Non-invasive therapies in the NICU

NeoHeart Conference Webinar Series


NeoHeart is the Neonatal Heart Society’s annual flagship conference. In 2020 the society partnered with New York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center to present the international event on the virtual stage for the first time.

 
Among the conference masterclasses was a series that reviewed evidence for the use of the three modes of non-invasive ventilation of the newborn:
 
Three leaders in neonatology, professors Brad Yoder, Richard Polin and Martin Keszler, presented in the three webinars that make up the masterclass series. We are pleased to share these webinars with you.

Be sure to also watch the additional Masterclass Discussion between these expert speakers.

Watch the Masterclass Discussion webinar
Newborn after being delivered in the hospital


An overview of the clinical literature:​

Continuous positive airway pressure (CPAP) and nasal high flow (NHF) for the neonatal population

CPAP continues to be the standard of care in neonates < 28 weeks gestational age (GA). However there are several pathways of care supporting the use of NHF when rescue CPAP is available, as shown below:

 

< 28 weeks GA
CPAP continues to be the standard of care and is used routinely as an alternative to invasive mechanical ventilation. There is emerging data describing the use of NHF in this population.
≥ 28 Weeks GA
Emerging evidence suggests that the use of NHF (with rescue CPAP available) may be considered once infants are stable, with no significant difference to intubation rates. The benefits of NHF for older preterm infants are demonstrated in the body of literature.
Evidence
Emerging RCT data and consensus of published expert opinion
< 28 weeks GA
CPAP continues to be the standard of care, however, NHF may be considered once infants are stable.
≥ 28 Weeks GA
The use of NHF as an alternative to prolonged CPAP may be considered once infants are stable. The benefits of NHF for older preterm infants are demonstrated in the body of the literature.
Evidence

✔  Strong Support

Consensus of published expert opinion.3,8

< 28 weeks GA
CPAP continues to be the standard of care, however, NHF may be considered once infants are stable.
≥ 28 Weeks GA
The use of NHF as an alternative to CPAP is associated with no difference in the rate of treatment failure, reintubation, and adverse outcomes (such as death, BPD and pneumothorax) and significantly less nasal trauma.
Evidence

✔  Strong Support

Cochrane Review.​1

 

Disclaimer: Clinical judgement is necessary to assess the appropriate treatment for an individual patient. The use of NHF therapy is not typically supported for infants with extreme prematurity, severe respiratory distress syndrome, or untreated surfactant deficiency.

Optiflow™ Junior 2 Blender Transition Kit

 

The Blender Transition Kit allows patients to receive NHF therapy as an alternative to prolonged CPAP therapy without changing the circuit. The kit comes with an Optiflow Junior 2 nasal cannula, pressure manifold and an adaptor which connects to the inspiratory limb of the CPAP circuit.

CPAP with FlexiTrunk™ Interface

Optiflow™ Junior 2 Blender Transition Kit

NHF with Optiflow™ Junior 2 Interface

The Rosie Maternity Hospital Documentary Series

The reason, the rollout and the results: The Rosie Hospital, a Cambridge University Hospital, shares its successful implementation of noninvasive therapies for neonatal patients.
The implementation of a new therapy at the Rosie

The journey to implement noninvasive therapies at the Rosie

This video explores research behind the decision to deliver CPAP and NHF at the unit.

The impact of a new therapy at the Rosie

The Rosie reveals how noninvasive therapies have impacted on the unit 

Hear how the successful implementation of NHF and CPAP therapies on to its wards is being experienced by staff and families.

A new therapy in practice at the Rosie

CPAP and NHF in practice at the Rosie

Learn how the maternity hospital is providing noninvasive therapies for its young patients.
 
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