Noninvasive respiratory support in neonates: A brief review

Koravangattu SANKARAN; Manna ADEGBITE

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Chinese Journal of Contemporary Pediatrics ›› 2012, Vol. 14 ›› Issue (09) : 643-652.

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Noninvasive respiratory support in neonates: A brief review

Koravangattu SANKARAN, Manna ADEGBITE

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Abstract

In the era of gentle ventilation and open lung strategy noninvasive ventilatory support in neonates has gained momentum and its use in nurseries around the world is also increased. This paper reviews various modalities of non-invasive respiratory support in some details and its relevance in the recent evidence based use. Continuous positive airway pressure (CPAP) is a mode of ventilatory assistance in which positive pressure is delivered to the airway throughout the respiratory cycle. It is also referred to as continuous distending pressure (CDP) or positive end expiratory pressure (PEEP) when applied through a ventilator along with intermittent mandatory ventilation (IMV). It has been proven over the years to be an effective mode of ventilatory support and as such has gained widespread use in the management of a variety of neonatal respiratory diseases. It is relatively cheap and easy to apply and certainly feasible for routine use in underdeveloped world. Besides improving oxygenation CPAP often functions as an airway stabilizer of the trachea thus helping to decrease the frequency of neonatal apneas, particularly the obstructive variety. There is good to fair quality supportive evidence from several studies that the use of primary CPAP can reduce the need for intubation and mechanical ventilation in infants less than 32 weeks gestation. In this review, we will attempt to describe different delivery devices and pressure generating systems and discuss different ways in which CPAP can be applied. Although it is unclear that primary use of CPAP can reduce overall neonatal mortality and morbidity it is becoming increasingly clear that early CPAP use is less invasive, baby friendly and decreases the need and frequency of the use of surfactants. Besides, clinical indications for CPAP, its advantages and limitations will also be explored. CPAP adjuncts such as nasal intermittent positive pressure ventilation (NIPPV) and infant flow driver will also be discussed.

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Noninvasive respiratory support / Continuous positive airway pressure / Neonate

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Koravangattu SANKARAN, Manna ADEGBITE. Noninvasive respiratory support in neonates: A brief review[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(09): 643-652

References

［1］Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure［J］. N Engl J Med, 1971, 284(24): 1333-1340.

［2］Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAAP or intubation at birth for very preterm infants (COIN trial) ［J］. N Engl J Med, 2008, 358(7): 700-708.

［3］Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EF, Wright LL, et al. Delivery room continuous positive airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial［J］. Pediatrics, 2004, 114(3): 651-657.

［4］Sekar KC, Corff KE. To tube or not to tube babies with respiratory distress syndrome［J］. J Perinatol, 2009, 29(Suppl 2): S68-S72.

［5］Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, et al. Early CPAP versus surfactant in extremely preterm infants［J］. N Engl J Med, 2010, 362(21): 1970-1979.

［6］Morley C. Continuous distending pressure［J］. Arch Dis Child Fetal Neonatal Ed, 1999, 81(2): F152-F156.

［7］De Paoli AG, Morley C, Davis PG. Nasal CPAP for neonates: What do we know in 2003?［J］. Arch Dis Child Fetal Neonatal Ed, 2003, 88(3): F168-F172.

［8］Morley C, Davis P. Continuous positive airway pressure: current controversies［J］. Curr Opin Pediatr, 2004, 16(2): 141-145.

［9］Finer N. Nasal cannula use in the preterm infant: oxygen or pressure?［J］. Pediatrics, 2005, 116(5): 1216-1217.

［10］De Paoli AG, Lau R, Davis PG, Morley CJ. Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure［J］. Arch Disease Child Fetal Neonatal Ed, 2005, 90(1): F79-F81.

［11］Goldbart AD, Gozal D. Non-invasive ventilation in preterm infants［J］. Pediatr Pulmonol Suppl, 2004, 26: 158-161.

［12］Sahni R, Wung JT. Continuous positive airway pressure (CPAP) ［J］. Indian J Pediatr, 1998, 65(2): 265-271.

［13］Lee KS, Dunn MS, Fenwick M, Shennan AT. A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation［J］. Biol Neonate, 1998, 73(2): 69-75.

［14］Pandit PB, Courtney SE, Pyon KH, Saslow JG, Habib RH. Work of breathing during constant-and variable-flow nasal continuous positive airway pressure in preterm neonates［J］. Pediatrics, 2001, 108(3): 682-685.

［15］Mazzella M, Bellini C, Calevo MG, Campone F, Massocco D, Mezzano P, et al. A randomised control study comparing the infant flow driver with nasal continuous positive airway pressure in preterm infants［J］. Arch Dis Child Fetal Neonatal Ed, 2001, 85(2): F86-F90.

［16］Stefanescu BM, Murphy WP, Hansell BJ, Fuloria M, Morgan TM, Aschner JL. A randomized, control trail comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants［J］. Pediatrics, 2003, 112(5): 1031-1038.

［17］Morley C, Davis P. Continuous positive airway pressure: current controversies［J］. Curr Opin Pediatr, 2004, 16(2): 141-145.

［18］Locke R, Greenspan JS, Shaffer TH, Rubenstein SD, Wolfson MR. Effect of nasal CPAP on thoracoabdominal motion in neonates with respiratory insufficiency［J］. Pediatr Pulmonol, 1991, 11(3): 259-264.

［19］Miller MJ, Carlo WA, Martin RJ. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants［J］. J Pedaitr, 1985, 106(1): 91-94.

［20］Miller MJ, DiFiore JM, Strohl KP, Martin RJ. Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants［J］. J Appl Physiol, 1990, 68(1): 141-146.

［21］Elgellab A, Riou Y, Abbazine A, Truffert P, Matran R, Lequien P, et al. Effects of nasal continuous positive airway pressure on breathing pattern in spontaneously breathing premature newborn infants［J］. Intensive Care Med, 2001, 27(11): 1782-1787.

［22］Dunn MS, Reilly MC. Approaches to the initial respiratory management of preterm neonates［J］. Paediatr Respir Rev, 2003, 4(1): 2-8.

［23］Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrom K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome［J］. N Engl J Med, 1994, 331(16): 1051-1055.

［24］Thomson MA. Early nasal CPAP + prophylactic surfactant for neonates at risk of RDS. The IFDAS trial ［abstract］［J］. Pediatr Res, 2001, 50:304A.

［25］Lemyre B, Davis PG, de Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurity［DB/OL］. Cochrane Database Syst Rev, 2000, (3): CD002272.

［26］Davis PG, Lemyre B, de Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation［DB/OL］. Cochrane Database Syst Rev, 2001, (3): CD003212.

［27］Davis PG, Lemyre B, de Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation［DB/OL］. Cochrane Database Syst Rev, 2001, (3): CD003212.