Noninvasive Ventilation in the Premature Newborn — Is Less Always More?

Endotracheal positive-pressure ventilation with end expiratory pressure has been the cornerstone of the modern approach to care for premature infants with respiratory insufficiency since the publication of a report by Gregory and colleagues in 1971.1 They found that endotracheal continuous positive airway pressure (CPAP) could establish and maintain functional residual capacity in the surfactant-deficient premature lung. However, this invasive, lifesaving approach has long been considered to increase the risk of bronchopulmonary dysplasia,2 the chronic lung disease of survivors of the neonatal intensive care unit. The risk of bronchopulmonary dysplasia increases with the degree of anatomical and biochemical immaturity of the . . .