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NeoReviews Vol.10 No.4 2009 e157
© 2009 American Academy of Pediatrics

International Perspectives

Nasal Ventilation in Preterm Infants: An Israeli Perspective

^* Department of Neonatology and Pediatric Pulmonary Unit, Bnai Zion Medical Center, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel

NRS is a noninvasive method of maintaining functional residual capacity without endotracheal ventilation. NRS, which includes nasal continuous positive airway pressure (NCPAP) and nasal ventilation, is an effective mode of treatment for preterm infants, especially in the era of prenatal corticosteroids. NRS has been used for the initial treatment of RDS, after extubation as a "bridge" to spontaneous unsupported breathing, and for the treatment of apnea of prematurity. However, NRS may not be sufficiently effective alone as the primary therapy for preterm infants who have RDS, especially for extremely preterm infants who have severe RDS. A significant number of such infants still need endotracheal ventilation, possibly due, in part, to not using surfactant. A new approach involves administration of surfactant during brief intubation followed by immediate extubation to NRS. This review examines recently developed noninvasive ventilatory strategies and offers a logical physiologic and evidence-based flow chart to aid in bedside decision making from the delivery room to the point of spontaneous unsupported breathing. Also discussed are issues that may be especially pertinent to outlying facilities that have limited personnel and equipment resources.

Abbreviations: BPD: bronchopulmonary dysplasia • CPAP: continuous positive airway pressure • ELBW: extremely low birthweight • FRC: functional residual capacity • IVH: intraventricular hemorrhage • NCPAP: nasal continuous positive airway pressure • NICU: neonatal intensive care unit • NIMV: nasal intermittent mandatory ventilation • NIPPV: nasal intermittent positive-pressure ventilation • NRS: nasal respiratory support • NSIMV: nasal synchronized intermittent mandatory ventilation • RDS: respiratory distress syndrome • VLBW: very low birthweight

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