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Noninvasive Ventilation for the Prevention of Bronchopulmonary Dysplasia

  • Louise S. OwenEmail author
  • Brett J. Manley
  • Vineet Bhandari
  • Peter G. Davis
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Noninvasive ventilation for neonates was developed in response to the initially high rates of mortality and morbidity seen in infants who were ventilated via an endotracheal tube. Although there have been improvements in ventilator design and techniques of ventilation (synchronization, volume targeting) as well as the development of proven effective therapies such as exogenous surfactant, clinicians now seek to avoid or at least minimize exposure of preterm infants to an endotracheal tube. Over the past three decades, evidence has accumulated evaluating nasal continuous positive airway pressure (CPAP), high-flow nasal cannulae, and nasal intermittent positive pressure ventilation (NIPPV), and a role for each is becoming better defined. Nasal CPAP is a useful strategy to ensure successful extubation following a period of endotracheal intubation. It also provides a reasonable alternative to endotracheal intubation for preterm infants with early respiratory distress, although its effect on bronchopulmonary dysplasia (BPD) is modest. NIPPV appears to augment the beneficial effects of nasal CPAP, especially as a mode of post-extubation support. Most convincing evidence of benefit is seen when the technique is delivered at pressures similar to those used in conventional ventilation and the inflations are synchronized with the infant’s own efforts. High-flow nasal cannulae are a useful alternative to nasal CPAP for post-extubation care and appear to be more comfortable and cause less nasal trauma. A role of high-flow nasal cannulae as primary support for infants with respiratory distress, particularly those born extremely preterm, remains to be determined. In spite of the theoretical benefits of avoiding or reducing exposure to an endotracheal tube, there is little evidence to indicate that noninvasive ventilation leads to a substantial reduction in rates of BPD.

Keywords

Bronchopulmonary dysplasia Noninvasive ventilation Continuous positive airway pressure Respiratory distress syndrome Airway extubation 

Notes

Acknowledgments

We sincerely thank Professor Bradley Yoder (University of Utah, USA) and Dr. Clare Collins (Mercy Hospital for Women, Melbourne, Australia) for providing unpublished subgroup data for this chapter. We also thank Dr. Ma Li (Hebei Provincial Children’s Hospital, Hebei, China), Dr. Manizheh Mostafa-Gharehbaghi (Tabriz University of Medical Sciences, Tabriz, Iran), and Dr. Ramin Iranpour (Isfahan University of Medical Sciences, Isfahan, Iran) for their assistance with translation and clarification of their trial methodology and results. A/Prof. Dominic Wilkinson (University of Oxford, Oxford, UK) assisted with the collection and clarification of data.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Louise S. Owen
    • 1
    • 2
    Email author
  • Brett J. Manley
    • 1
    • 2
  • Vineet Bhandari
    • 3
    • 4
    • 5
  • Peter G. Davis
    • 1
    • 2
  1. 1.Royal Women’s Hospital, Neonatal Services and Newborn Research CentreMelbourneAustralia
  2. 2.Department of Obstetrics and Gynaecology, University of MelbourneMelbourneAustralia
  3. 3.Department of Neonatology (Pediatrics)Drexel University College of Medicine, St. Christopher’s Hospital for ChildrenPhiladelphiaUSA
  4. 4.Hahnemann University HospitalPhiladelphiaUSA
  5. 5.Temple University HospitalPhiladelphiaUSA

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