2 Respiratory management in the context of neonatal care
Since prolonged length of mechanical ventilation via the ET seems related to Bronchopulmonary Dysplasia (BPD) [5, 6],
clinicians are increasingly using non-invasive respiratory supports to try to protect the preterm infant’s lungs [7, 8]. In the
NICU the utilization of non invasive modality as unique respiratory support in the management of RDS has increased in
the last years (see Figure 1). Between the numerous non invasive modalities, the widespread used is nasal-CPAP
(N-CPAP), introduced by Gregory in 1971 for the treatment of neonatal RDS [9] and initially delivered via an endotracheal
tube but subsequently with more efficient interfaces is now widespread used. N-CPAP supports the breathing of preterm
infant by splinting the upper airways and therefore reducing obstruction and apnea [10]; moreover N-CPAP reduces
thoraco-abdominal asynchrony so maintaining lung volume by stabilization of the chest wall compliance and of the
alveoli, which are prone to collapse due to surfactant deficiency in course of RDS [11]. When the physicians decide to
support the spontaneously breathing baby by a “continuous distending pressure” from the delivery room, this respiratory
support has to be maintained during the transport to the NICU in an incubator with apposite device to deliver CPAP (see
Figure 2), in order to preserve the lung volume.