Recommendations: Although high oxygen concentrations can be achieved with a nasal cannula at high flow rates, particularly in small babies, we recommend that nasal cannula be utilized when the infant has relative low supplemental oxygen requirements (<40 percent FiO2). Cannulas should be used with low liter flow (<1 liter/minute) to avoid CPAP administration. Using lower flow rates can diminish some of the adverse side effects, such as drying of the nasal mucosa. If a higher liter flow is utilized, the possibility of airway pressure delivery, as well as irritation from drying, should be recognized, and consideration should be given to placing the infant on a controlled CPAP delivery device that would have a better humidity system. Nasal cannulas seem to work well in the treatment of preterm infants with apnea, but more investigation is needed to determine the etiology of this effectiveness. Nasal cannulas also seem to be particularly useful for the stable infant who can tolerate variability in oxygen delivery and who can benefit from more mobility. A nasal cannula is also effective as an adjunct to other oxygen delivery therapies when the infant needs to be moved or held and when supplemental oxygen is to be utilized at home. As with the head hood, the potential limitations should be recognized and precautions included in the care plan.
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