Evidence mapPaperPMID 41344689Full record

SynthesisArchives of disease in childhood2026

High-flow nasal cannula for lower respiratory infections in children under 2 years: a systematic review of indications.

Gregorio Paolo Milani, Adriano La Vecchia, Eleonora Fusco, Martina Mazzoni, Mauro Lizzi, Elena Chiappini, Renato Cutrera

Abstract readSystematic Review
In one paragraph

Synthesis in Archives of disease in childhood, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Gregorio Paolo MilaniPediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Adriano La VecchiaPediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy adrianolvecchia@gmail.com.ORCID 0000-0001-5008-823X
Eleonora FuscoPaediatric Department, Vittore Buzzi Children's Hospital, Milan, Lombardy, Italy.
Martina MazzoniDepartment of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy.
Mauro LizziPediatric Pulmonology & Cystic Fibrosis Unit, Bambino Gesu Pediatric Hospital IRCCS, Rome, Italy.
Elena ChiappiniDepartment of Health Sciences, University of Florence, Florence, Italy.
Renato CutreraRespiratory Unit, Department of Pediatric Medicine, Bambino Gesu Pediatric Hospital IRCCS, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHigh-flow nasal cannula (HFNC) therapy is increasingly used for lower respiratory tract infections (LRTIs) in infants and young children, but recommendations vary, and standardised practice is lacking.

objectiveTo systematically review national or international guidelines on HFNC use in children aged 1-23 months with LRTIs, focusing on initiation, administration, monitoring, discontinuation and feeding.

methodsWe searched MEDLINE, EMBASE, CINAHL, Web of Science and professional society websites (2014-2025) for guidelines on HFNC use in this age group. Four reviewers independently screened, extracted data and assessed quality with the AGREE II tool. Interguideline concordance was calculated for all guidelines and separately for those addressing bronchiolitis and for evidence-based versus consensus-based guidelines. Recommendations were synthesised narratively.

resultsFifteen guidelines were included, including nine bronchiolitis guidelines. All addressed HFNC initiation, with low oxygen saturation (73%) and respiratory distress (47%) as common indications. Initial flow recommendations varied; 2 L/kg/min was most frequent (57%), and all bronchiolitis guidelines reporting it advised weight-based settings. Only two guidelines included weaning or discontinuation protocols, and seven addressed failure criteria. Monitoring typically included pulse oximetry and clinical observation; pulse oximetry was endorsed by all bronchiolitis guidelines that reported it (8/9). Enteral feeding was supported by all reporting guidelines (6/15). Guideline quality was moderate to high, though applicability and updating were frequent gaps.

conclusionsHFNC guideline recommendations for young children with LRTIs remain inconsistent, particularly regarding weaning, failure criteria and procedural details. Regular updates and greater standardisation are needed to improve care and optimise resource use. PROSPERO REGISTRATION NUMBER: CRD42024622544.

Indexed as

CannulaOxygen Inhalation TherapyRespiratory Tract InfectionsBronchiolitisHumansInfantInfant, NewbornPractice Guidelines as TopicChild HealthCommunicable DiseasesEmergency Service, HospitalPaediatricsRespiratory Medicine

Identifiers

PMID41344689
PMCPMC13018767

What Socratic holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.