Seminars in perinatology最新文献

Physiological basis of non-invasive ventilation in the newborn 新生儿无创通气的生理基础。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2024.152023

Theodore Dassios

{"title":"Physiological basis of non-invasive ventilation in the newborn","authors":"Theodore Dassios","doi":"10.1016/j.semperi.2024.152023","DOIUrl":"10.1016/j.semperi.2024.152023","url":null,"abstract":"<div><div>Non-invasive ventilation (NIV) is a form of respiratory support provided primarily to preterm born infants in an effort to avoid any endotracheal intubation or as a weaning step following invasive ventilation. In the context of the respiratory distress syndrome of the newborn, NIV could target and partially reverse specific pathophysiological phenomena, by improving alveolar recruitment and establishing adequate functional residual capacity. It can also assist in minimizing lung injury by avoiding excessive pressure delivery, which can be harmful for the developing lung. Non-invasive ventilation can unload the respiratory muscles and decrease the work of breathing as reported by studies that compare the measured work of breathing at increasing levels of non-invasive support. NIV can also be beneficial in moderating the frequency and intensity of apnea of prematurity. Unintended physiological effects of NIV include gaseous distension of the gastrointestinal tract and increased incidence of air-leak complications. During NIV there is also a lack of direct access to the trachea for suctioning and pulmonary toiletry. Insufficient non-invasive respiratory support could be associated with inadequate oxygenation and ventilation, insufficient gas exchange and atelectotrauma. Excessive provision of non-invasive support could be inefficient or harmful, as overdistention can be associated with decreased compliance of the respiratory system, impaired gas exchange and abnormal diaphragmatic function. An individualized physiological approach could, thus, aim to optimize the beneficial effects of non-invasive ventilation while avoiding inadequate or excessive levels of support.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152023"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hemodynamics during noninvasive ventilation in neonates 新生儿无创通气期间的血流动力学。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152065

Vidhi Jhaveri, Satyan Lakshminrusimha, Yogen Singh

{"title":"Hemodynamics during noninvasive ventilation in neonates","authors":"Vidhi Jhaveri, Satyan Lakshminrusimha, Yogen Singh","doi":"10.1016/j.semperi.2025.152065","DOIUrl":"10.1016/j.semperi.2025.152065","url":null,"abstract":"<div><div>Noninvasive ventilation (NIV) is increasingly used in neonatal care to reduce lung injury and improve respiratory outcomes. However, its effects on cardiovascular function and cardiopulmonary interactions, particularly in preterm neonates, remain unclear. This paper reviews the hemodynamic changes associated with NIV and provides an overview of how NIV influences cardiac preload, pulmonary vascular resistance, ventricular output, and systemic blood flow. NIV also affects these parameters in different ways in neonates with compromised cardiovascular stability, such as those with persistent pulmonary hypertension, patent ductus arteriosus and systemic hypotension. The synthesis of current evidence underscores that optimizing NIV requires careful titration of ventilatory parameters and highlights the potential role of targeted echocardiography and other clinical monitoring tools in guiding individualized management strategies. This review emphasizes the need for a nuanced approach that balances respiratory support with hemodynamic stability and calls for further research to establish best practices for the safe and effective use of NIV in neonates with hemodynamic compromise.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152065"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-invasive ventilation of preterm infants in the delivery room 产房早产儿的无创通气。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152080

J. Dekker , S.B. Hooper , A.B. te Pas

引用次数: 0

Optimizing synchronized non-invasive support: Clinical management guidelines for non-invasive neurally adjusted ventilatory assist 优化同步无创支持：无创神经调节通气辅助的临床管理指南

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152036

Kimberly Firestone , Howard Stein

{"title":"Optimizing synchronized non-invasive support: Clinical management guidelines for non-invasive neurally adjusted ventilatory assist","authors":"Kimberly Firestone , Howard Stein","doi":"10.1016/j.semperi.2025.152036","DOIUrl":"10.1016/j.semperi.2025.152036","url":null,"abstract":"<div><div>Neurally Adjusted Ventilatory Assist (NAVA) is an innovative ventilation mode that empowers patients to control both the timing and level of ventilatory support. By utilizing the electrical activity of the diaphragm (Edi) as the control signal, NAVA enables synchronized non-invasive ventilation (NIV-NAVA) even in the presence of leaks, while also providing continuous monitoring of the patient's respiratory pattern and drive. NIV-NAVA offers several advantages compared to conventional non-invasive ventilation, including enhanced patient-ventilator interaction and synchrony, reliable respiratory monitoring, and self-regulation of respiratory support. These features make NIV-NAVA theoretically ideal for providing effective and tailored non-invasive support to newborns with respiratory insufficiency. In clinical practice, NIV-NAVA has been successfully employed in neonates to prevent intubation, facilitate early extubation, and deliver nasal continuous positive airway pressure in a novel manner. Set up and management of NAVA has unique differences from conventional ventilation and an understanding of these is essential for successful NAVA ventilation. The efficacy of this approach in neonatal care is supported by numerous studies and clinical experiences with NIV-NAVA, demonstrating its potential to improve outcomes for infants with respiratory challenges</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152036"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extending CPAP in stable preterm infants to increase lung growth and development as measured by pulmonary function testing 通过肺功能测试，延长稳定早产儿的CPAP以促进肺生长发育。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152059

