‘Rational use of high‐flow therapy in infants with bronchiolitis. What do the latest trials tell us?’ A Paediatric Research in Emergency Departments International Collaborative perspective

Bronchiolitis is the most common reason for infants to be hospitalised. Over the past decade, the use of high‐flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence‐base for the use of HFNC in infants with bronchiolitis. We searched Ovid Medline, OvidEmbase, PubMed, Cinahl, Cochrane Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials for systematic reviews and randomised controlled trials of HFNC therapy in infants with bronchiolitis from 1 January 2000 to 27 June 2018. We identified four randomised controlled trials (n = 1891) of HFNC in infants with bronchiolitis: three of these studies involved infants treated in emergency departments and inpatient paediatric wards in Spain, Australia and New Zealand, and one study involved infants treated in paediatric intensive care units in France. The findings of this review suggest that HFNC should be used as a rescue treatment for hypoxaemic infants who have not responded to standard sub nasal oxygen therapy. The use of HFNC for work of breathing in the absence of hypoxaemia, and severe disease, is not currently supported by the evidence, and should only be considered in the context of an appropriate research trial.     

A randomised cross‐over study showed no difference in diaphragm activity during weaning from respiratory support

Aim

We measured electrical activity of the diaphragm (Edi) to compare the breathing effort in preterm infants during weaning from respiratory support with high‐flow nasal cannulae (HFNC) or nasal continuous positive airway pressure (nCPAP).

Methods

This randomised cross‐over study was carried out at St Olav's University Hospital, Trondheim, Norway, from December 2013 to June 2015. We gave 21 preterm infants weighing at least 1000 g HFNC 6 L/minute for four hours and nCPAP 3 cmH₂O for four hours with a one‐hour wash‐out period. Measurements included diaphragmatic load, Edi, vital signs and a modified Silverman‐Andersen Retraction Score.

Results

We found no differences in HFNC and nCPAP in the median Edi peak (8.0 μV versus 7.8 μV, p = 0.095), median Edi min (1.1 μV versus 1.2 μV in, p = 0.958) or mean heart rate (157 versus 159, p = 0.300) in the 21 infants who took part. The mean respiratory rate was significantly lower during HFNC than nCPAP (47 versus 52, p = 0.012). The modified Silverman‐Andersen Retraction Score showed no significant differences.

Conclusion

This study of preterm infants found no difference in the breathing effort measured by Edi between HFNC 6 L/minute and nCPAP 3 cmH₂O. HFNC could replace nCPAP when preterm infants are ready for weaning.     

Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit

The objective of the current study is to compare the use of a nasal continuous positive airway pressure (nCPAP) to a high-flow humidified nasal cannula (HFNC) in infants with acute bronchiolitis, who were admitted to a pediatric intensive care unit (PICU) during two consecutive seasons. We retrospectively reviewed the medical records of all infants admitted to a PICU at a tertiary care French hospital during the bronchiolitis seasons of 2010/11 and 2011/12. Infants admitted to the PICU, who required noninvasive respiratory support, were included. The first noninvasive respiratory support modality was nCPAP during the 2010/11 season, while HFNC was used during the 2011/2012 season. We compared the length of stay (LOS) in the PICU; the daily measure of PCO₂ and pH; and the mean of the five higher values of heart rate (HR), respiratory rate (RR), FiO_2, and SpO₂ each day, during the first 5 days. Thirty-four children met the inclusion criteria: 19 during the first period (nCPAP group) and 15 during the second period (HFNC group). Parameters such as LOS in PICU and oxygenation were similar in the two groups. Oxygen weaning occurred during the same time for the two groups. There were no differences between the two groups for RR, HR, FiO_2, and CO₂ evolution. HFNC therapy failed in three patients, two of whom required invasive mechanical ventilation, versus one in the nCPAP group. Conclusion: We did not find a difference between HFNC and nCPAP in the management of severe bronchiolitis in our PICU. Larger prospective studies are required to confirm these findings.     

