Non-invasive ventilation in the delivery room.

UNLABELLED: Non-invasive respiratory support in the delivery room (DR) is a relatively new concept. Now, instead of immediately intubating most babies in respiratory distress, initial use of nasal CPAP or intermittent positive pressure ventilation (NIPPV) is recommended, to prevent lung injury. How to best implement non-invasive ventilation is still under investigation. What are the best levels of nasal CPAP, is NIPPV better to employ, and how can we synchronize breaths with the infant's efforts are all questions that are not yet answered. CONCLUSION: This article reviews the history of DR respiratory resuscitation, and explores the questions that yet remain as to the best approach. WHAT IS KNOWN: • Nasal CPAP is recommended as the first intervention for the neonate requiring respiratory support in the delivery room. • Ideal ways to provide nCPAP, NIPPV, surfactant, and prolonged respiratory support are not yet known but are being widely investigated. WHAT IS NEW: • Non-invasive intermittent positive pressure ventilation (NIPPV) is now often recommended in the DR either if nCPAP fails, or at the start of respiratory support. • Important areas for future research include how best to provide non-invasive support, and what may be effective in the extremely low birth weight infant population.