Effect of non-invasive ventilation on Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a major complication of prematurity, leading to long-term pulmonary morbidity. Invasive mechanical ventilation (IMV) is associated with ventilator-induced lung injury, oxygen toxicity, and inflammation, all contributing to BPD pathogenesis. Non-invasive ventilation (NIV) has emerged as a key strategy to reduce the incidence and severity of BPD. We examine the role of various NIV strategies in the respiratory management of premature infants. We discuss the common forms of NIV, including nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, bilevel positive airway pressure, high-flow nasal cannula, and nasal high-frequency ventilation, with a focus on their mechanisms of action, benefits, and limitations. Several studies have demonstrated that early and appropriate NIV use can reduce the incidence of BPD, improve oxygenation, and promote lung growth. However, NIV is not without challenges, including patient selection, the timing of initiation, and potential difficulties in achieving adequate ventilation, especially in extremely low birth weight neonates. Adjunctive therapies such as early surfactant therapy, less invasive surfactant administration, and caffeine may enhance the effectiveness of NIV. In conclusion, NIV is a promising approach to decreasing BPD, yet its effectiveness relies on proper clinical application and integration with other therapies to maximize its benefits.