Wilkinson DJ, Andersen C, Holberton J Neonatology Today 2008; 3: 1-5

High flow nasal cannula (HFNC) is a novel means of respiratory support in infants that has been adopted by a large number of neonatal units in the US, UK and Australia in the last 5 years. HFNC refers to the delivery of heated, humidified and blended oxygen/air via small caliber nasal cannulae at flow rates of >1 l/min. HFNC has been used post-extubation in extremely low birth weight infants (when the use of conventional continuous positive airway pressure (CPAP) may be technically difficult, and lead to significant nasal trauma), as well as for the longer-term support of CPAP-dependent infants with evolving or manifest chronic lung disease. However the popularity of this modality has caused some concern and controversy. To date, the evidence base for its use in preterm infants is thin, and it has been suggested that HFNC may subject infants to dangerously high (and unmeasured) pressures. This paper will review the recent evidence for HFNC, and explore some of the specific reasons why HFNC may have become so popular so quickly. It will provide some practical guidelines for the use of HFNC while awaiting further trial evidence.
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