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Review
. 2019 Mar 8;116(11):177-183.
doi: 10.3238/arztebl.2019.0177.

Non-Invasive Ventilation in Neonatology

Judith Behnke  1 , Brigitte Lemyre, Christoph Czernik, Klaus-Peter Zimmer, Harald Ehrhardt, Markus Waitz
Affiliations
Review

Non-Invasive Ventilation in Neonatology

Judith Behnke et al. Dtsch Arztebl Int. .

Abstract

Background: Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes.

Methods: We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes.

Results: Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]).

Conclusion: Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.

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Figures

Figure 1
Figure 1
Interfaces for nCPAP application 1 = endotracheal 2 = short binasal prongs 3 = nasal mask
Figure 2
Figure 2
Preterm infant with nCPAP and binasal prongs (bonnet)
eFigure 1
eFigure 1
Time and Pressure Cycling during Bilevel-NIPPV versus CMV-NIPPV Different pressure wave types during (A) bilevel-NIPPV and (B) CMV-NIPPV PIP, peak inspiratory pressure; PEEP, positive end-expiratory pressure Adapted from Waitz et al. Clin Perinatol 2016 (e19)
eFigure 2
eFigure 2
Preterm infant with HHHFNC
See this image and copyright information in PMC

References

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