Infants with pulmonary disease whose respiratory status has stabilized (they no longer require assisted ventilation  or NCPAP (Nasal Continuous Positive Airway Pressure) but still have a supplemental oxygen requirement  may receive O₂ by nasal cannula (NC).

NCPAP is the preferred modality over NC for respiratory support in an infant who is exhibiting significant chest wall instability or one in whom a measurable amount of distending airway pressure is desired.  However, the use of NC instead of NCPAP is more comfortable for the infant and allows the infant to be cared for more easily.  The literature suggests that a degree of continuous distending airway pressure can be generated by higher flows via NC (> 0.4 L/min), particularly in ELBW infants. 

Currently there are 3 ways of delivering oxygen  by NC in the NICU.  They are listed in descending order of presumed support:

1.  Vapotherm NC.  This system can deliver 1-8 L/min of gases heated to body temperature at nearly 100% humidity.  Vapotherm is particularly useful in the infant who is experiencing discomfort from nasal drying, bleeding and nasal septum breakdown.  In the smaller babies, Vapotherm should be used with caution at flow rates > 5-6 L/min due to increased delivered pressures.

2.  High-flow NC.  A fixed liter flow of air at 0.5–1 L/min plus blended O₂ to achieve the desired range of O₂ saturations.    

3.  Low-flow NC.  100% O₂ from the wall with the flow adjusted to achieve the desired range of O₂ saturations.  Infants requiring less than 0.2 L/min flow should have a low flowmeter (0 – 200 mL/min.)

The physician order for NC oxygen should include directions regarding: the desired flow rate, O₂ concentration, and target SaO₂.  Keep in mind, unlike other oxygen delivery devices, the delivered oxygen concentration is largely unknown when using a NC. 

The NC flow delivered and the infant’s oxygen saturation should be recorded hourly.  Nares care should be performed at least every 4 hours to ensure nasal patency.

The Division of Neonatology has agreed to use the article in Pediatrics by Michelle Walsh for calculating the conversion equivalence of oxygen.  See attached article.

This attached article gives the same results as the Michele Walsh article and may be easier to use if the infant is in unblended oxygen at 100%, see the appendix