文本框: Noninvasive Ventilation for Newborn Infants Henrik Verder. Department of Pediatrics Holbaek. Denmark Aim: To describe treatment of respiratory distress syndrome (RDS) with nasal continuous positive airway pressure (CPAP) and surfactant. Background: The treatment of RDS has always been a great challenge to the clinicians. We all want to do our best for the weakest babies. From an academically view point the best and most sophisticated ventilators should also bee the best offer for the babies with RDS. However, the solution of this problem is not quite simple. How soon after birth does we have to start the ventilators; - how to pull the knobs of the ventilators and which additionally treatments may we offer the babies? First of all surfactant treatment has to be mentioned. First time we heard about it was thirty years ago in animal experiences and for twenty years ago it was used in babies. Also CPAP has been used in about thirty years. In the last ten years the combined use of nasal CPAP and surfactant has shown to be effective even in very tiny babies with RDS. The oxygenation is increased in the initial phase of the disease and the babies develop very few sequelae. Methods: Nasal CPAP at the first signs of respiratory distress. The indication for surfactant treatment (Curosurf) is an arterial to alveolar oxygen tension ratio (a/A PO2) <0.36 (FiO2 ~0.37). The dose of Curosurf is 200 mg /kg divided on two bolus fractions. Results: After conduction two pilot studies and two controlled studies we have found that half of the newborns with gestational age <30 weeks can be treated with nasal CPAP alone and at least 25% can be treated effectively with early nasal CPAP and early surfactant. The need of mechanical ventilation was reduced from 63% in babies treated at a/A PO2 <0.22 (FiO2 ~0.57) to 21% in babies treated at a/A PO2 <0.36. In 70 babies <30 weeks treated after these principles the mortality was 12% and the incidence of cerebral palsy was 6% at the four years follow-up. Conclusion: The combined treatment of nasal-CPAP and surfactant is a cost-effective treatment with a moderate use of surfactant and very few complications.