Efficacy and Safety of Nasal High-Flow Therapy for Neonatal Transport

Abstract

Objective: Noninvasive ventilation, including nasal high-flow therapy (nHFT), provides effective neonatal respiratory support. There are limited data on nHFT use during neonatal transport. Our objective was to assess the efficacy and safety of nHFT during neonatal transport.

Methods: One hundred ninety-five neonates transported on nHFT via a Neo-Pod "T" system (Westmed Inc, Tucson, AZ) were identified from Life Flight transport data. Data included demographics, transport location, distance, indication, and mode as well as pretransport and intratransport respiratory support data. We compared neonates who successfully tolerated nHFT transport with those who required support escalation (defined as increase in flow ≥2 L/min or fraction of inspired oxygen [FiO₂] ≥20%).

Results: Eighty-seven percent of neonates (170/195) were effectively transported on nHFT. Infants requiring escalation of nHFT support had a significantly higher pretransport FiO₂ (median = 0.60 [interquartile range, 0.36-1.00] vs. 0.36 [0.23-0.56]; P < .05) and a longer ground time for stabilization (56 ± 25 vs. 39 ± 18 minutes, P < .05) and were more frequently transported by air.

Conclusion: Nasal HFT can be an effective mode of respiratory support in the transport of selected neonates. FiO₂ at the time of transport may be a key parameter to aid in determining neonates who can be safely transported on nHFT.