Consensus approach to nasal high-flow therapy in neonates.
Nasal high-flow therapy (nHFT) is commonly used for noninvasive respiratory support in the neonatal intensive care unit. Our objective was to determine which aspects of neonatal nHFT have achieved adequate evidence base to support consensus among experienced clinical investigators, and to document areas lacking consensus to promote future investigations.



Prospective, modified Delphi collation of tabular queries related to specific aspects of neonatal nHFT. Seven international nHFT clinical researchers were queried regarding approaches to initiation, escalation, weaning and discontinuing nHFT. Completed tables were reviewed independently by each investigator, results clarified and discussed and areas of consensus determined.



Consensus agreement was reached for many aspects of nHFT including: need for adequate heating and humidification, need to prevent nares occlusion, maximum flow rate of 8 l min-1, assessment of fraction of inspired oxygen (FiO2) and work of breathing for either flow escalation or weaning, equivalence of nHFT to nasal continuous positive airway pressure (nCPAP) for noninvasive support of infants of ⩾28 weeks with resolving respiratory distress and use of nHFT for noninvasive support of stable infants on nCPAP. There was general agreement for initial gas flow rates in the range of 4 to 6 l min-1and for nHFT as primary therapy for mild respiratory distress. There was no consensus on the approach to discontinuing nHFT.



Among an experienced group of nHFT clinical researchers, there was general consensus in the approach to neonatal nHFT. Additional randomized studies are indicated to provide better evidence related to several aspects of nHFT, as well as to identify other clinical conditions where nHFT may provide safe, effective noninvasive support.
Department of Pediatrics-Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Yoder
The Royal Women's Hospital, Melbourne, and the Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia.
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Manley
Mercy Hospital for Women, Melbourne, VIC, Australia.
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Collins
John Radcliffe Hospital, Oxford, UK.
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Ives
Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Kugelman
Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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Lavizzari
Division of Neonatology, Banner Health System, Phoenix, AZ, USA.
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McQueen
D032921:Consensus; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003697:Delphi Technique; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards; D007391:International Cooperation; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy