Kumar Jogender, Kumar Praveen, Bhandari Vineet
Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Division of Neonatology, Department of Pediatrics, Cooper Medical School of Rowan University, The Children's Regional Hospital at Cooper, One Cooper Plaza, Camden, NJ, 08103, USA.
Indian Pediatr. 2025 Apr 29. doi: 10.1007/s13312-025-00077-7.
We provide recommendations on neonatal noninvasive ventilation (NIV) strategies used in the delivery room (DR) and neonatal intensive care unit (NICU). A systematic search was performed in the PubMed, Embase, and CENTRAL databases to identify relevant literature from the past 5 years. A critical review of the available literature was conducted to provide context-specific recommendations. In the DR, we recommend using nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (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 HO and FiO > 0.3, using less invasive surfactant administration techniques. Infants should be transported to the NICU on positive pressure support using NCPAP or TPR. In extremely preterm infants with severe respiratory distress requiring intubation in the DR, surfactant should be considered during the intubation. If equipment and expertise 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. Additional clinical trials are needed for nasal high frequency ventilation and noninvasive ventilation neurally adjusted ventilatory assist modes of NIV. Guidelines for the recommended initial and maximal settings for primary, post-extubation, and weaning off NIV in neonates are provided in this article. NIPPV and NCPAP are the preferred modes of NIV in neonates with respiratory distress.
我们针对产房（DR）和新生儿重症监护病房（NICU）中使用的新生儿无创通气（NIV）策略提供建议。在PubMed、Embase和CENTRAL数据库中进行了系统检索，以识别过去5年的相关文献。对现有文献进行了批判性综述，以提供针对具体情况的建议。在产房，我们建议使用鼻持续气道正压通气（NCPAP）或通过T形管复苏器（TPR）进行鼻间歇正压通气（NIPPV）。对于需要6 - 7 cm H₂O的NCPAP且FiO₂ > 0.3的婴儿，应在出生后2小时内尽早给予表面活性剂替代疗法，并采用侵入性较小的表面活性剂给药技术。婴儿应在使用NCPAP或TPR的正压支持下转运至NICU。对于在产房需要插管的极早产儿且伴有严重呼吸窘迫，在插管期间应考虑使用表面活性剂。如果NICU具备设备和专业知识，NIPPV是无创通气的首选模式。鼻面罩或短双侧鼻导管是首选的鼻接口。不建议将加热、加湿的高流量鼻导管作为无创通气的主要模式。对于鼻高频通气和无创通气神经调节通气辅助模式的无创通气，还需要进行更多的临床试验。本文提供了新生儿无创通气初始和最大推荐设置的指南，包括初次使用、拔管后以及撤离无创通气时的设置。对于有呼吸窘迫的新生儿，NIPPV和NCPAP是无创通气的首选模式。
