Noninvasive Ventilation in Preterm Neonates: Impact on the Incidence and Outcomes of Bronchopulmonary Dysplasia

Noninvasive ventilation has become a fundamental strategy in the respiratory management of preterm neonates, offering effective support while avoiding the complications associated with invasive mechanical ventilation. By delivering positive airway pressure through noninvasive interfaces, it helps maintain airway patency, preserve functional residual capacity, and improve gas exchange, thereby reducing alveolar collapse and the work of breathing. These physiological benefits are particularly relevant in premature infants with immature lungs and limited respiratory reserve. Among the available modalities, continuous positive airway pressure remains the most widely used; however, nasal intermittent positive pressure ventilation and nasal high-frequency ventilation have demonstrated advantages in reducing reintubation rates and potentially lowering the incidence of bronchopulmonary dysplasia. High-flow nasal cannula, while better tolerated and associated with fewer nasal complications, has not consistently shown superiority in preventing treatment failure. The effectiveness of these modalities is closely influenced by the timing of initiation, with early application in the delivery room associated with improved outcomes and reduced need for invasive ventilation. The integration of less invasive surfactant administration techniques with noninvasive ventilation has further enhanced respiratory management by improving oxygenation and decreasing exposure to mechanical ventilation. Despite these advances, variability in clinical outcomes persists, particularly regarding duration of respiratory support, hospitalization, and long-term pulmonary function, which appear similar across modalities. Importantly, current evidence does not suggest adverse effects on neurodevelopmental outcomes. Although noninvasive ventilation reduces the incidence of bronchopulmonary dysplasia, its impact on mortality remains less clear. Ongoing research focusing on synchronized ventilation modes, automated systems, and personalized strategies may further optimize outcomes, highlighting the need for standardized protocols and high-quality evidence.