{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/30128"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/30128","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa","abstract":"Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saharan Africa. Objective: To describe the outcomes and adverse events of HFNC in the first year of its use in a level two (L2) general paediatric ward, compared with outcomes of a historical cohort when this intervention was unavailable. Methods: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group; n=66). Demographic data, clinical characteristics, and outcomes (death, treatment failure, length of HFNC, and HFNC-related adverse events) were assessed. A comparative description of children that required transfer to level 3 (L3) for respiratory support (more than available standard low-flow oxygen) in the 12-month period prior to HFNC availability (pre-HFNC group; n=54) was performed and outcomes were compared using standard descriptive and comparative statistics. Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9– 14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and 30 (25%) were ex-premature infants. The most common diagnoses were pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities were the most prevalent underlying co-morbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: 19 were immediately transferred to L3 where 17 (89.4%) received CPAP or invasive ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h (IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2. Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children admitted with lower respiratory tract infections required support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to the protocol is needed at L2.","abstract_html":"Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saharan Africa. Objective: To describe the outcomes and adverse events of HFNC in the first year of its use in a level two (L2) general paediatric ward, compared with outcomes of a historical cohort when this intervention was unavailable. Methods: This retrospective descriptive study included children aged &lt;13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group; n=66). Demographic data, clinical characteristics, and outcomes (death, treatment failure, length of HFNC, and HFNC-related adverse events) were assessed. A comparative description of children that required transfer to level 3 (L3) for respiratory support (more than available standard low-flow oxygen) in the 12-month period prior to HFNC availability (pre-HFNC group; n=54) was performed and outcomes were compared using standard descriptive and comparative statistics. Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9– 14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and 30 (25%) were ex-premature infants. The most common diagnoses were pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities were the most prevalent underlying co-morbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: 19 were immediately transferred to L3 where 17 (89.4%) received CPAP or invasive ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h (IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2. Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children admitted with lower respiratory tract infections required support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to the protocol is needed at L2.","abstract_has_math":false,"creators":["Hoffman, Elizabeth"],"institution":"Department of Paediatrics and Child Health","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Cooke, Melissa Louise"],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018","date_published":"2018","updated_at":"2026-07-22T22:22:58Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/30128","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Cooke, Melissa Louise"]},{"key":"dc:creator","label":"Author","values":["Hoffman, Elizabeth"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2019-05-15T10:44:15Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2019-05-15T10:44:15Z"]},{"key":"dc:date.issued","label":"Date","values":["2018"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Department of Paediatrics and Child Health"]},{"key":"dc:type","label":"Dc Type","values":["Master Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Masters"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["MMed"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/30128"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saharan Africa. Objective: To describe the outcomes and adverse events of HFNC in the first year of its use in a level two (L2) general paediatric ward, compared with outcomes of a historical cohort when this intervention was unavailable. Methods: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group; n=66). Demographic data, clinical characteristics, and outcomes (death, treatment failure, length of HFNC, and HFNC-related adverse events) were assessed. A comparative description of children that required transfer to level 3 (L3) for respiratory support (more than available standard low-flow oxygen) in the 12-month period prior to HFNC availability (pre-HFNC group; n=54) was performed and outcomes were compared using standard descriptive and comparative statistics. Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9– 14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and 30 (25%) were ex-premature infants. The most common diagnoses were pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities were the most prevalent underlying co-morbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: 19 were immediately transferred to L3 where 17 (89.4%) received CPAP or invasive ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h (IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2. Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children admitted with lower respiratory tract infections required support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to the protocol is needed at L2."]},{"key":"dc:title","label":"Title","values":["A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa"]}]}],"canonical_facts":{"dc:contributor.advisor":["Cooke, Melissa Louise"],"dc:creator":["Hoffman, Elizabeth"],"dc:date.accessioned":["2019-05-15T10:44:15Z"],"dc:date.available":["2019-05-15T10:44:15Z"],"dc:date.issued":["2018"],"dc:description.abstract":["Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saharan Africa. Objective: To describe the outcomes and adverse events of HFNC in the first year of its use in a level two (L2) general paediatric ward, compared with outcomes of a historical cohort when this intervention was unavailable. Methods: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group; n=66). Demographic data, clinical characteristics, and outcomes (death, treatment failure, length of HFNC, and HFNC-related adverse events) were assessed. A comparative description of children that required transfer to level 3 (L3) for respiratory support (more than available standard low-flow oxygen) in the 12-month period prior to HFNC availability (pre-HFNC group; n=54) was performed and outcomes were compared using standard descriptive and comparative statistics. Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9– 14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and 30 (25%) were ex-premature infants. The most common diagnoses were pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities were the most prevalent underlying co-morbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: 19 were immediately transferred to L3 where 17 (89.4%) received CPAP or invasive ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h (IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2. Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children admitted with lower respiratory tract infections required support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to the protocol is needed at L2."],"dc:identifier.uri":["http://hdl.handle.net/11427/30128"],"dc:publisher.department":["Department of Paediatrics and Child Health"],"dc:title":["A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa"],"dc:type":["Master Thesis"],"dc:type.qualificationlevel":["Masters"],"dc:type.qualificationname":["MMed"]},"updated_at":"2026-07-22T22:22:58Z"}