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Consensus approach to nasal high-flow therapy in neonates.
Summary
Nasal high-flow therapy (nHFT) has consensus on many aspects for neonatal respiratory support, including initiation and escalation. Further research is needed for discontinuing nHFT and other clinical applications.
Area of Science:
- Neonatal Medicine
- Respiratory Care
- Clinical Research Methodology
Background:
- Nasal high-flow therapy (nHFT) is a common noninvasive respiratory support method in neonatal intensive care units.
- Evidence supporting optimal nHFT practices in neonates is evolving.
Purpose of the Study:
- To identify areas of consensus among experienced clinicians regarding neonatal nHFT.
- To highlight areas lacking consensus to guide future research.
Main Methods:
- A prospective, modified Delphi method was employed.
- Seven international nHFT clinical researchers participated in a tabular query process.
- Consensus was determined through independent review, clarification, and discussion.
Main Results:
- Consensus was achieved on heating/humidification, preventing nares occlusion, maximum flow rates (8 L/min), FiO2 assessment, and work of breathing monitoring.
- nHFT was considered equivalent to nCPAP for infants ≥28 weeks with resolving respiratory distress.
- General agreement existed for initial flow rates (4-6 L/min) and nHFT as primary therapy for mild respiratory distress.
- No consensus was reached on the approach to discontinuing nHFT.
Conclusions:
- Experienced clinicians generally agree on many aspects of neonatal nHFT.
- Further randomized studies are necessary to strengthen evidence for nHFT practices.
- Additional research should explore nHFT for other clinical conditions in neonates.
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