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

Area of Science:

• Neonatology
• Pediatric Respiratory Medicine
• Critical Care

Background:

• Assessing healthcare improvements, especially in neonates, requires evaluating multiple outcomes.
• While neonatal survival has improved due to respiratory support, conditions like bronchopulmonary dysplasia remain challenging.
• Significant advancements in neonatal respiratory care have occurred over the past six decades.

Purpose of the Study:

• To review the evolution of neonatal respiratory support over the last 60 years.
• To highlight scientific advances in invasive mechanical ventilation and identify knowledge gaps.
• To discuss the role of non-invasive ventilation, less-invasive surfactant administration, and pharmacological therapies, alongside cost-benefit analyses and future perspectives.

Main Methods:

• Literature review of neonatal respiratory care advancements over 60 years.
• Analysis of scientific progress in invasive mechanical ventilation.
• Discussion of non-invasive ventilation, surfactant administration, pharmacological therapies, and cost-benefit.

Main Results:

• Progress in invasive mechanical ventilation has improved neonatal survival rates.
• Certain neonatal outcomes, such as bronchopulmonary dysplasia, have not seen commensurate improvement.
• Non-invasive ventilation, less-invasive surfactant administration, and pharmacological therapies offer alternative or adjunctive strategies.

Conclusions:

• Neonatal respiratory care has evolved significantly, with key advances in invasive ventilation.
• There are persistent challenges and knowledge gaps, particularly concerning outcomes like bronchopulmonary dysplasia.
• Future directions involve optimizing current therapies, exploring novel approaches, and conducting thorough cost-benefit analyses for neonatal respiratory support.