Noninvasive Ventilation Strategies in Neonates

We provide recommendations on neonatal noninvasive ventilation (NIV) strategies used in the delivery room (DR) and neonatal intensive care unit (NICU). A systematic search was performed in the PubMed, Embase, and CENTRAL databases to identify relevant literature from the past 5 years. A critical review of the available literature was conducted to provide context-specific recommendations. In the DR, we recommend using nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) with a T-piece resuscitator (TPR). Surfactant replacement therapy should be administered early (< 2 h of life) in infants requiring NCPAP of 6-7 cm H₂O and FiO₂ > 0.3, using less invasive surfactant administration techniques. Infants should be transported to the NICU on positive pressure support using NCPAP or TPR. In extremely preterm infants with severe respiratory distress requiring intubation in the DR, surfactant should be considered during the intubation. If equipment and expertise are available in the NICU, NIPPV is the preferred mode of NIV. Nasal masks or short binasal prongs are the preferred nasal interfaces. A heated, humidified, high flow nasal cannula is not recommended as the primary mode of NIV. Additional clinical trials are needed for nasal high frequency ventilation and noninvasive ventilation neurally adjusted ventilatory assist modes of NIV. Guidelines for the recommended initial and maximal settings for primary, post-extubation, and weaning off NIV in neonates are provided in this article. NIPPV and NCPAP are the preferred modes of NIV in neonates with respiratory distress.