Abstract
The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia.
Highlights
The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation
Several advances have been made in mechanical ventilation, in Intermittent Mandatory Ventilation (IMV) modes, such as, Synchronized IMV (SIMV), and volume targeted or Volume Guarantee (VG) modes of ventilation
Several meta-analyses published since have shown no significant difference in Bronchopulmonary Dysplasia (BPD) rates between SIMV and High Frequency Oscillatory Ventilation (HFOV), when HFOV was used as a primary mode of ventilation in preterm infants with Respiratory Distress Syndrome (RDS) [9,10,11]
Summary
Bronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short- and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants
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