High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

J Pediatr. 2016 Jun:173:50-55.e1. doi: 10.1016/j.jpeds.2016.02.051. Epub 2016 Mar 19.


Objective: To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP).

Study design: This is a retrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis.

Results: A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035-1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group.

Conclusions: In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants.

Keywords: bronchopulmonary dysplasia (BPD); continuous positive airway pressure (CPAP); extremely low birth weight (ELBW); high flow nasal cannula (HFNC).

Publication types

  • Comparative Study

MeSH terms

  • Bronchopulmonary Dysplasia / epidemiology*
  • Continuous Positive Airway Pressure
  • Drug Utilization
  • Female
  • Glucocorticoids / therapeutic use
  • Hospital Mortality
  • Humans
  • Infant
  • Infant, Extremely Low Birth Weight*
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Length of Stay / statistics & numerical data*
  • Male
  • Oxygen Inhalation Therapy / adverse effects*
  • Oxygen Inhalation Therapy / methods*
  • Retrospective Studies
  • Time Factors
  • United States / epidemiology


  • Glucocorticoids