Strategies to assist ventilation in preterm infants

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A refreshing development in recent years has been innovative attempts to help babies breathe who do not include intubation and mechanical ventilation. These innovations have included various devices to deliver CPAP, high flow nasal cannulae, and non-invasive devices that assist inspiration without intubation. Although these varied approaches suggest that there is not likely to be one solution, clinicians, of course, will ask which is better. In this issue of The Journal, Gupta et al report a comparison of bubble CPAP and a flow driver CPAP device for respiratory support after elective extubation of preterm infants. Each device has different characteristics and, in general, few differences were identified, although the bubble CPAP device seemed to work better for infants intubated for <14 days. In an accompanying editorial, Polin reflects on how different respiratory technologies are accepted into neonatal practice. The bottom line is that innovation for non-invasive respiratory support techniques will benefit babies, but they do need to be rigorously assessed.