Hemodynamics during noninvasive ventilation in neonates

Noninvasive ventilation (NIV) is increasingly used in neonatal care to reduce lung injury and improve respiratory outcomes. However, its effects on cardiovascular function and cardiopulmonary interactions, particularly in preterm neonates, remain unclear. This paper reviews the hemodynamic changes associated with NIV and provides an overview of how NIV influences cardiac preload, pulmonary vascular resistance, ventricular output, and systemic blood flow. NIV also affects these parameters in different ways in neonates with compromised cardiovascular stability, such as those with persistent pulmonary hypertension, patent ductus arteriosus and systemic hypotension. The synthesis of current evidence underscores that optimizing NIV requires careful titration of ventilatory parameters and highlights the potential role of targeted echocardiography and other clinical monitoring tools in guiding individualized management strategies. This review emphasizes the need for a nuanced approach that balances respiratory support with hemodynamic stability and calls for further research to establish best practices for the safe and effective use of NIV in neonates with hemodynamic compromise.