{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:52:19Z","timestamp":1791294739522,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL150244"],"award-info":[{"award-number":["K23HL150244"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heated, humidified, high\u2010flow nasal cannula (HFNC) before intubation has been associated with increased mortality in children with immunocompromising conditions (ICC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We sought to describe HFNC failure (intubation) rate and aimed to develop a novel score associated with HFNC failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a single center, retrospective cohort. Patients (aged 0\u201326 years) with ICCs who used HFNC between 2021 and 2023 were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010four (47.3%) of 93 included subjects failed HFNC. PICU mortality was 14% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913). The median duration of HFNC was 18.7\u2009h (IQR: 6.0, 40.4). We developed the novel FLOX ((flow in Liters\/minute)\/weight (kg)*FiO\n                      <jats:sub>2<\/jats:sub>\n                      ) score. Median FLOX score was higher with HFNC failure at initiation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), 2\u2009h (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), 4\u2009h (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05), and 6\u2009h (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). Adjusting for acuity, the odds of HFNC failure with a FLOX score (\u22650.20) were as follows: Initiation OR\u2009=\u20092.5 (95%CI: 1.03, 5.9),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042); 2\u2009h of HFNC, OR\u2009=\u20094.3 ((95%CI: 1.7, 10.9),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002); 4\u2009h of HFNC, OR\u2009=\u20096.5 (95%CI: 2.5, 16.8), (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); and 6\u2009h of HFNC, OR\u2009=\u20094.9 (95%CI: 1.9, 12.7), (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In children with ICCs, almost half fail HFNC. Mortality was high in those who fail HFNC. The FLOX score, specifically a FLOX\u2009\u2265\u20090.20 is associated with increased odds of failing HFNC in our ICC cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71814","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:05:41Z","timestamp":1788174341000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of the Novel FLOX Score to Assess Risk of Intubation in Children With Immunocompromising Conditions Receiving High Flow Nasal Cannula"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7072-8063","authenticated-orcid":false,"given":"Michelle A.","family":"Mai","sequence":"first","affiliation":[{"name":"Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5251-2399","authenticated-orcid":false,"given":"Colin M.","family":"Rogerson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Critical Care Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Riley Hospital for Children at IU Health Indianapolis Indiana USA"},{"name":"Regenstrief Center for Biomedical Informatics Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1393-6476","authenticated-orcid":false,"given":"Courtney M.","family":"Rowan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Critical Care Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Riley Hospital for Children at IU Health Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003421"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07205"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(16)30093-5"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.14282"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-1097-0"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002085"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005535"},{"issue":"11","key":"e_1_2_9_9_1","article-title":"High\u2010Flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications","volume":"10","author":"Lodeserto F. J.","year":"2018","journal-title":"Cureus"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003147"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199605000-00004"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003161"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(22)00058-3"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-020-03847-6"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181b0653d"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000011"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.06.006"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.653607"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09765"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-024-03029-2"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(18)30344-8"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003281"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71814","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.71814","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:52:20Z","timestamp":1791291140000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.71814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":21,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ppul.71814"],"URL":"https:\/\/doi.org\/10.1002\/ppul.71814","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"2026-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71814"}}