Lesson 1Noninvasive respiratory support modalities: nasal CPAP, NIPPV, HFNC—settings, interfaces, and contraindications in 29‑week infantsThis section describes noninvasive respiratory support options for very preterm infants, including nasal CPAP, NIPPV, and high-flow nasal cannula, with stress on settings, interfaces, contraindications, and 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 infantsThis section compares T-piece and self-inflating bag-mask ventilation in the delivery room, focusing on setup, mask seal, pressure control, and safe targets for tidal volume, inspiratory time, and 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 interpretationThis section explains how to monitor respiratory support using continuous heart rate and oxygen saturation, postnatal age–based SpO2 targets, blood gas sampling, transcutaneous monitoring, and 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 techniqueThis section details indications, timing, and methods for intubation in very preterm infants, including premedication options, equipment selection, safest laryngoscopy techniques, confirmation of tube placement, and 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 responsesThis section reviews surfactant therapy in very preterm infants, covering indications, timing of early rescue versus prophylaxis, dosing strategies, administration techniques such as INSURE and LISA, and expected clinical and 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 breathingThis section presents a practical decision framework for choosing initial support—CPAP, positive pressure ventilation, or intubation—based on respiratory drive, heart rate, tone, work of breathing, and antenatal risk factors in very preterm infants in the 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 circulationThis section reviews preterm lung physiology, stressing surfactant deficiency, reduced compliance, high airway resistance, pulmonary vascular resistance, and transitional circulation, and links these features to respiratory support strategies and risks of 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 strategiesThis section examines complications of respiratory support in preterm infants, including air leak syndromes, volutrauma, atelectrauma, oxygen toxicity, and bronchopulmonary dysplasia, and outlines prevention, early recognition, and mitigation strategies in the 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 pathwaysThis section outlines criteria for escalation when CPAP or noninvasive support fails, including persistent apnea, bradycardia, or high oxygen needs, and describes structured de-escalation and weaning pathways to minimize instability and 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
