Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) is a highly specialized care area for ill or premature infants led by neonatologists and staffed with a team nurses and respiratory therapists specially trained to support the neonatal patient. Babies who are born prematurely, have low birth weight, or are born with congenital defects represent the largest group of NICU patients. Patients are admitted to the NICU within the first 24 hours of life and stay until they have gained sufficient weight, strength and development to no longer require the high intensity of care.

Infants often require respiratory support in the NICU. Premature babies may have underdeveloped lungs, and babies with cardiac or metabolic problems may also require significant respiratory support.

Vapotherm Hi-VNITM Therapy

Hi-VNI Therapy reduces the work of breathing – the effort required to breathe in and out - by delivering breathing gas at flow rates that exceed a baby's inspiratory demand. It is delivered through a simple loose fitting nasal cannula that is comfortable for the baby. The breathing gas is heated and humidified to make the high flow rates easy to tolerate.

Infants are able to more effectively ventilate (exchange carbon dioxide for oxygen) on Hi-VNI Therapy. The high flow rates of breathing gas flush out the CO2 and fill the upper airway with fresh oxygenated gas after each breath.

For more on the mechanisms of action click here

Preserving the temperature and humidification of the breathing gas as it travels from the Vapotherm Precision Flow to the patient is critical to providing effective therapy. If the temperature is not maintained, the humidity in the gas can condense to water in the air tube. This condition is known to respiratory therapists as "rain-out" and particularly needs to be avoided in neonatal patients who can have significant clinical consequences if they aspirate even small amounts of water.

Vapotherm eliminates rain-out by using medical grade vapor for humidification, and heating the humidified gas all the way to the patient. The water jacket insulated delivery tube that transports the gas feels warm to the touch, although it is never too hot to put next to the baby's skin.

The water jacket insulation also allows the Vapotherm delivery tube to be placed inside the radiant warmer. The length of the delivery tube and the loose fitting nasal prongs allow parents to hold their baby while on therapy.

For more information on Precision Flow technology click here.

Recent clinical studies have shown Hi-VNI Therapy to be equivalent to CPAP in providing respiratory support to neonates, while showing improved outcomes related nasal trauma. There is a significant body of literature on supporting neonates with Hi-VNI therapy.

For these studies and additional clinical information click here.

Clinical Use & Flow Rate Settings

In order to maintain effective flush of CO2 it is important that the cannula not occlude more than 50% of the nares. Vapotherm offers a variety of cannula sizes, including the Solo single prong cannula that leaves one nare completely open. The Solo single prong cannula allows placement of an NG tube, and assures an open system. Research has shown that the single prong cannula is as effective as a dual prong cannula at delivering Hi-VNI Therapy.

Flow rates should be set so they meet or exceed the patient's inspiratory demand and thus flush the upper airway and prevent the entrainment of room air. Although the Vapotherm Precision Flow can be used to heat and humidify low flow oxygen for neonates needing only supplemental oxygen support, the flush effect, and largest therapeutic impact of Hi-VNI Therapy, does not usually begin until flow rates of 4-8 LPM.

FiO2 should be set at a level to maintain blood oxygenation saturation as measured by patient monitors. Temperature should be set at 36-370 C, or one degree less than the radiant warmer.

To wean babies off of Hi-VNI Therapy, sequentially reduce FiO2 and then flow rate until the patient no longer needs support.

For more information on Clinical Use, please view the Vapotherm NICU Pocket Guide.
For information on contraindications, please visit the Precision Flow product page.


Common NICU Admissions

  • Babies born less than 37 weeks or more than 42 weeks
  • Babies weighing less than 2500 grams or more than 4000 grams
  • Respiratory Distress
    • rapid breathing
    • grunting
    • apnea (stopping breathing)
  • Need for extra oxygen
  • Seizures