidence intervals (CI) to allow for comparison to the VON means.
  
  
  RESULTS
  Patient characteristics between the HFT centers and the VON were not different in any meaningful way, despite the HFT having a greater percentage of smaller infants. The average VON center primarily used nCPAP (69% of all infants) whereas the HFT centers primarily used HFT (73%). A lesser percentage of VLBW infants in the HFT cohort experienced mortality and nosocomial infection. Compared to VON data, an appreciably lesser percent of the HFT cohort were receiving oxygen at 36 weeks and less went home on oxygen.
  
  
  CONCLUSIONS
  Considering there was no trend for adverse events, and there was a trend for better outcomes pertaining to long-term oxygen use, these data support claims of safety for HFT as a routine respiratory management strategy in the NICU.
authors.affiliation: Division of Neonatology, Banner Estrella, Thunderbird, and Del E. Webb Medical Centers, Phoenix, AZ, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: McQueen
authors.affiliation: Pediatrix, Baptist Hospital, Nashville, TN, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rojas
authors.affiliation: Saint Barnabas Medical Center, Livingston, NJ, USA.
authors.forename: Shyan C
authors.initials: SC
authors.lastname: Sun
authors.affiliation: Saint Barnabas Medical Center, Livingston, NJ, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Tero
authors.affiliation: Oxford University Hospitals, Oxford, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ives
authors.affiliation: UMass Memorial, Worcester, MA, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Bednarek
authors.affiliation: UMass Memorial, Worcester, MA, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Owens
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Dysart
authors.affiliation: Vapotherm, Inc., Stevensville, USA ; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Sydney, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Dungan
authors.affiliation: Nemours, Wilmington, USA ; Temple University School of Medicine, Philadelphia, PA, USA ; Department of Pediatrics, Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shaffer
authors.affiliation: Vapotherm, Inc., Stevensville, USA ; Department of Pediatrics, Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Miller
keywords: High flow nasal cannula; High flow therapy; Neonatal respiratory distress; Oxygen therapy; Respiratory Dead space; Ventilatory efficiency; Work of breathing