Abstract
Non-invasive ventilation (NIV) has gained increased popularity in the neonatal intensive care unit, because it is less likely to cause the short and long-term pulmonary complications associated with invasive mechanical ventilation. There are now number of NIV strategies available for the routine respiratory care of preterm infants including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), nasal high frequency oscillatory ventilation (NHFO) and high flow nasal cannula (HFNC). These strategies are often used in combination with less invasive surfactant administration (LISA) and methylxanthines to augment respiratory drive. This review describes these various modes of NIV evaluating their impact on neonatal mortality and morbidity in preterm infants.
Highlights
With the increased survival of extreme low gestational ageneonates (ELGAN)< 28 weeks non-intubated, non-invasive ventilation (NIV) has gained increased popularity in the neonatal intensive care unit (NICU)
There are a number of ways NIV can be applied, including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), nasal high frequency oscillatory ventilation (NHFOV) and humidified high flow nasal cannula (HFNC)
NCPAP, started soon after birth has become the first line strategy for the management of preterm infants with respiratory distress syndrome (RDS), especially in combination with Intubation surfactant administration and rapid extubation (INSURE) [1,2]
Summary
With the increased survival of extreme low gestational ageneonates (ELGAN)< 28 weeks non-intubated, non-invasive ventilation (NIV) has gained increased popularity in the neonatal intensive care unit (NICU). The acceptance of surfactant therapy in combination with improvements in the performance of neonatal ventilators further supported the dominant role of CMV for the respiratory management of preterm infants with RDS. Recent meta-analyses have shown that early NCPAP compared to routine endotracheal intubation and prophylactic surfactant administration reduces the combined outcome of death and BPD [6,10,11] in preterm infants with RDS. There are a number of overlapping NIPPV terms used in the literature such as Bi-level CPAP, N-BiPAP, Si-PAP, DUOPAP describing basically the same functional principle, namely providing cycling inspiratory pressures in addition to the single, basic CPAP pressure, which is unchanged throughout the respiratory cycle (figure 2)[13] This strategy may be beneficial in preterm infants with increased work of breathing and or inconsistent respiratory drive. SNIPPV N-BiPAP synchronized synchronized or not use of lower PIP and Frq and longer Ti ,allows
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