BACKGROUND: High flow nasal cannulae (HFNC) are small, thin, tapered cannulae 
used to deliver oxygen or blended oxygen and air at flow rates of > 1 L/min. 
HFNC can be used to provide high concentrations of oxygen and may deliver 
positive end-expiratory pressure.
OBJECTIVES: To compare the safety and efficacy of HFNC with other forms of 
non-invasive respiratory support in preterm infants.
SEARCH STRATEGY: The strategy included searches of the Cochrane Central Register 
of Controlled Trials (CENTRAL) (The Cochrane Library 2010), MEDLINE, CINAHL, 
EMBASE and abstracts from conference proceedings.
SELECTION CRITERIA: Randomised or quasi-randomised trials comparing HFNC with 
other non-invasive forms of respiratory support in preterm infants immediately 
after birth or following extubation.
DATA COLLECTION AND ANALYSIS: Data were extracted and analysed by the authors. 
Relative risk, risk difference and number needed to treat were calculated.
MAIN RESULTS: Four studies were identified for inclusion in the review. The 
studies differed in the interventions compared (nasal continuous positive airway 
pressure (CPAP), humidified HFNC, non-humidified HFNC), the flow rates provided 
and the indications for respiratory support. Meta-analysis and subgroup analysis 
were not possible. When used as primary respiratory support after birth, one 
trial found similar rates of treatment failure in infants treated with HFNC and 
nasal CPAP. Following extubation, one trial found that infants treated with HFNC 
had a significantly higher rate of reintubation than those treated with nasal 
CPAP. Another trial found similar rates of reintubation for humidified and 
non-humidified HFNC, and the fourth trial found no difference between two 
different models of equipment used to deliver humidified HFNC.
AUTHORS' CONCLUSIONS: There is insufficient evidence to establish the safety or 
effectiveness of HFNC as a form of respiratory support in preterm infants. When 
used following extubation, HFNC may be associated with a higher rate of 
reintubation than nasal CPAP. Further adequately powered randomised controlled 
trials should be undertaken in preterm infants comparing HFNC with nasal CPAP 
and with other means of respiratory support; or of support following extubation. 
These trials should measure clinically important outcomes.