# Characteristics and outcomes of children initiated on high flow nasal cannula and continuous positive airway pressure at the emergency centre of a district hospital in South Africa

## TL;DR

This study examines the outcomes of children in South Africa who received high-flow nasal cannula or CPAP at a district hospital and were transferred to a higher-level facility.

## Contribution

The study provides real-world data on the safety and outcomes of interfacility transfers for children on respiratory support in South Africa.

## Key findings

- 23.9% of children were weaned from respiratory support within 24 hours of transfer.
- In-hospital mortality was low at 1.7%.
- No major adverse events occurred during interfacility transfers.

## Abstract

High-flow nasal cannula (HFNC) and continuous positive airway pressure delivered via a nasal interface (nCPAP) are increasingly used for paediatric emergency care in South Africa. In Cape Town, initiation of HFNC/nCPAP at a district hospital, in most instances, necessitates transfer to a paediatric high-care facility. We sought to describe the population of children initiated on HFNC/nCPAP and their short-term hospital outcomes post interfacility transfer.

The authors conducted a one-year retrospective observational study between August 1st 2021, to July 31st, 2022 of children initiated on HFNC or nCPAP in the emergency centre (EC) of Khayelitsha district Hospital and transferred by ambulance to Tygerberg Hospital paediatric emergency centre. Children were excluded from the study if they were <10 days or >13 years of age, if they had an advanced care plan that restricted the escalation of respiratory support or if their medical records were incomplete.

At Khayelitsha Hospital, 117 patients were initiated on HFNC (n = 58) or nCPAP (n = 59). Participants had a median age of 6.8 months. There were no major adverse events reported during inter-facility transfer. Respiratory support was weaned to low flow oxygen or room air within 24 h of transfer in 23.9 % and escalated in 9.4 %. During hospital stay 14.5 % were admitted to intensive care, 6.0 % ultimately required mechanical ventilation, and the in-hospital mortality rate was 1.7 %.

Roughly a quarter of patients were weaned from respiratory support within 24 h of transfer. Short term outcomes were good overall, demonstrating safe interfacility transfer and low mortality. Further research is needed to inform practice on best use of HFNC and nCPAP in the emergency care of children presenting with acute respiratory illness in South Africa.