Background and Significance: High-flow therapy (HFT) is a frequently selected respiratory support. However, HFT has only recently become available in some parts of the world, such as in Asia. Although numerous studies have been conducted and a recent meta-analysis along with a Cochrane review provides evidence-based guidance, supporting evidence for HFT use for certain gestational age groups or conditions still needs refinement. Also, current practice patterns are not described well. To our knowledge, there is no published data describing the current practice of HFT in North America, although previous publications from the United Kingdom, Australia, and New Zealand reported HFT practice patterns. These reports also provide only the physician practices. The North American neonatal intensive care unit model is highly neonatal nurse practitioner (NNP)-dependent unlike the global counterparts, and NNPs are the frontline decision makers in collaboration with physician colleagues, contributing to the respiratory care of neonatal population. Purpose: To examine the current practice patterns related to HFT, availability of guidelines, and providers' perceptions regarding the benefits and challenges of HFT in North America. To examine the contribution of both NNPs and neonatologists in respiratory care using HFT in North America. Methods: Design/Instruments : A web-based survey to explore the clinical practice and perceptions of benefits and challenges related to HFT was created by a group of experienced neonatal providers in collaboration with international advisory members. The survey was disseminated using multiple professional organizational platforms to include neonatal providers. The inclusion criteria included neonatal providers and who use HFT. The recruiting strategies included sending direct e-mail invitations to professional organizational members and posting survey invitations to organizational community web pages. Sample : A convenience sample of neonatal providers (both NNPs and physicians) who responded to the survey. Analysis/Results: A total of 1102 responses were received from wide regions in North America. Nine hundred fortyseven responses were included in the final analyses (626 MDs, 321 NNPs) by eliminating responses that did not meet the inclusion criteria; 58.9% of MD group and 50.1% of NNP group reported greater than 20 years as licensed providers and 31% of all the respondents have more than 10 years of experience using HFT. Two-thirds of respondents practice in either level III or IV settings; 35% reported the availability of clinical guideline. Univariate analyses suggest a wide range of approach to utilizing HFT. Bivariate analyses revealed little significant differences between the MD and NNP groups in most aspects of practice or perceptions of benefits and challenges. Statistically significant differences emerged in gestational age groups of infants to be considered for HFT use under certain clinical circumstances, providers' years of experiences, as it relates to the use of HFT in conjunction with high-frequency ventilator modality, and lastly, clinical approaches between users of 2 main types of HFT devices available today. Implications for Practice and Research: The resulted practice patterns and variability suggest providers to reexamine and reflect on own current practice patterns, and researchers to consider areas of practice where evidence is lacking. Future work is also needed to explore the existing barriers against adopting practice guidelines. [ABSTRACT FROM AUTHOR]