高流量鼻导管吸氧对比经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征疗效的Meta分析

目的 系统评价高流量鼻导管吸氧（HFNC）对比经鼻持续气道正压通气（nCPAP）治疗新生儿呼吸窘迫综合征（RDS）的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库、中国知网和维普数据库建库至2020年4月1日的文献,收集HFNC对比nCPAP运用于新生儿RDS的随机对照试验（RCT）。采用RevMan5.3软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入12篇RCT文献,包括2 861例新生儿,其中胎龄≥28周2 698例（94.30%）, < 28周163例（5.70%）。在初始呼吸支持中,HFNC组治疗失败率高于nCPAP组（RR=1.86,95% CI：1.53~2.25,P < 0.001）;两组有创机械通气率（P=0.40）、肺表面活性物质使用率（P=0.77）的比较差异无统计学意义。在拔管后呼吸支持中,两组治疗失败率、重新插管率、总用氧时间的比较差异均无统计学意义（P > 0.05）。在初始呼吸支持和拔管后呼吸支持中,HFNC组的鼻损伤发生率均明显低于nCPAP组（P < 0.001）;HFNC组和nCPAP组病死率及气漏综合征、支气管肺发育不良、坏死性小肠结肠炎等并发症的发生率的比较差异均无统计学意义（P > 0.05）。结论 基于现有临床证据,HFNC作为新生儿RDS初始治疗时失败率高于nCPAP,不建议在新生儿RDS初始治疗时使用;在胎龄≥28周RDS新生儿撤机阶段可以考虑使用HFNC作为拔管后辅助呼吸支持。     

高流量鼻导管氧疗与早产儿呼吸支持

高流量鼻导管氧疗(high flow nasal cannulae,HFNC)是一种经充分湿化、加温,流量大于1～2 L/min,通过鼻塞外联吸氧管输送高流量混合氧气的无创性呼吸支持模式。在新生儿的应用中,HFNC 产生的扩张压与氧流量呈正相关,与新生儿体型呈负相关,同时沿导管泄露氧气也会对其造成影响。HFNC在提高新生儿潮气量、呼吸功等方面与经鼻持续气道正压通气(nasal continuous positive airway pressure, nCPAP)可能有相似效果,但仅限于流量低于2 L/min 的情况下。HFNC 可替代 CPAP /nCPAP 等各类无创通气方法,但在早产儿中推广普及则缺乏更强有力的证据支持。     

Premedication for neonatal intubation in Australia and New Zealand: A survey of current practice

Aim: This study aims to describe the current approach to intubation premedication in neonatal intensive care units (NICUs) in Australia and New Zealand Methods: A literature review regarding intubation premedication in the newborn was carried out to inform questionnaire design. A web‐based survey of 28 NICUs and two neonatal emergency transport services was conducted and supplemented by telephone contact to ensure completion. Results: All the tertiary NICUs and neonatal emergency transport services in Australia and New Zealand use premedication for elective intubation of neonates. Eighty per cent of units have a written policy. There were 28 of 30 units (93%) that use muscle relaxants, mostly suxamethonium. The choice of sedative medication is varied. Conclusions: Australian and New Zealand neonatal units have a high use of intubation premedication including muscle relaxants, but vary considerably in their choice of sedative medication.     

