Non-invasive ventilation in neonatal care: where are we now?

Survival of extremely preterm infants has improved from enhanced antenatal care and high uptake of antenatal steroids along with early use of surfactant. However, the burden of ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD) has proportionately increased. Despite a greater understanding of pulmonary graphics and advances in neonatal ventilation techniques such as volume-targeted ventilation, lung morbidities remain high. Since the advent of CPAP in the early 70's, there have been several attempts to expand the non-invasive ventilation (NIV) techniques to improve survival and reduce morbidity. NIV is perceived to be ‘gentler’ and therefore better accepted for use throughout the UK. We present a comprehensive review of the key modes of non-invasive respiratory support currently used in preterm and term infants, including their mechanism of action and evidence of benefit from clinical trials.