Continuous Positive Airway Pressure to Prevent Neonatal Lung Injury: How Did We Get Here, and How Do We Improve?

Nasal continuous positive airway pressure (NCPAP) or noninvasive neurally adjusted ventilatory assist (NIV‐NAVA) for preterm infants with respiratory distress after birth: A randomized controlled trial

“…NCPAP failure is associated with the need for invasive MV, development of BPD and death. No consensus exists regarding the criteria used to characterize NCPAP failure, which is variably defined in studies, and neonatal units may have different success rates based on how NCPAP is applied at the bedside . However, different success rates in neonatal units have been reported, based on their experience with NCPAP use .…”

“…No consensus exists regarding the criteria used to characterize NCPAP failure, which is variably defined in studies, and neonatal units may have different success rates based on how NCPAP is applied at the bedside. [25][26][27] However, different success rates in neonatal units have been reported, based on their experience with NCPAP use. 4,28 The failure criteria for noninvasive ventilation used in this study correspond to our historical NCPAP failure rate of 40% to 50% among VLBW infants and are very similar to those used in other studies.…”

Refining noninvasive support strategies to help babies breathe

“…This practice is now supported by evidence from randomised trials and is the first choice in most NICUs . The downside of a one size fits all CPAP approach is that it is applied to babies weighing from 500 g to 5 kg and, at worst, can lead to overuse in infants that do not need the lung expansion provided by CPAP or a high incidence of CPAP failure in the smallest infants . Also, the proper maintenance of CPAP therapy requires solid routines and skilled personnel.…”

When should we start continuous positive airway pressure in the delivery room and how high should we go?

“…Despite advances in neonatal care, the incidence of bronchopulmonary dysplasia (BPD) remains unacceptably high . Several randomised controlled trials have demonstrated that the routine use of continuous positive airway pressure (CPAP) in very preterm infants of less than 28 weeks of gestational age decreases the incidence of BPD when compared with routine intubation and surfactant administration . It is generally accepted that the protective effect provided by CPAP is real and should be used for initial respiratory support in babies at risk of developing BPD .…”

“…Unfortunately, CPAP failure occurs frequently in this high‐risk population . It is reasonable to hypothesise that interventions that decrease CPAP failure would lead to improved efficacy.…”