高流量鼻导管吸氧对比经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征疗效的Meta分析

目的 系统评价高流量鼻导管吸氧（HFNC）对比经鼻持续气道正压通气（nCPAP）治疗新生儿呼吸窘迫综合征（RDS）的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库、中国知网和维普数据库建库至2020年4月1日的文献,收集HFNC对比nCPAP运用于新生儿RDS的随机对照试验（RCT）。采用RevMan5.3软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入12篇RCT文献,包括2 861例新生儿,其中胎龄≥28周2 698例（94.30%）, < 28周163例（5.70%）。在初始呼吸支持中,HFNC组治疗失败率高于nCPAP组（RR=1.86,95% CI：1.53~2.25,P < 0.001）;两组有创机械通气率（P=0.40）、肺表面活性物质使用率（P=0.77）的比较差异无统计学意义。在拔管后呼吸支持中,两组治疗失败率、重新插管率、总用氧时间的比较差异均无统计学意义（P > 0.05）。在初始呼吸支持和拔管后呼吸支持中,HFNC组的鼻损伤发生率均明显低于nCPAP组（P < 0.001）;HFNC组和nCPAP组病死率及气漏综合征、支气管肺发育不良、坏死性小肠结肠炎等并发症的发生率的比较差异均无统计学意义（P > 0.05）。结论 基于现有临床证据,HFNC作为新生儿RDS初始治疗时失败率高于nCPAP,不建议在新生儿RDS初始治疗时使用;在胎龄≥28周RDS新生儿撤机阶段可以考虑使用HFNC作为拔管后辅助呼吸支持。     

Trends in use and outcome of newborn infants treated with high frequency ventilation in Australia and New Zealand, 1996-2003

AIM: To examine the use of high frequency ventilation (HFV) to treat newborn infants in Australia and New Zealand and the associated complications and outcomes. METHODS: Data for all infants receiving HFV were collected from the 28 neonatal intensive care units contributing to the Australian and New Zealand Neonatal Network database between 1996 and 2003, inclusive. For comparison, the same data were gathered on all infants who received conventional mechanical ventilation (CMV) and nasal continuous positive airway pressure. RESULTS: HFV was used to treat 3270 infants (10.1% of all ventilated infants) between 1996 and 2003; uptake doubled during this period from 5.9% to 12.6% of ventilated infants per year. HFV was most frequently applied in the context of extreme prematurity (29.9% of ventilated infants <26 weeks gestation). HFV is being increasingly used to treat complex diseases such as meconium aspiration syndrome and congenital diaphragmatic hernia (12.2% and 10.6% in 1996 to 25.2% and 48.4% in 2003, respectively, chi2 -test for trend, P<0.001). Infants receiving HFV spent longer on respiratory support than infants treated with CMV (median 21 days compared with 7 days, Mann-Whitney test P<0.001) and required a higher initial FiO2 (median 0.8 compared to 0.5, Mann-Whitney test, P<0.001). The use of HFV was associated with a higher mortality than CMV and nasal continuous positive airway pressure (39.7%, 10.1% and 0.4%, chi2 -test, P<0.001). The incidence of death and intraventricular haemorrhage decreased over time in the HFV group (chi2 -test for trend, P<0.001 and P=0.02 respectively). CONCLUSION: HFV is an established mode of neonatal ventilation in Australia and New Zealand. HFV is being applied to infants at the greatest risk of serious adverse outcomes, most likely as a rescue therapy.     

High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure

Apnea of prematurity (AOP) is frequently managed with nasal continuous positive airway pressure (NCPAP). Nasal cannula (NC) are used at low flows (<0.5 L/min) to deliver supplemental oxygen to neonates. A number of centers use high-flow nasal cannula (HFNC) in the management of AOP without measuring the positive distending pressure (PDP) generated. Objective. To determine the NC flow required to generate PDP equal to that provided by NCPAP at 6 cm H(2)O and to assess the effectiveness of HFNC as compared NCPAP in the management of AOP. Method. Forty premature infants, gestation 28.7 +/- 0.4 weeks (mean +/- standard error of mean), postconceptual age at study 30.3 +/- 0.6 weeks, birth weight 1256 +/- 66 g, study weight 1260 +/- 63 g who were being managed with conventional NCPAP for at least 24 hours for clinically significant apnea of prematurity, were enrolled in a trial of ventilator-generated conventional NCPAP versus infant NC at flows of up to 2.5 L/min. End expiratory esophageal pressure was measured on NCPAP and on NC, and the gas flow on NC was adjusted to generate an end expiratory esophageal pressure equal to that measured on NCPAP. Two 6-hour periods were continuously recorded and the data were stored on computer. Results. The flow required to generate a comparable PDP with NC varied with the infant's weight and was represented by the equation: flow (L/min) = 0.92 + 0.68x, x = weight in kg, R = 0.72. There was no difference in the frequency and duration of apnea, bradycardia or desaturation per recording between the 2 systems. Conclusion. NC at flows of 1 to 2.5 L/min can deliver PDP in premature neonates. HFNC is as effective as NCPAP in the management of AOP.     

Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand

OBJECTIVE: The equipment used to provide positive pressure ventilation at neonatal resuscitation varies between institutions. Available devices were reviewed and their use surveyed in a geographically defined region. The aim of this study was to establish which resuscitation equipment is used at neonatal intensive care units in Australia and New Zealand. METHODS: A questionnaire was sent to a neonatologist at each of the 29 neonatal intensive care units in Australia and New Zealand, asking which resuscitation equipment they used. If it was not returned, follow up was by email and telephone. RESULTS: Data was obtained from all units. Round face masks are used at all centres. Anatomically shaped masks are infrequently used at two of the three centres (10%) that have them. Straight endotracheal tubes are used exclusively at 23 (79%) centres. Shouldered tubes are used infrequently at three of the six centres that have them. The Laerdal Infant Resuscitator self-inflating bag is used at 22 (76%) centres. Flow-inflating bags are used at 12 (41%) centres. The Neopuff Infant Resuscitator is used at 14 (48%) centres. Varying oxygen concentrations are provided at delivery at 6/25 (24%) centres. CONCLUSIONS: There is a paucity of evidence for the efficacy of the equipment used currently to resuscitate newborn infants. This complete survey of the tertiary centres in a geographical region shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Further research is necessary to determine which devices are preferable for this most important and common intervention.     

加温湿化高流量经鼻导管氧疗的作用机制及在儿科的应用

加温湿化高流量经鼻导管氧疗(heated humidified high flow nasal cannula oxygen therapy,HFNC)具有改善呼吸做功,产生呼吸末正压效应,操作简单,患者耐受性优良,安全性高的特点.目前已经广泛用于新生儿相关的呼吸支持治疗,但缺乏在婴幼儿和儿童的广泛使用和研究.从HFNC作用机制及儿科生理学角度看,适合用于婴儿病毒性毛细支气管炎、儿童肺炎、哮喘、急性呼吸窘迫综合征以及拔管后呼吸支持治疗.HFNC应该成为儿科首选的常规氧疗模式.     

Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units

European Journal of Pediatrics - High-flow nasal cannula (HFNC) is frequently used in infants with acute viral bronchiolitis outside pediatric intensive care units (PICU). A structured...     

Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey

Aim: Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Methods: Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. Results: A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. Conclusion: This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are diverse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC.     

First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure

Background

Viral bronchiolitis is the leading cause of hospitalization in children during the first 12 months of life. There is evidence to support the use of noninvasive ventilation in bronchiolitis. A recent respiratory management of bronchiolitis is the use of high-flow nasal cannula (HFNC) therapy. The primary objective of this study was to evaluate the use of HFNC as the first-line treatment for children with severe bronchiolitis and the secondary objective was to identify factors for HFNC therapy failure.

Australian and New Zealand Committee on Resuscitation Neonatal Resuscitation guidelines 2016

New Australian and New Zealand Neonatal Resuscitation guidelines reflect recent advances in neonatal resuscitation science, as critically appraised by the International Liaison Committee on Resuscitation. Substantial changes since the 2010 guidelines include: (i) updates to the Newborn Resuscitation Flowchart to include a greater emphasis on maintaining normal body temperature, and to emphasise the importance of beginning assisted ventilation by 1 min in infants who have absent or ineffective spontaneous breathing; (ii) updates to the physiology of the normal perinatal transition that resuscitation is trying to restore; (iii) recommendations for more frequent reinforcement of training, and for structured feedback for resuscitation training instructors; (iv) new guidance in relation to the timing of cord clamping for preterm newborn infants; (v) recommendation to monitor body temperature on admission to newborn units as a resuscitation quality indicator; (vi) suggestion to consider electrocardiographic (ECG) monitoring (as an adjunct to oximetry) to obtain more rapid and accurate estimation of heart rate during resuscitation; (vii) removal of previous suggestions to intubate meconium‐exposed, non‐vigorous term infants to suction the trachea; and (viii) suggestion to establish vascular access to enable administration of intravenous adrenaline (epinephrine) as soon as chest compressions are deemed to be needed.     

