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.

Study Design:

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−1 and 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.

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Author contributions

BA Yoder initiated the study design and implementation, participated in data collection and analysis and wrote the initial manuscript; B Manley contributed to study design, data collection, initial manuscript writing and revisions; C Collins, K Ives, A Kugelman, A Lavizarri and M McQueen contributed to study design, data collection and manuscript revisions; all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to B A Yoder.

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Yoder, B., Manley, B., Collins, C. et al. Consensus approach to nasal high-flow therapy in neonates. J Perinatol 37, 809–813 (2017).

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