Noninvasive Ventilation Strategies in Neonates.

Area of Science:

• Neonatal Medicine
• Respiratory Care
• Pediatric Critical Care

Background:

• Noninvasive ventilation (NIV) is crucial for managing neonatal respiratory distress.
• Optimal NIV strategies in the delivery room (DR) and neonatal intensive care unit (NICU) require clear guidelines.
• Evidence-based recommendations are needed to improve outcomes for neonates requiring respiratory support.

Purpose of the Study:

• To provide evidence-based recommendations for neonatal NIV strategies in the DR and NICU.
• To guide the selection of appropriate NIV modes, interfaces, and settings.
• To inform clinical practice regarding early surfactant administration and transport support.

Main Methods:

• Systematic literature search of PubMed, Embase, and CENTRAL databases (last 5 years).
• Critical review of identified literature to formulate context-specific recommendations.
• Synthesis of evidence to establish guidelines for NIV settings and surfactant therapy.

Main Results:

• Nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) with a T-piece resuscitator (TPR) are recommended in the DR.
• Early surfactant replacement therapy (<2 hours) is advised for infants needing NCPAP with high oxygen requirements, using less invasive techniques.
• NIPPV is the preferred NIV mode in the NICU if resources allow; nasal masks or short binasal prongs are recommended interfaces.
• Heated, humidified high flow nasal cannula is not recommended as a primary NIV mode.

Conclusions:

• NCPAP and NIPPV are preferred NIV modes for neonates with respiratory distress.
• Specific guidelines for initial and maximal NIV settings are provided for various clinical scenarios.
• Further research is needed for nasal high frequency ventilation and neurally adjusted ventilatory assist modes.