Fine Tuning Non-invasive Respiratory Support to Prevent Lung Injury in the Extremely Premature Infant

Area of Science:

• Neonatal Medicine
• Pediatric Respiratory Medicine

Background:

• Therapeutic advances have improved survival in extremely premature infants.
• However, rates of neonatal morbidities like bronchopulmonary dysplasia (BPD) remain high.
• This necessitates effective non-invasive respiratory support strategies to mitigate risks of invasive mechanical ventilation.

Purpose of the Study:

• To review current strategies for respiratory support in premature infants.
• To highlight the shift towards non-invasive methods like continuous positive airway pressure (CPAP).
• To discuss adjunctive therapies and recent changes in delivery room practices.

Main Methods:

• Review of recent therapeutic advances and clinical practices in neonatal respiratory care.
• Analysis of the evolution from invasive mechanical ventilation to non-invasive support.
• Evaluation of adjunctive therapies and specific delivery room interventions.

Main Results:

• Continuous positive airway pressure (CPAP) is increasingly preferred over invasive mechanical ventilation for initial stabilization.
• Adjunctive therapies are being implemented to prevent CPAP failure and support lung function.
• Sustained lung inflations in the delivery room were abandoned due to increased mortality.

Conclusions:

• Non-invasive respiratory support, particularly CPAP, is crucial for managing respiratory distress syndrome in premature infants.
• Ongoing research focuses on optimizing non-invasive strategies and adjunctive therapies to reduce BPD.
• Evidence-based evaluation of interventions, like the abandonment of sustained lung inflations, guides clinical practice.