What is the maximum high flow nasal cannula flow rate in liters per minute (L/min) in neonates (newborns) and preterm infants?

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From the Guidelines

The maximum high flow nasal cannula (HFNC) flow rate for neonates and premature infants is ≥ 1 L/kg/min for patients up to 10 kg, according to the most recent guidelines 1.

Key Considerations

  • For patients up to 10 kg, the flow rate should be ≥ 1 L/kg/min, as defined in the operational definitions related to pediatric ventilator liberation 1.
  • For patients above 10 kg, the flow rate should be ≥ 10 L/min, but this is less relevant for neonates and premature infants.
  • The flow rates should be initiated at lower levels and titrated up as needed based on clinical response, monitoring for signs of respiratory distress, adequate oxygenation, and potential complications.

Rationale

  • The anatomical airway size of neonates and the risk of delivering excessive pressure to immature lungs are key considerations in determining the maximum flow rates.
  • Higher flow rates create higher positive pressure, which can be beneficial for recruiting alveoli and reducing work of breathing, but can also potentially cause barotrauma in the delicate respiratory system of premature infants.
  • Clinical assessment should guide therapy, with flow rates adjusted based on oxygen requirements, work of breathing, and respiratory rate.

Clinical Implications

  • The guidelines provide a clear definition for high-flow nasal cannula (HFNC) flow rates, which is essential for ensuring consistent and effective care for neonates and premature infants.
  • By following these guidelines, healthcare providers can minimize the risk of complications and optimize outcomes for these vulnerable patients.
  • The use of HFNC should be individualized and guided by clinical judgment, taking into account the unique needs and circumstances of each patient 1.

From the Research

Maximum High Flow Nasal Cannula Flow in Neonates and Prematures

  • The maximum high flow nasal cannula (HFNC) flow in neonates and prematures is not explicitly stated in the provided studies, but we can look at the flow rates used in the studies:
    • A study from 2020 2 used flow rates of 2,4,6, and 8 L/min in preterm infants and found that changes in flow resulted in changes in work of breathing.
    • Another study from 2015 3 used a flow rate of 2 L/min in preterm infants.
  • It appears that flow rates up to 8 L/min have been used in preterm infants, but the optimal flow rate is not clear.
  • A dose-finding study from 2020 2 suggested that flows of 4,6, and 8 L/min may be equally effective in reducing work of breathing in preterm infants.

Flow Rates Used in Studies

  • 2 L/min: used in a study from 2015 3 in preterm infants.
  • 4 L/min: used in a study from 2020 2 in preterm infants.
  • 6 L/min: used in a study from 2020 2 in preterm infants.
  • 8 L/min: used in a study from 2020 2 in preterm infants.

Considerations

  • The choice of flow rate may depend on the individual patient's needs and response to treatment.
  • Further studies are needed to determine the optimal flow rate for HFNC in neonates and prematures.
  • The studies provided do not give a clear answer to the question of the maximum high flow nasal cannula flow in neonates and prematures, but they do provide some guidance on the flow rates that have been used in clinical practice 3, 2.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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