Abstract
Recent advances in neonatology have led to the increased survival of extremely low-birth weight infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not improved proportionally, partly due to increased survival of extremely premature infants born at the late-canalicular stage of lung development. Due to minimal surfactant production at this stage, these infants are at risk for severe respiratory distress syndrome, needing prolonged ventilation. While the etiology of BPD is multifactorial with antenatal, postnatal, and genetic factors playing a role, ventilator-induced lung injury is a major, potentially modifiable, risk factor implicated in its causation. Infants with BPD are at a higher risk of developing complications including sepsis, pulmonary arterial hypertension, respiratory failure, and death. Long-term problems include increased risk of hospital readmissions, respiratory infections, and asthma-like symptoms during infancy and childhood. Survivors who have BPD are also at increased risk of poor neurodevelopmental outcomes. While the ultimate solution for avoiding BPD lies in the prevention of preterm births, strategies to decrease its incidence are the need of the hour. It is time to focus on gentler modes of ventilation and the use of less invasive surfactant administration techniques to mitigate lung injury, thereby potentially decreasing the burden of BPD. In this article, we discuss the use of non-invasive ventilation in premature infants, with an emphasis on studies showing an effect on BPD with different modes of non-invasive ventilation. Practical considerations in the use of nasal intermittent positive pressure ventilation are also discussed, considering the significant heterogeneity in clinical practices and management strategies in its use.
Highlights
Bronchopulmonary dysplasia (BPD) was first described by Northway et al in 1967 to describe the inflammatory and fibrotic changes noticed in the lungs of premature infants exposed to mechanical ventilation and hyperoxia [1]
It has been replaced by early use of nasal continuous positive airway pressure (NCPAP), starting in the delivery room, and selective surfactant use, after large trials showed a benefit with such an approach [11,12]
Studies done to predict the variables associated with NCPAP failure revealed, expectedly, that smaller gestational age, lower birth weight, higher fraction of inspired oxygen (FiO2) requirement, and abnormal initial blood gas values were associated with higher rates of NCPAP failure [23,24,25]
Summary
Bronchopulmonary dysplasia (BPD) was first described by Northway et al in 1967 to describe the inflammatory and fibrotic changes noticed in the lungs of premature infants exposed to mechanical ventilation and hyperoxia [1]. A recent study analyzing a large database of premature infants showed that the incidence of BPD has decreased over the last few years, with an increase in the use of non-invasive ventilation during the same period [8]. Routine intubation of extremely preterm infants was the standard of care It has been replaced by early use of nasal continuous positive airway pressure (NCPAP), starting in the delivery room, and selective surfactant use, after large trials showed a benefit with such an approach [11,12]. Use of non-invasive ventilation minimizes the risk for lung injury and decreases the risk of BPD compared to invasive mechanical ventilation [13,14]. The quest for an optimal definition of BPD is ongoing [16], but for the purpose of this review, we have utilized the National Institutes of Health consensus definition from 2001 [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
