Lesson 1Noninvasive respiratory support modalities: nasal CPAP, NIPPV, HFNC—settings, interfaces, and contraindications in 29‑week infantsDis section describe noninvasive respiratory support options fi very preterm infants, includin nasal CPAP, NIPPV, an high-flow nasal cannula, wid emphasis pon settings, interfaces, contraindications, an practical considerations in 29-week gestation infants.
Nasal CPAP: pressure settings and titrationNIPPV: indications and synchronization optionsHigh-flow nasal cannula: flow and FiO2 limitsChoosing prongs, masks, and interface sizeContraindications and failure indicatorsSkin care and nasal injury preventionLesson 2Positive pressure ventilation technique in the delivery room: T‑piece resuscitator vs bag-mask, tidal volume targets, inspiratory time, peak inspiratory pressure guidance for small infantsDis section compare T-piece an self-inflatin bag-mask ventilation in di delivery room, focusin pon setup, mask seal, pressure control, an safe targets fi tidal volume, inspiratory time, an peak inspiratory pressure in very preterm infants.
T-piece vs self-inflating bag: pros and consMask fit, positioning, and leak minimizationSetting PIP, PEEP, and inspiratory time safelyTidal volume targets and monitoring optionsAssessing chest rise and clinical responseLesson 3Monitoring respiratory support: continuous heart rate, SpO2 targeting by postnatal minutes, transcutaneous/arterial blood gases, chest radiograph interpretationDis section explain how to monitor respiratory support usin continuous heart rate an oxygen saturation, postnatal age–based SpO2 targets, blood gas samplin, transcutaneous monitorin, an chest radiograph interpretation to guide safe adjustments.
Continuous heart rate and ECG monitoringSpO2 targets by postnatal minute and ageTranscutaneous CO2 and oxygen monitoringArterial and capillary blood gas samplingChest radiograph signs of overdistensionRadiographic assessment of tube positionLesson 4Indications, timing, and methods for intubation in very preterm infants; premedication considerations and safest techniqueDis section detail indications, timin, an methods fi intubation in very preterm infants, includin premedication options, equipment selection, safest laryngoscopy techniques, confirmation a tube placement, an strategies to minimize physiologic instability.
Clinical indications and optimal timingChoosing tube size and depth of insertionPremedication regimens and contraindicationsDirect versus video laryngoscopy techniqueConfirming endotracheal tube placementManaging desaturation and bradycardiaLesson 5Surfactant therapy: indications, timing (early rescue vs prophylactic), dosing, administration techniques (INSURE, LISA/MIST), and expected responsesDis section review surfactant therapy in very preterm infants, coverin indications, timin a early rescue versus prophylaxis, dosin strategies, administration techniques such as INSURE an LISA, an expected clinical an radiographic responses after treatment.
Clinical and radiographic indications for surfactantEarly rescue versus prophylactic strategiesWeight-based dosing and repeat dosing criteriaINSURE technique: steps and precautionsLISA and MIST: procedure and monitoringExpected response and nonresponse patternsLesson 6Decision framework: initial choice between CPAP, positive pressure ventilation, and intubation based on respiratory drive, heart rate, and work of breathingDis section present a practical decision framework fi choosin initial support—CPAP, positive pressure ventilation, or intubation—based pon respiratory drive, heart rate, tone, work a breathin, an antenatal risk factors in very preterm infants in di delivery room.
Assessing respiratory drive and spontaneous effortUsing heart rate and tone to guide decisionsWork of breathing and grunting evaluationWhen to start CPAP as primary supportWhen to provide brief positive pressure breathsWhen to proceed directly to intubationLesson 7Physiology of preterm lung: surfactant deficiency, compliance, pulmonary vascular resistance, and transitional circulationDis section review preterm lung physiology, emphasizin surfactant deficiency, reduced compliance, high airway resistance, pulmonary vascular resistance, an transitional circulation, an link dem features to respiratory support strategies an risks a injury.
Structural immaturity of distal airwaysSurfactant deficiency and surface tensionCompliance, resistance, and time constantsPulmonary vascular resistance in pretermsTransitional circulation and shunt patternsImplications for ventilator settingsLesson 8Complications of respiratory support in preterms: air leak, bronchopulmonary dysplasia risk factors, volutrauma/atelectrauma mitigation strategiesDis section examine complications a respiratory support in preterm infants, includin air leak syndromes, volutrauma, atelectrauma, oxygen toxicity, an bronchopulmonary dysplasia, an outline prevention, early recognition, an mitigation strategies in di NICU.
Pathophysiology of air leak syndromesRecognizing and managing pneumothoraxVolutrauma and atelectrauma mechanismsStrategies to limit oxygen toxicityBronchopulmonary dysplasia risk factorsLung-protective ventilation approachesLesson 9Criteria for escalation (failure of CPAP, persistent apnea/bradycardia, high oxygen/pressure requirements) and de‑escalation weaning pathwaysDis section outline criteria fi escalation when CPAP or noninvasive support fails, includin persistent apnea, bradycardia, or high oxygen needs, an describe structured de-escalation an weanin pathways to minimize instability an chronic lung injury risk.
Defining CPAP failure in very preterm infantsApnea, bradycardia, and desaturation thresholdsOxygen and pressure limits prompting escalationTransition from CPAP to NIPPV or intubationStructured CPAP and HFNC weaning protocolsMonitoring stability during step-down
