Neonatal non-invasive respiratory support: Physiological implications

• Published in: Pediatric pulmonology Vol. 47; no. 9; pp. 837 - 847
• Main Authors: Shaffer, Thomas H., Alapati, Deepthi, Greenspan, Jay S., Wolfson, Marla R.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.09.2012; Wiley-Liss
• Subjects: Administration, Inhalation; Biological and medical sciences; Bronchodilator Agents - therapeutic use; Bronchopulmonary Dysplasia - prevention & control; bubble CPAP; Continuous Positive Airway Pressure - methods; CPAP; Drug Combinations; Fatty Alcohols - therapeutic use; General aspects; high-flow nasal cannula; Humans; Infant, Newborn; Infant, Premature; Medical sciences; NIMV; nitric oxide; Nitric Oxide - therapeutic use; Noninvasive Ventilation - methods; Oxygen Inhalation Therapy - methods; oxygen therapy; Phosphatidylglycerols - therapeutic use; Pneumology; Proteins - therapeutic use; Pulmonary Surfactants - therapeutic use; Respiration, Artificial - methods; Respiratory Insufficiency - therapy; surfactant therapy; Human; High; NIMV; Pediatrics; Neonatal; Oxygen; CPAP; Cannula; Surfactant; Respiratory support; bubble CPAP; high-flow nasal cannula; oxygen therapy; Bubble; Newborn; Treatment; Pulmonary surfactant; Nitric oxide; Nose; Non invasive method; surfactant therapy; Pneumology
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.22610

The introduction of assisted ventilation for neonatal pulmonary insufficiency has resulted in the successful treatment of many previously fatal diseases. During the past three decades, refinement of invasive mechanical ventilation techniques has dramatically improved survival of many high‐risk neonates. However, as with many advances in medicine, while mortality has been reduced, morbidity has increased in the surviving high‐risk neonate. In this regard, introduction of assisted ventilation has been associated with chronic lung injury, also known as bronchopulmonary dysplasia. This disease, unknown prior to the appearance of mechanical ventilation, has produced a population of patients characterized by ventilator or oxygen dependence with serious accompanying pulmonary and neurodevelopmental morbidity. The purpose of this article is to review non‐invasive respiratory support methodologies to address the physiologic mechanisms by which these methods may prevent the pathophysiologic effects of invasive mechanical ventilation. Pediatr Pulmonol. 2012. 47:837–847. © 2012 Wiley Periodicals, Inc.