New research finds role for nasal High-Flow treatment in Special Care Nurseries

Dr Calum Roberts, a research fellow in the Department of Paediatrics, is part of a team of Melbourne researchers who have found that nasal High-Flow therapy can be used effectively as respiratory support for many newborn infants, without the need for a higher level of breathing support.

Each year in Australia, thousands of newborn babies require breathing support soon after birth. While the sickest and most premature babies are treated in neonatal intensive care units (NICUs), a large proportion of term and premature babies can receive breathing support in local special care nurseries (SCNs).

The HUNTER Trial included 754 infants and compared two forms of breathing support: continuous positive airway pressure (CPAP), the existing standard treatment, and nasal High-Flow, a newer treatment that is simpler, easier to use and more comfortable for babies.

The study found CPAP to be the most effective treatment, but that High-Flow was effective in 80% of babies. Using High-Flow, with backup CPAP if required, meant that the babies were no more likely to need a higher level of breathing support, or require transfer to a NICU. This is the first study to assess the use of High-Flow in regional SCNs, and provide guidance on how best to use High-Flow breathing support in these hospitals.

This study suggests there is likely to be a role for High-Flow treatment in SCNs, particularly in hospitals that currently have limited ability to use CPAP. This will mean that babies can receive breathing support in an SCN close to home, without the need for transfer to a NICU, over potentially long distances.

Respiratory distress affects around 1% of newborn babies and 10% of all babies born prematurely. Approximately 10,000 babies per year in Australia, and hundreds of thousands worldwide, will require breathing support soon after birth.

“This is the largest ever study of High-Flow treatment in newborn infants, a treatment that is easier to use, more comfortable for babies, and preferred by parents. By developing strategies to provide breathing support in SCNs, we can avoid the need for transfer of infants to NICUs, which are sometimes over hundreds of kilometres away, keeping them together with their families and close to home.” Dr Roberts says.

Dr Roberts was part of the team that designed and conducted the study from 2015-2017 and successfully applied for funding, led by Dr Brett Manley from the Royal Women’s Hospital in Melbourne. The group of researchers have published several previous studies of High-Flow in NICUs, and expanded the team to include nine regional SCNs in Victoria and New South Wales for this study.

The National Health and Medical Research Council (NHMRC) and the Monash University Kathleen Tinsley Research Fellowship supported the research. The findings have been published in The New England Journal of Medicine.