Prevention of neonatal group B streptococcus disease in the 21st century

There have been significant reductions in early-onset neonatal group B streptococcus (GBS) disease following implementation of maternal intrapartum antibiotic prophylaxis (IAP) policies. Nevertheless, GBS remains a leading cause of neonatal sepsis in Australia and New Zealand resulting in considerable morbidity and mortality, particularly among preterm infants. In the United States, the universal screening-based approach for identifying women for IAP results in apparently lower rates of early-onset neonatal GBS infection than risk-based assessment. In addition, IAP has altered the profile of newborn infants who develop early-onset disease. Many affected infants lack the typical intrapartum risk factors for GBS infection, are born to mothers with a negative GBS screen or represent missed opportunities for prevention. Clinicians should remain alert for signs of sepsis in any newborn infant. We provide an update of GBS preventative management strategies in the perinatal period taking into account recent United States, Australian and New Zealand guidelines.     

Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomised control study

OBJECTIVE: To compare the incidence of nasal trauma associated with the use of prong or mask during nasal continuous positive airway pressure (nCPAP) support in very low birthweight (<1501 g) infants. DESIGN: Randomised controlled clinical trial. SETTING: Tertiary care university hospital, Department of Paediatrics, Kuala Lumpur, Malaysia. METHODS: All very low birthweight infants admitted to the neonatal intensive care unit between July 2001 and December 2003 who received nCPAP through the Infant Flow Driver were randomised to the use of either nasal prong or mask. The nasal cavity of these infants was inspected daily during the first week and then weekly until they were weaned off nCPAP. RESULTS: Of the 89 infants recruited, 41 were randomised to the mask group and 48 to the prong group. There was no significant difference in the incidence of nasal trauma between the two groups (p = 0.5). The primary site of trauma was at the junction between the nasal septum and the philtrum in infants in the mask group and the walls of the nasal septum in the prong group. Logistic regression analysis showed that duration of nCPAP was the only significant risk factor associated with development of nasal injury, after birth weight, gestational age, and nasal device used had been controlled for (adjusted odds ratio 1.04; 95% confidence interval 1.01 to 1.07; p = 0.003). CONCLUSION: Irrespective of the type of nasal device used, nasal trauma is common during nCPAP treatment, which should therefore be terminated as soon as possible.     

Use of oxygen for delivery room neonatal resuscitation in non-tertiary Australian and New Zealand hospitals: A survey of current practices, opinions and equipment

Background: Delivery room resuscitation of hypoxic newborn infants with pure or 100% oxygen causes oxidative toxicity and increases mortality. Current international resuscitation guidelines therefore recommend that oxygen be used judiciously. However, this requires staff education and special equipment that may not be available in non-tertiary maternity hospitals where the majority of births occur. Aim: To determine current attitudes, practices and available equipment for the use of air and blended oxygen for newborn delivery room resuscitation in non-tertiary maternity hospitals of Australia and New Zealand (ANZ). Methods: Structured questionnaires sent by mail and e-mail after personal phone contact. A total of 203 eligible hospitals in ANZ were identified. A second mailing was conducted a month later for non-responders. Responders: Final response rate was 64% (n= 130: 70% physicians, 30% midwives). The majority (121, 93%) of respondents were aware of Australian Resuscitation Council recommendations, but only one in five hospitals had the capacity to deliver blended oxygen and 38% used pulse oximeters at delivery. Only 24 (18.5%) hospitals had guidelines. Air would be used by 68 (57%) hospitals to resuscitate term infants compared to 35 (31%) for preterm infants. Most (111, 91%) advocated the use of blended oxygen despite the lack of facilities. Conclusion: Only one in five ANZ non-tertiary maternity hospitals had the capacity to resuscitate newborn infants with air or blended oxygen. Most are aware of current recommendations and agreed that the use of less oxygen would be beneficial for this purpose. Further study into the necessary infrastructure required to implement these guidelines are recommended.     

