Symposium: neonatologyHigh-flow ventilation in newborn infants - what is the evidence?

Heated Humidified High Flow Nasal Cannula (HHHFNC) devices deliver an adjustable mixture of heated and humidified oxygen and air at a variable flow rate. Over recent years HHHFNC devices have become a popular method of non-invasive respiratory support in infants and preterm neonates due to ease of use and being well tolerated by infants. Recent evidence suggests that HHHFNC therapy may reduce work of breathing and improve the efficiency of ventilation in newborn infants, possibly with clinically significant outcomes such as avoidance of the need for nasal continuous positive airways pressure (nCPAP) and a reduced requirement for invasive ventilation. Despite its rapid adoption, there is relatively limited data about the exact mechanisms of action of HHHFNC. There is growing evidence of the feasibility of HHHFNC as an alternative to other forms of non-invasive ventilation in preterm infants. We review the mechanisms of action, and the supporting evidence in favour of using heated humidified high-flow nasal cannula therapy in newborn infants.