We welcome the interest shown by Weiner et al in our article on the use of high-flow nasal cannulas in the neonatal population. However, we would like to address a few important issues. The authors report the pharyngeal pressures achieved by using Vapotherm with 2-mm outer-diameter prongs in only 2 large infants. They describe passing a 2F catheter transnasally to measure pharyngeal pressure, which possibly could have altered the size of the nasal leak. We also emphasized that for infants who weighed >1500 g, we found no relationship between the flow rate and maximal oral cavity pressure, which we attributed to the presence of a larger nasal leak. Oral cavity pressure generated by high-flow nasal cannula ultimately depends on whether the mouth is closed, the flow rate, and the size of the nasal leak. Clinically relevant levels of continuous positive airway pressure could be achieved only in infants <1500 g...

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