Who's got what? A benchmarking exercise for tertiary neonatal units

OBJECTIVES: To determine the current facilities available in level-3 neonatal units (NNU) in Australia and New Zealand to assist with establishment of standards for new NNU design. Background: Many current NNU in Australia and New Zealand are planning new or redesigning existing facilities. There are no adequate local standards for NNU design available which reflect changing neonatal practices. METHODS: All level-3 neonatal units belonging to the Australia and New Zealand Neonatal Network (ANZNN) were invited to respond to a survey on NNU facilities. Questions were based around obtaining information on whether the NNU were planning to build or redesign the space and clinical facilities available in their existing facilities and what support and family spaces were provided. RESULTS: Twenty-six (six in New Zealand and 20 in Australia) of the 29 tertiary NNU in the ANZNN responded the survey. The oldest facility was built in 1960, with the most recent NNU being commissioned in 2003. Of the 26 responders, 18 indicated that they were planning to rebuild or renovate, with 13 anticipating completion within 6 years. The median floor area for existing level-3 cots was 11.1 m(2) (range 5.5-18.0 m(2)) and 5.8 m(2) (range 2.3-15.6 m(2)) for level-2 cots, respectively. Most units responded that storage space was insufficient (median 1.5 m(2) per cot, range 0.4-3.3 m(2) per cot). Most units had facilities for parents including a family lounge and parent overnight rooms, although 16 units indicated that they needed more overnight rooming in facilities. Noise levels in level-3 areas were described as being 'generally' or 'mostly noisy' in 14 of 25 responses, but noise levels in level-2 areas were less in the majority of responses. Privacy was cited as an issue for 80% of responding NNU with comments directed at either the layout or space constraints interfering with confidentiality or interactions with families. CONCLUSIONS: The majority of NNU have inadequate space and environmental control. The lack of space particularly impacts on infection control aspects, parental privacy and participation and staff satisfaction. Level-2 areas, where parent participation in the care of infants is often greater, should receive as much attention as higher technology level-3 areas. Furthermore, work should be undertaken to develop appropriate local recommendations for NNU design which are acknowledged by local government agencies and professional bodies and take into account the changes in neonatal care practices, integration of family in the care of infants and the needs of the staff.     

High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study

High-flow nasal cannula (HFNC) is a widely used ventilatory support in children with bronchiolitis in the intensive care setting. No data is available on HFNC use in the general pediatric ward. The aim of this study was to evaluate the feasibility of HFNC oxygen therapy in infants hospitalized in a pediatric ward for moderate–severe bronchiolitis and to assess the changes in ventilatory parameters before and after starting HFNC support. This prospective observational pilot study was carried out during the bronchiolitis season 2011–2012 in a pediatric tertiary care academic center in Italy. Interruptions of HFNC therapy and possible side effects or escalation to other forms of respiratory support were recorded. Oxygen saturation (SpO₂), end-tidal carbon dioxide (ETCO₂), and respiratory rate (RR), measured for a baseline period of 1 h before and at specific time intervals in 48 h after the start of HFNC were recorded. Twenty-seven infants were included (median age 1.3 months; absolute range 0.3–8.5). No adverse events, no premature HFNC therapy termination, and no escalation to other forms of respiratory support were recorded. Median SpO₂ significantly increased by 1–2 points after changing from standard oxygen to HFNC (p <0.001). Median ETCO₂ and RR rapidly decreased by 6–8 mmHg and 13–20 breaths per minute, respectively, in the first 3 h of HFNC therapy (p <0.001) and remained steady thereafter. Conclusions: Use of HFNC for oxygen administration is feasible for infants with moderate–severe bronchiolitis in a general pediatric ward. In these children, HFNC therapy improves oxygen saturation levels and seems to be associated with a decrease in both ETCO₂ and RR.