Non-invasive Respiratory Support of the Premature Neonate: From Physics to Bench to Practice

Abstract

Premature births continue to rise globally with a corresponding increase in various morbidities among this population. Rates of respiratory distress syndrome and the consequent development of Bronchopulmonary Dysplasia (BPD) are highest among the extremely preterm infants. The majority of extremely low birth weight premature neonates need some form of respiratory support during their early days of life. Invasive modes of respiratory assistance have been popular amongst care providers for many years. However, the practice of prolonged invasive mechanical ventilation is associated with an increased likelihood of developing BPD along with other comorbidities. Due to the improved understanding of the pathophysiology of BPD, and technological advances, non-invasive respiratory support is gaining popularity; whether as an initial mode of support, or for post-extubation of extremely preterm infants with respiratory insufficiency. Due to availability of a wide range of modalities, wide variations in practice exist among care providers. This review article aims to address the physical and biological basis for providing non-invasive respiratory support, the current clinical evidence, and the most recent developments in this field of Neonatology.

Is There a Decreased Risk of Bronchopulmonary Dysplasia Treated With High-Flow Nasal Cannulae Compared to Cpap? A Systematic Review and Meta-Analysis of Randomized Clinical Trial

“…Even with the signi cant increase in the use of these non-invasive ventilation devices in the past two decades, there is evidence that incidence rates of BPD 30 remained unchanged. Studies suggest that these results may occur due to the excessive use of interventions associated with other risk factors for BPD, such as infections in the peri and postnatal period, contributing to premature lung injuries 30,31 .…”

Non-invasive Ventilation for Children With Chronic Lung Disease

“…To decrease the volu- and barotrauma related lung injury NIV strategies are introduced in neonatal respiratory management, and it has become increasingly popular over time. NIV allows infants with BPD to wean from invasive mechanical ventilation and prevents the recurrence of respiratory failure requiring re-intubation ( 47 ).…”

“…Non-invasive respiratory support has been used after extubation to reduce extubation failures, or as a primary modality for premature infants with respiratory distress syndrome, and also to prevent late respiratory morbidity/BPD for premature babies ( 47 ).…”

High CPAP vs. NIPPV in preterm neonates — A physiological cross-over study

“…Non-invasive respiratory support use has increased in the last decades in neonatal intensive care units to reduce the burden of lung injury caused by invasive mechanical ventilation [1]. While there are a variety of non-invasive support modes, continuous positive airway pressure (CPAP) and non-invasive positive pressure ventilation (NIPPV) are typical forms [2].…”