Non-invasive ventilation of preterm infants in the delivery room

The approach to respiratory support in preterm infants at birth has shifted from invasive to non-invasive techniques. The effectiveness of non-invasive respiratory support relies on a good mask seal and maintaining a patent airway, but this appears to be more challenging than initially thought. The force applied to the mask must be sufficient for a good mask seal to reduce leak, but too much pressure on the face mask can inhibit breathing. Also, airway obstruction due to a closed glottis can prevent the lungs from being effectively ventilated. It is now evident that spontaneous breathing is essential for a patent airway, with oxygenation playing a key role in stimulating breathing. This can be improved by increasing the surface area available for gas exchange with appropriate continuous positive airway pressures (CPAP) and/or increasing the inspired oxygen concentration. Tactile stimulation can help promote spontaneous breathing, which promotes lung aeration and gas exchange potential, thereby improving oxygenation, which further improves the overall effectiveness of non-invasive respiratory support.