Non-Invasive Ventilation in Neonatology

Overview

Journal Dtsch Arztebl Int

Specialties General Medicine
Public Health

Date 2019 Apr 25

PMID 31014448

Citations 22

Authors

Judith Behnke

Brigitte Lemyre

Christoph Czernik

Klaus-Peter Zimmer

Harald Ehrhardt

Markus Waitz

Affiliations

Soon will be listed here.

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Background: Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of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.

Citing Articles

Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants.

Louie K, Amatya S, Alpan G, Parton L Children (Basel). 2024; 11(10).

PMID: 39457149 PMC: 11506030. DOI: 10.3390/children11101184.

Intubation at Birth Is Associated with Death after Pulmonary Hemorrhage in Very Low Birth Weight Infants.

Sun Y, Qin H, Feng Y, Zou Y, Liu Y, Cheng R Children (Basel). 2024; 11(6).

PMID: 38929201 PMC: 11201528. DOI: 10.3390/children11060621.

RAM Cannula Versus Bi-Nasal Prongs as Respiratory Device Interfaces in Neonates of Thirty-Two or More Weeks of Gestation With Respiratory Distress: The First "ProRAM" Randomized Trial Report.

Al-Lawama M, Alaraj B, Abu Zahra M, AlHasanat I, Habash H, Alhyari A J Clin Med Res. 2024; 16(1):24-30.

PMID: 38327391 PMC: 10846486. DOI: 10.14740/jocmr5077.

Construction and evaluation of neonatal respiratory failure risk prediction model for neonatal respiratory distress syndrome.

Lei Y, Qiu X, Zhou R BMC Pulm Med. 2024; 24(1):8.

PMID: 38166798 PMC: 10759760. DOI: 10.1186/s12890-023-02819-4.

Oxygen and mechanical stretch in the developing lung: risk factors for neonatal and pediatric lung disease.

Zhang E, Bartman C, Prakash Y, Pabelick C, Vogel E Front Med (Lausanne). 2023; 10:1214108.

PMID: 37404808 PMC: 10315587. DOI: 10.3389/fmed.2023.1214108.

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