Using a Nasal Cannula for Preemies

A preemie with a nasal cannula.
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A nasal cannula is a thin, plastic tube that delivers oxygen directly into the nose through two small prongs. It’s used in adult and pediatric patients alike as a type of respiratory support. Difficulty breathing is one of the most common challenges premature babies face. There are multiple interventions a neonatal care team can use to assist babies in breathing, including a nasal cannula, ventilator-assisted breathing, and continuous positive airway pressure (CPAP).

What Is a Nasal Cannula?

Care providers will carefully consider which type of support best matches your baby's needs, with the problem's cause and extent front of mind. One of the least aggressive interventions, known as a nasal cannula, is used when only a small amount of oxygen is required. In some cases, the air flow of the cannula can help babies with apnea (pauses in their breathing) remember to breathe. In other cases, a cannula is used for long periods of time in the most premature babies, even after they are discharged and at home.

Signs a Premature Baby Might Need a Nasal Cannula

Regular room air contains 21% oxygen, and the nasal cannulas used in most NICUs can deliver up to 100% (pure) oxygen. Without adequate oxygen, a condition called hypoxia can develop.

Signs and symptoms of hypoxia, or low oxygen, can include:

  • Increased breathing and heart rate
  • Changes in the level of consciousness
  • Restlessness
  • Cyanosis (bluish lips and nailbeds)

How Nasal Cannulas Help

Nasal cannulas are used to deliver oxygen when a low flow, low or medium concentration is required, and the patient is in a stable state. In the NICU, nasal cannulas almost always deliver warmed, humidified oxygen.

The oxygen they deliver can help babies in two ways. First, nasal cannulas provide a small amount of pressure as the oxygen blows into the nose, which can help babies’ lungs to stay inflated and can remind them to breathe. Parents may hear this called “flow” or a certain number of “liters.” Second, they can deliver a higher than normal amount of oxygen to help babies oxygenate their bodies. CPAP therapy is used to deliver higher flow. Some babies need this instead of a nasal cannula.

When a baby breathes in, they get a mixture of room air and oxygen from the nasal cannula. The actual oxygen concentration that the baby breathes can range from 21% to 100%. Larger babies may receive less concentrated oxygen. A special blender can be used to mix oxygen with room air.

Compared to babies receiving CPAP, those who are given a nasal cannula may have decreased gastric distension, can more easily breast or bottle-feed, and more easily enjoy the benefits of close physical contact with parents.

3 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. World Health Organization. Newborn health: Challenges facing preterm babies.

  2. Viaroli F, Cheung PY, O'Reilly M, Polglase GR, Pichler G, Schmölzer GM. Reducing brain injury of preterm infants in the delivery roomFront Pediatr. 2018;6:290. doi:10.3389/fped.2018.00290

  3. El-Farghali OG. High-flow nasal cannula in neonates. Respir Care. 2017;62(5):641-642. doi:10.4187/respcare.05566

By Cheryl Bird, RN, BSN
Cheryl Bird, RN, BSN, is a registered nurse in a tertiary level neonatal intensive care unit at Mary Washington Hospital in Fredericksburg, Virginia.