Noninvasive Strategies for Management of Respiratory Problems in Neonates

Abstract

Multiple techniques have been developed to provide noninvasive strategies for respiratory support of the newborn that provide positive airway pressure continuously, with or without ventilation cycles, in nonintubated infants. The core physiologic variable is positive airway pressure used clinically as nasal continuous positive airway pressure (CPAP). CPAP can be augmented with intermittent positive pressure breaths that are, or are not, synchronized to the breathing of the infant. Pressures delivered by high-flow nasal cannula are less predictable than those delivered by a CPAP device. A renewed interest in testing and innovating to improve noninvasive respiratory support techniques has resulted from efforts to avoid intubation, mechanical ventilation, and ultimately bronchopulmonary dysplasia. These noninvasive techniques now are used to stabilize respiratory status after birth, to manage respiratory distress syndrome, and to facilitate extubation of infants. Large trials, in aggregate, demonstrate a modest benefit from the use of CPAP soon after birth, relative to intubation, surfactant treatment, and ventilation. Small trials yield conflicting results for the relative benefits of different noninvasive techniques for the clinical management of respiratory distress syndrome and for attempts at extubation. Success with noninvasive ventilation for the management of preterm infants depends greatly on the skills and commitment of the personnel caring for the infant.