TOPLINE:

Among infants hospitalised with bronchiolitis, the use of high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) varied widely across hospitals in Norway, with practice differences persisting over three seasons and a greater use seen in younger infants with lower weight and longer hospital stays.

METHODOLOGY:

• Researchers conducted a retrospective study to evaluate the use of HFNC and CPAP in infants younger than 12 months hospitalised with bronchiolitis and to assess variation in respiratory support practices across hospitals and seasons.
• The analysis included 1186 infants (median age, 11 weeks; 59% boys) who were hospitalised for bronchiolitis (admission more than 6 hours) at five hospitals in Norway during 2017-2018, 2018-2019, and 2021-2022 seasons.
• Data were collected from electronic medical records and included clinical characteristics, diagnostic tests, and treatment modalities with a focus on the mode of respiratory support including HFNC and CPAP.
• The study also evaluated the length of hospital stay, readmission rates, and differences in patient characteristics between infants who received respiratory support and those who did not.

TAKEAWAY:

• The use of HFNC differed significantly between hospitals across all seasons, ranging from 0% to 53% in 2017-2018, 3% to 53% in 2018-2019, and 20% to 52% in 2021-2022 (adjusted P < .001 for each season), but remained relatively stable over time for most hospitals.
• Similarly, the use of CPAP differed significantly between hospitals for all seasons, ranging from 1% to 24% in 2017-2018, 10% to 38% in 2018-2019, and 7% to 30% in 2021-2022 (adjusted P < .001 for each season), with an overall increase over the seasons, but this trend was not significant after adjustment.
• Infants who received respiratory support were younger (median age, 7 vs 14 weeks) and had lower weight (median, 5.0 vs 6.3 kg) and longer hospital stays (median, 116 vs 38 hours; P < .001 for all) than those who did not.
• The use of HFNC, CPAP, or any non-invasive respiratory support did not differ between groups of different gestational ages, and readmission rates were similar between groups receiving respiratory support and those not receiving it.

IN PRACTICE:

"Our results call for similar programs and updated guidelines both in Norway and other Nordic countries with clear advice when to initiate non-invasive respiratory support and which modality to choose," the authors wrote.

SOURCE:

This study was led by Knut Øymar, Division of Paediatrics, Stavanger University Hospital, Stavanger, Norway. It was published online on June 09, 2026, in Acta Paediatrica.

LIMITATIONS:

The study did not record the use of standard oxygen therapy; hence, it could not determine how many children received it before escalating to HFNC and/or CPAP.

DISCLOSURES:

One author received a 3-month unconditional support from a quality improvement grant provided by the Norwegian Medical Association to conduct the study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.