Clinical practice : noninvasive respiratory support in newborns

Abstract

The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infants.

Fig. 1

Electromyography tracings of the diaphragm obtained from surface electrodes and mouth pressure in a 1-day-old healthy newborn. Arrow A points to post-inspiratory diaphragm activity at the start of expiration. Arrow B points to the early start of the next inspiration (insp) at the end of the same expiration (exp)

Fig. 2

Proposed algorithm for the treatment of RDS using noninvasive ventilation in premature infants with increasing respiratory distress syndrome. GA gestational age; INSURE Intubation Surfactant Extubation; nCPAP nasally delivered continuous positive airway pressure; nIPPV nasal intermittent positive pressure ventilation; SIMV synchronized intermittent mandatory ventilation