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Introducing high‐flow nasal cannula to the neonatal transport environment

Dear Editor, We are encouraged to see that other neonatal transport services are using high-flow nasal cannula (HFNC) respiratory support during neonatal transport as outlined by Brunton and O’Shea (1). The experiences appear to be broadly similar across the two services; however, due to the central location of the neonatal transport base and the well served road network in the East of England region air transports are not conducted. Despite the increasing numbers of articles relating to HFNC use in neonatal units and consensus statements on best practice there is a relative paucity of data relating to its use on transport (2,3). It is also standard practice in the Acute Neonatal Transfer Service (ANTS) to assess each individual infant referred in terms of the appropriateness of the different modes of respiratory support to be used on transport. The initial impetus to introduce HFNC to the transport service was to improve the efficient transfer of infants between units and to remove unnecessary delays due to changes in respiratory support to facilitate the transfer. When this was first explored in 2013 there was no documented use of HFNC on neonatal transport. Responsible introduction of a new therapy or device to the transport environment mandates a careful evaluation, regardless of the degree of familiarity from the static environment of neonatal intensive care unit. The initial parameters chosen for the pilot study of 31 infants were liberalised with further experience. The subsequent parameters published in 2016 are deliberately cautious without being overly risk averse and were chosen to mitigate potential risk of decompensation on transfer. We have not experienced any issues with gas supply when transferring infants on HFNC since 2013, which may be secondary to prudence in relation to the upper limits of flow rates used. However, the authors point regarding conservative parameters is well made and highlights the need for continual auditing of practices and revision accordingly. A planned review is currently ongoing. We welcome this additional data on the use of high-flow nasal cannula respiratory support on neonatal transport and the positive experience of other services and look forward to future research addressing HFNC on air transport and over longer distances.