The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review

Abstract

Defining improvements in healthcare can be challenging due to the need to assess multiple outcomes and measures. In neonates, although progress in respiratory support has been a key factor in improving survival, the same degree of improvement has not been documented in certain outcomes, such as bronchopulmonary dysplasia. By exploring the evolution of neonatal respiratory care over the last 60 years, this review highlights not only the scientific advances that occurred with the application of invasive mechanical ventilation but also the weakness of the existing knowledge. The contributing role of non-invasive ventilation and less-invasive surfactant administration methods as well as of certain pharmacological therapies is also discussed. Moreover, we analyze the cost-benefit of neonatal care-respiratory support and present future challenges and perspectives.

Keywords: bronchopulmonary dysplasia; mechanical ventilation; neonate; non-invasive ventilation; outcome; prematurity; respiratory distress.

Figure 1

Schematic presentation of the intertemporal evolution of neonatal respiratory management from the early 1960s to the present. BiPAP, Bi-level positive airway pressure; BPD, bronchopulmonary dysplasia; CPAP, continuous positive airway pressure; HFNC, high flow nasal canula; HFV, high-frequency ventilation; IPPV, intermittent positive pressure ventilation; iNO, inhaled nitric oxide; IMV, invasive mechanical ventilation; NAVA, neurally adjusted ventilatory assist; Vt, tidal volume; VILI, ventilator-induced lung injury.