Management of respiratory failure in the preterm infant

Respiratory failure is common in the preterm infant. Support of the infant with oxygen, positive pressure, and assisted ventilation are among the commonest interventions required in neonatal care. This article is an overview of many features of respiratory care of the preterm infant, including the goals of therapy, continuous positive airways pressure (CPAP), non-invasive ventilation, various modes of ''conventional'' ventilation, high frequency ventilation and inhaled nitric oxide use. The proven benefits and limitations of various interventions are discussed, and areas requiring further investigation are highlighted. Although it is clear that respiratory support is life-saving, there is a lack of good evidence to choose one mode of support over another. Many prospective trials have been performed which, in general, have failed to demonstrate a significant additional benefit of any newer mode of ventilation over conventional time-cycled pressure limited ventilation. Many of the currently available modes of respiratory support have never been subjected to adequate study. Newer modes of respiratory support including such innovations as volume targeted ventilation, pressure support ventilation, and inhaled nitric oxide use in the preterm, require further investigation prior to their adoption for routine clinical use.