The use of non- invasive ventilation (NIV) in neonatal intensive care has increased in recent decades to reduce ventilator induced lung injury. NIV is frequently used to avoid intubation or as post extubation support for spontaneously breathing neonates experiencing respiratory distress. Various modes of NIV strategies used in preterm neonates include nasal continuous positive airway pressure (NCPAP), bilevel CPAP (Bi-PAP), humidified high flow nasal cannula (HHFNC) and nasal intermittent positive pressure ventilation (NIPPV).
NCPAP is a mainstay of NIV for preterm neonates. NCPAP is preferred to HHFNC as primary mode of NIV in preterm infants with respiratory distress syndrome (RDS), whereas HHFNC is an effective alternative to NCPAP after extubation. HHFNC is associated with significantly less nasal trauma and air leak. Combining the early use of NIV with surfactant therapy may reduce the need of mechanical ventilation (MV).
NIPPV is as strategy that combines a continuous distending pressure with intermittent pressure increases. Bilevel CPAP and NIPPV differs in pressure and cycling times. NIPPV is an alternative to NCPAP as primary or post extubation respiratory support. Studies have shown that early NIPPV is superior to NCPAP to decrease the need for MV in preterm infants with RDS especially when ventilator generated, synchronized NIPPV is used.
Newer modes, nasal high frequency oscillatory ventilation (nHFOV) and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) are promising interventions but are not well studied in neonates and need further evaluations before routine use of these modes.