Rachna R. Mamidi , Cindy T. McEvoy

引用次数: 0

Update on nasal high frequency oscillatory ventilation: A living review 鼻高频振荡通气的最新进展：动态回顾。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152056

Daniele De Luca , Costanza Neri , Roberta Centorrino (Attending Neonatologist)

{"title":"Update on nasal high frequency oscillatory ventilation: A living review","authors":"Daniele De Luca , Costanza Neri , Roberta Centorrino (Attending Neonatologist)","doi":"10.1016/j.semperi.2025.152056","DOIUrl":"10.1016/j.semperi.2025.152056","url":null,"abstract":"<div><div>Non-invasive high-frequency oscillatory ventilation (NHFOV) is the main non-conventional ventilatory mode used in newborn infants. NHFOV has been spreading, while knowledge about its physiology, mechanics and clinical application has increased overtime. This is to be considered as a living review, since we here update the knowledge that was originally summarized in a previously published review<em>.</em> We first focus on physiology of such a complex respiratory support technique with practical data on interfaces, patient-ventilator interaction and devices to provide NHFOV. We then move to the evidence-based review of parallel randomized clinical trial published so far. We provide both qualitative and quantitative synthesis of results for the two commonest outcomes, i.e. need for intubation and invasive ventilation and CO<sub>2</sub> elimination. We also provide our protocol to use NHFOV together with other respiratory support modes and we provide suggestions on parameters boundaries and identification of patients to treat. We finally identify still open questions needing future research to optimize the use of NHFOV In preterm infants.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152056"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-invasive respiratory support paired with minimally invasive surfactant therapy in preterm infants 无创呼吸支持与微创表面活性剂治疗在早产儿中的应用。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152092

Peter A. Dargaville , Emily K. Cripps

{"title":"Non-invasive respiratory support paired with minimally invasive surfactant therapy in preterm infants","authors":"Peter A. Dargaville , Emily K. Cripps","doi":"10.1016/j.semperi.2025.152092","DOIUrl":"10.1016/j.semperi.2025.152092","url":null,"abstract":"<div><div>Non-invasive ventilation (NIV) commenced soon after birth is highly effective in providing mechanical respiratory support for preterm infants with respiratory distress syndrome (RDS). However, NIV alone frequently fails to provide adequate respiratory support for infants with more significant respiratory compromise due to RDS. Without an endotracheal tube as the conduit to administer exogenous surfactant in such cases, less invasive approaches to surfactant delivery have emerged, with those involving the use of a thin catheter (termed minimally invasive surfactant therapy, MIST) now in the ascendancy. The application of MIST with NIV support continuing allows spontaneous breathing to be harnessed for optimal surfactant dispersal to the distal airspaces. Here we examine the importance of this pairing of NIV with MIST and review the evidence for optimization of NIV before, during and after delivery of surfactant. All evidence points to NIV and MIST being an elegant and synergistic pairing of two therapies for optimal respiratory support of preterm infants in early life. Whilst much of the clinical trial data regarding the pairing of NIV and MIST relates to application of standard continuous positive airway pressure, non-invasive positive pressure ventilation in its various forms may offer additional advantage, and further studies are warranted.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152092"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advances in management of noninvasive ventilation for preterm infants 早产儿无创通气治疗的进展。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152060

