Format

Send to

Choose Destination
Dtsch Arztebl Int. 2019 Mar 8;116(11):177-183. doi: 10.3238/arztebl.2019.0177.

Non-Invasive Ventilation in Neonatology.

Author information

1
Department of General Pediatrics & Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen; Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin; Member of the German Lung Research Center (DZL), Giessen.

Abstract

BACKGROUND:

Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes.

METHODS:

We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes.

RESULTS:

Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]).

CONCLUSION:

Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.

PMID:
31014448
DOI:
10.3238/arztebl.2019.0177
Free full text

Supplemental Content

Full text links

Icon for Deutsches Aerzteblatt International
Loading ...
Support Center