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Transport - neonatal on humidified high flow oxygen

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Humidified high flow (HHF) is used for the transfer of infants that are already established and stable on HHF. It is not currently used in the retrieval setting.


Humidified high flow is frequently used as a mode of respiratory support for infants with mild respiratory dysfunction. Its use in neonatal transport is recent.

Published data suggests that it is well tolerated and there have been no adverse events experienced. The available data concludes that HHF is a safe mode of respiratory support to use in the neonatal transport setting.

This guideline is to be used in addition to the Newborn Services Clinical Guideline 'Humidified High Flow Oxygen or Air'.


  • Continuation of HHF during transport for infants already established and stable on HHF.
  • Infants must have been stable on HHF for at least 48 hours prior to transfer. Infants outside of this criteria must be transferred on CPAP.
  • Option to utilise HHF for transfer of fragile infants not currently on any respiratory support
  • The transfer of any infant on HHF must be discussed and agreed between the medical & nursing teams prior to transfer.

Set Up

Refer to Newborn Services Clinical Guideline Humidified High Flow Oxygen or Air for correct application of HHF/sizing of prongs etc.


  • Neither set up will alarm if there is a displacement or disconnection of the circuit.
  • Continuous ECG & Sp02 monitoring must be used.
  • Document baseline observations prior to transfer.
  • Document observations at 15 minutes intervals throughout the transfer.
  • Please complete the audit form for each high flow transfer and return to the transport team

Managing clinical deterioration

If an infant shows signs of receiving insufficient respiratory support (increased WOB, apnoea, desaturations, significant increase in Fio2 etc) check the follow:

  • Check correct placement of the nasal cannulae
  • Clear any secretions & suction if required
  • Ensure there are no leaks in the circuit and that the circuit has not disconnected
  • Ensure the cannulae are patent
  • Ensure there is power (Stephan)
  • Ensure tanks have adequate gas supply
  • Increase FiO2
  • Increase flow (up to a max of 8L/min)
  • Utilise neopuff/bag & mask to manage rapid respiratory deterioration
  • Consider changing to CPAP


  1. Boyle M, Chaudhary, R, Kent S, O'Hare S, Broster S, Dassios T. (2014) High-flow nasal cannula on transport: moving with the times. Acta P├Ždiatrica. Vol 103 (5): 181
  2. Boyle M, Kent S, Dassios T, Chaundhary R, O ' hare S, Broster S. (2015). Conference Paper: High-flow nasal cannula on neonatal transfer - A year's experience. Transport of high-risk neonates, Genova. Available from: High-flow nasal cannula on neonatal transfer - A year 27s_experience Accessed on 01/05/2015
  3. Roberts C. (2015). Highflow on the Highway. PSANZ breakfast session
  4. Schlapbach L, Schaefer J, Brady A, Mayfield S, Schibler A. (2014). High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive Care Med. Apr;40(4):592-9
  5. Tsakmakis M, Bagga G, Hayward A, Webb J. (2014). Audit of High flow on Transport undertaken by CHANTS - the Welsh experience. From: Prog.pdf Accessed on 01/05/2015

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Document Control

  • Date last published: 29 February 2016
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years