Noninvasive Ventilation Strategies in Neonates
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Date
2025-06
Journal Title
Journal ISSN
Volume Title
Publisher
Indian Academy of Pediatrics
Abstract
We provide recommenda?ons on neonatal noninvasive ven?la?on (NIV) strategies used in the delivery room (DR) and neonatal intensive care unit (NICU). A systema?c search was performed in the PubMed, Embase, and CENTRAL databases to iden?fy relevant literature from the past 5 years. A cri?cal review of the available literature was conducted to provide context- specific recommenda?ons. In the DR, we recommend using nasal con?nuous posi?ve airway pressure (NCPAP) or nasal intermi?ent posi?ve pressure ven?la?on (NIPPV) with a T-piece resuscitator (TPR). Surfactant replacement therapy should be administered early (< 2 h of life) in infants requiring NCPAP of 6–7 cm H 2 O and FiO 2 >0.3, using less invasive surfactant administra?on techniques. Infants should be transported to the NICU on posi?ve pressure support using NCPAP or TPR. In extremely preterm infants with severe respiratory distress requiring intuba?on in the DR, surfactant should be considered during the intuba?on. If equipment and exper?se are available in the NICU, NIPPV is the preferred mode of NIV. Nasal masks or short binasal prongs are the preferred nasal interfaces. A heated, humidified, high flow nasal cannula is not recommended as the primary mode of NIV. Addi?onal clinical trials are needed for nasal high frequency ven?la?on and noninvasive ven?la?on neurally adjusted ven?latory assist modes of NIV. Guidelines for the recommended ini?al and maximal se?ngs for primary, post-extuba?on, and weaning off NIV in neonates are provided in this ar?cle. NIPPV and NCPAP are the preferred modes of NIV in neonates with respiratory distress.
Description
Keywords
Preterm, RDS, NCPAP, NIPPV, HHHFNC, NIV-NAVA, NHFV, NIV
Citation
Kumar Jogender, Kumar Praveen, Bhandari Vineet . Noninvasive Ventilation Strategies in Neonates. Indian Pediatrics. 2025 Jun; 62(6): 451-460