Manoj Biniwale, Rangasamy Ramanathan

{"title":"Advances in management of noninvasive ventilation for preterm infants","authors":"Manoj Biniwale, Rangasamy Ramanathan","doi":"10.1016/j.semperi.2025.152060","DOIUrl":"10.1016/j.semperi.2025.152060","url":null,"abstract":"<div><div>Providing most appropriate noninvasive ventilation (NIV) for preterm infants remains priority in neonatal intensive care units. Several newer modes of ventilation have evolved including continuous positive airway pressure, nasal intermittent positive pressure ventilation and noninvasive high frequency ventilation to meet patients’ demands. Advanced level of monitoring is performed while patients are receiving NIV for optimization of the respiratory support. Point of care lung ultrasound and electrical impedance tomography are the newer tools that give insights towards aeration of the lungs. Pulmonary near infrared spectroscopy, electromyography of the diaphragm and advanced techniques of noninvasive pulmonary function testing provide data focusing on the performance of lungs. The hybrid modalities of ventilators used often in adults are needed in neonates to provide on demand individualized level of noninvasive respiratory support. Automated oxygen adjustment, inhaled nitric oxide and heliox can be benefcial when successfully provided through NIV. Delivery room NIV has a strong potential to improve neonatal outcomes. Further research should be focused taking into consideration physiologic needs and applying customized approach to meet patient's demands. Artificial intelligence leading to precision treatment is the way forward for providing individualized respiratory support for newborn infants</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152060"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

NIPPV vs CPAP: Lessons from meta-analyses NIPPV与CPAP：来自荟萃分析的教训。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152062

Marc-Olivier Deguise , Brigitte Lemyre

{"title":"NIPPV vs CPAP: Lessons from meta-analyses","authors":"Marc-Olivier Deguise , Brigitte Lemyre","doi":"10.1016/j.semperi.2025.152062","DOIUrl":"10.1016/j.semperi.2025.152062","url":null,"abstract":"<div><div>Care of the extremely premature infant has been in constant state of re-evaluation as the population, technologies and knowledge continue to evolve. A growing population of extremely low gestational age neonates (ELGAN - <28 weeks) and “nanopremies” (<24 weeks) are undergoing successful resuscitation, stabilization, and intensive care leading to improved survival. Respiratory care is the cornerstone of ELGAN management, as their lungs are at a critical stage of development. The lifesaving intensive care they require can lead to various injurious stimuli making them prone to bronchopulmonary dysplasia (BPD). Non-invasive ventilation (NIV), including continuous positive airway pressure ventilation (CPAP) and nasal intermittent positive pressure ventilation (NIPPV) has evolved and can appropriately support premature infants’ breathing, while limiting the invasiveness and associated complications of mechanical ventilation. This review focuses on our current understanding, knowledge and evidence gathered via meta-analysis on these two modes of NIV in preterm infants, when used either as primary intent respiratory support post-birth or following extubation. We will summarize the current data of recent meta-analyses, their pitfalls, and the remaining questions to be addressed by future research to optimize the use of these modes of respiratory support in preterm infants most at risk for BPD.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152062"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of non-invasive ventilation on Bronchopulmonary Dysplasia 无创通气对支气管肺发育不良的影响。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-08-01 DOI: 10.1016/j.semperi.2025.152061

Vikramaditya Dumpa , Indirapriya Avulakunta , Vineet Bhandari

{"title":"Effect of non-invasive ventilation on Bronchopulmonary Dysplasia","authors":"Vikramaditya Dumpa , Indirapriya Avulakunta , Vineet Bhandari","doi":"10.1016/j.semperi.2025.152061","DOIUrl":"10.1016/j.semperi.2025.152061","url":null,"abstract":"<div><div>Bronchopulmonary dysplasia (BPD) is a major complication of prematurity, leading to long-term pulmonary morbidity. Invasive mechanical ventilation (IMV) is associated with ventilator-induced lung injury, oxygen toxicity, and inflammation, all contributing to BPD pathogenesis. Non-invasive ventilation (NIV) has emerged as a key strategy to reduce the incidence and severity of BPD. We examine the role of various NIV strategies in the respiratory management of premature infants. We discuss the common forms of NIV, including nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, bilevel positive airway pressure, high-flow nasal cannula, and nasal high-frequency ventilation, with a focus on their mechanisms of action, benefits, and limitations. Several studies have demonstrated that early and appropriate NIV use can reduce the incidence of BPD, improve oxygenation, and promote lung growth. However, NIV is not without challenges, including patient selection, the timing of initiation, and potential difficulties in achieving adequate ventilation, especially in extremely low birth weight neonates. Adjunctive therapies such as early surfactant therapy, less invasive surfactant administration, and caffeine may enhance the effectiveness of NIV. In conclusion, NIV is a promising approach to decreasing BPD, yet its effectiveness relies on proper clinical application and integration with other therapies to maximize its benefits.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152061"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0