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Noninvasive respiratory support for neonates

DeMauro, Sara B.a; Millar, Davidb; Kirpalani, Haresha

Current Opinion in Pediatrics: April 2014 - Volume 26 - Issue 2 - p 157–162
doi: 10.1097/MOP.0000000000000066
NEONATOLOGY AND PERINATOLOGY: Edited by Richard A. Polin and Tara M. Randis

Purpose of the review Noninvasive respiratory support for neonates is growing in popularity as clinicians increasingly recognize the dangers of prolonged invasive ventilation. The purpose of this review is to critically evaluate the existing evidence for safety and efficacy of these modes of respiratory support in neonates.

Recent findings In recent years, multiple randomized controlled trials (RCTs) have evaluated several modes of noninvasive support, most importantly nasal intermittent positive pressure ventilation and high flow nasal cannulae, in comparison to the standard therapy of continuous positive airway pressure (CPAP). The three largest RCTs were recently published in 2013. One demonstrated no difference in death or survival with bronchopulmonary dysplasia between nasal intermittent positive pressure ventilation and CPAP, both when used as primary support and as postextubation support. Two others demonstrated that high flow nasal cannulae are noninferior to or no better than CPAP when used to support preterm infants after extubation. These trials showed no serious safety concerns with current modalities.

Summary The optimal forms of noninvasive respiratory support for neonates remain to be determined. Continued evaluation of these technologies with large, well-designed RCTs is warranted.

aThe Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

bDepartment of Neonatology, Royal Maternity Hospital, Belfast, UK

Correspondence to Haresh Kirpalani, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, 2nd Floor, Main Building, Division of Neonatology, Philadelphia, PA 19104, USA. Tel: +1 215 590 1653; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins