EC Paediatrics

This article aims to examine non-invasive methods of respiratory support and other strategies to mitigate the negative impacts of invasive mechanical ventilation. Despite significant progress in medicine, the morbidity rate among surviving high-risk neonates has risen, even as mortality rates have fallen. Over the past thirty years, the use of sophisticated invasive mechanical ventilation techniques has greatly enhanced the survival rates of high-risk neonates. Yet, with every medical breakthrough, while death rates have declined, the morbidity among surviving high-risk neonates has escalated. The advent of assisted ventilation has been linked to bronchopulmonary dysplasia a condition not known before the use of mechanical ventilation. This has resulted in a group of patients who are dependent on ventilators or oxygen and suffer from severe pulmonary and neurodevelopmental morbidity. The airways of young infants are highly flexible and prone to damage during mechanical ventilation. In the initial hours of life, all infants have a higher surface tension in the alveoli, and some degree of atelectasis is common until a monomolecular layer of surfactant is formed at the air-liquid interface. It appears that surface tension and structural immaturity are the primary contributors to respiratory insufficiency in the premature lung, potentially leading to respiratory distress syndrome (RDS). This review provides a comprehensive overview of the latest developments and strategies in neonatal respiratory therapy, with a particular focus on managing RDS.

 Keywords: Non-Invasive Ventilation (NIV); Respiratory Distress Syndrome (RDS); Neonatal Respiratory Therapy; Neonatal Resuscitation

1. Jobe AH. “The new bronchopulmonary dysplasia”. Current Opinion in Pediatrics 2 (2011): 167-172.
2. Santin R., et al. “A prospective observational pilot study of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a primary mode of ventilation in infants>or=28 weeks with respiratory distress syndrome (RDS)”. Journal of Perinatology 8 (2004): 487-493.
3. Breatnach C., et al. “A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population”. Pediatric Critical Care Medicine 1 (2010): 7-11.
4. Klingenberg C., et al. “Volume-targeted versus pressure-limited ventilation in neonates”. Cochrane Database of Systematic Reviews 10 (2017): CD003666.
5. Ari A and Fink JB. “Recent advances in aerosol devices for the delivery of inhaled medications”. Expert Opinion on Drug Delivery 2 (2020): 133-144.
6. Nowadzky T., et al. “Bubble continuous positive airway pressure, a potentially better practice, reduces the use of mechanical ventilation among very low birth weight infants with respiratory distress syndrome”. Pediatrics 6 (2009): 1534-1540.
7. Rudolph AM. “Congenital cardiovascular malformations and the fetal circulation”. Archives of Disease in Childhood-Fetal and Neonatal Edition 2 (2010): F132-F136.
8. Greer JJ. “Current concepts on the pathogenesis and etiology of congenital diaphragmatic hernia”. Respiratory Physiology and Neurobiology 2 (2013): 232-240.
9. Josephsen JB., et al. “Delayed umbilical cord clamping in preterm infants”. Neoreviews 3 (2019): e174-e176.
10. Mathew JL., et al. “Systematic review evaluating therapeutic hypothermia for newborns with hypoxic ischaemic encephalopathy”. PROSPERO, CRD42021279682 (2021).
11. Kesecioglu J., et al. “Exogenous natural surfactant for treatment of acute lung injury and the acute respiratory distress syndrome”. American Journal of Respiratory and Critical Care Medicine 10 (2009): 989-994.
12. Keogh SJ., et al. “Practice guidelines for sedation and analgesia management of critically ill children: a pilot study evaluating guideline impact and feasibility in the PICU”. BMJ Open3 (2015): e006428.
13. Handley AJ., et al. “European Resuscitation Council Guidelines for Resuscitation 2005: Section 2. Adult basic life support and use of automated external defibrillators”. Resuscitation1 (2005): S7-S23.
14. Thomas EJ., et al. “Artificial intelligence and neonatal resuscitation: a review”. Journal of Perinatology8 (2018): 1002-1010.
15. van Schaik S., et al. “Simulating neonatal resuscitation: a review of training methodologies”. Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare4 (2019): 237-244.
16. Rajpurkar P., et al. “CheXNet: Radiologist-level pneumonia detection on chest X-rays with deep learning”. arXiv preprint arXiv: 1711.05225 (2017).
17. Frates MC and Viscomi SG. “Ultrasonography in neonatal resuscitation”. Clinics in Perinatology2 (2021): 279-293.
18. Wu J., et al. “Predicting risk of preterm birth and low birth weight using artificial intelligence: a cross-sectional study”. Journal of Medical Internet Research7 (2019): e13479.
19. Kattwinkel J. “Neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care”. Pediatrics2 (2015): S196-S218.