Clinics in perinatology
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To minimize ventilator-associated lung injury in neonates, use of noninvasive (NIV) respiratory support has markedly increased over the past decade, especially in neonates younger than 28-weeks gestational age and 1250 g. Previously, neonates with respiratory failure who required anything greater than an oxyhood or low-flow nasal cannula were intubated for transport. This increased use has required transport teams to develop or incorporate a new set of support tools to minimize lung injury. This article reviews the various modes of NIV used during neonatal transport, important patient selection criteria, appropriate assessment, and the associated risks and benefits.
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Clinics in perinatology · Dec 2016
ReviewNeurally Adjusted Ventilatory Assist for Noninvasive Support in Neonates.
Noninvasive ventilation (NIV) is frequently used in the NICU to avoid intubation or as postextubation support for spontaneously breathing infants experiencing respiratory distress. Neurally adjusted ventilatory assist (NAVA) is used as a mode of noninvasive support in which both the timing and degree of ventilatory assist are controlled by the patient. NIV-NAVA has been successfully used clinically in neonates as a mode of ventilation to prevent intubation, allow early extubation, and as a novel way to deliver nasal continuous positive airway pressure.
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Clinics in perinatology · Dec 2016
ReviewContinuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System.
Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. ⋯ Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing.
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Clinics in perinatology · Dec 2016
ReviewHigh-Frequency Ventilation as a Mode of Noninvasive Respiratory Support.
High-frequency ventilation (HFV) as a mode of noninvasive respiratory support (NRS) in preterm neonates is gaining popularity. Benefits may accrue from combining the ventilatory efficiency of HFV delivered through a noninvasive interface, enhancing respiratory support while potentially limiting lung injury. ⋯ Animal data suggest NIHFV may promote improved alveolar development compared to endotracheal ventilation. However, adequately powered large-scale controlled trials are required to evaluate efficacy and safety prior to widespread use of NIHFV.
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Clinics in perinatology · Dec 2016
ReviewNoninvasive Support: Does It Really Decrease Bronchopulmonary Dysplasia?
Noninvasive support of preterm infants with respiratory distress is an evidenced-based strategy to decrease the incidence of bronchopulmonary dysplasia. Continuous positive airway pressure (CPAP) is the only noninvasive strategy with sufficient evidence to support its use in acute respiratory distress syndrome. It is unclear if one method for delivering CPAP is superior to another. Future research will focus on strategies (eg, sustained lung inflation, and administration of surfactant using a thin plastic catheter) that increase the likelihood of success with CPAP, especially in infants with a gestational age of less than 26 weeks.