title: Noninvasive respiratory support for neonates.
abstract: OBJECTIVE
  Noninvasive respiratory support for neonates is growing in popularity as clinicians increasingly recognize the dangers of prolonged invasive ventilation. The purpose of this review is to critically evaluate the existing evidence for safety and efficacy of these modes of respiratory support in neonates.
  
  
  RESULTS
  In recent years, multiple randomized controlled trials (RCTs) have evaluated several modes of noninvasive support, most importantly nasal intermittent positive pressure ventilation and high flow nasal cannulae, in comparison to the standard therapy of continuous positive airway pressure (CPAP). The three largest RCTs were recently published in 2013. One demonstrated no difference in death or survival with bronchopulmonary dysplasia between nasal intermittent positive pressure ventilation and CPAP, both when used as primary support and as postextubation support. Two others demonstrated that high flow nasal cannulae are noninferior to or no better than CPAP when used to support preterm infants after extubation. These trials showed no serious safety concerns with current modalities.
  
  
  CONCLUSIONS
  The optimal forms of noninvasive respiratory support for neonates remain to be determined. Continued evaluation of these technologies with large, well-designed RCTs is warranted.
authors.affiliation: aThe Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA bDepartment of Neonatology, Royal Maternity Hospital, Belfast, UK.
authors.forename: Sara B
authors.initials: SB
authors.lastname: DeMauro
authors.forename: David
authors.initials: D
authors.lastname: Millar
authors.forename: Haresh
authors.initials: H
authors.lastname: Kirpalani
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D010102:Oxygen Inhalation Therapy; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015996:Survival Rate