Respiratory failure in the premature infants remains a difficult challenge. An 
alternative to the use of nasal continuous positive airway pressure (NCPAP) as a 
non-invasive modality to support respiratory distress in premature infants has 
been the recent introduction of high flow nasal cannula (HFNC) devices in many 
neonatal units. There has been increased use of HFNC presumably because of 
anecdotal reports and experience that it is easy to use, and well tolerated by 
the infants, while experiencing decreased nasal septumerosion. The paucity of 
evidence regarding its efficacy and safety, would support a caution approach to 
the use of HFNC. Particular concern has focused on the imprecise regulation and 
generation of pressure that may occur at higher flows especially in the smallest 
of infants.