www.sciedu.ca/jnep Journal of Nursing Education and Practice, 2013, Vol. 3, No. 12 Published by Sciedu Press 111 ORI GI NAL RESEARCH Non-invasive respiratory support and preterm infants: The crucial role of nurse management Gianluca Lista, Francesca Castoldi, Paola Fontana, Mariella Frongia, Petojevic Mirjana, Laura Tansini, Valentina Pivetti NICU "Vittore Buzzi" Children's Hospital, ICP, Milan, Italy Correspondence: Gianluca Lista, MD. Address: NICU "Vittore Buzzi" Children's Hospital, ICP, Milan, Italy. Telephone: 39-025-799-5341. Email: g.lista@icp.mi.it. Received: December 27, 2012 Accepted: March 5, 2013 Online Published: May 22, 2013 DOI : 10.5430/jnep.v3n12p111 URL: http://dx.doi.org/10.5430/jnep.v3n12p111 Abstract Premature delivery is often a failure of transition to create an early Functional Residual Capacity (FRC) and therefore preterm infants frequently need a respiratory support. To reduce the occurrence or severity of respiratory distress, neonatologists have to plan an optimal respiratory strategy from the first breath and within the “working-team” the nurses play a crucial role. Since duration of mechanical ventilation via the ET seems related to Bronchopulmonary Dysplasia (BPD), clinicians are increasingly using non invasive respiratory supports (e.g. n-CPAP and Non-Invasive Ventilation- NIV) to try to protect the preterm infant’s lungs. Nurses are essential fundamental in choosing the best fitted devices and interfaces (e.g. hat, prongs), in protecting skin from infections, in taking a continuous care of the neonate to avoid nasal trauma, in maintaining and protecting parental bonding. The success of non-invasive respiratory support improves with staff experience and it is recognized that there is an urgent need for continuous education of nursing staff in preventing failure of non-invasive respiratory support. Key words Nurse, Non-invasive respiratory support, Preterm infants 1 Introduction Premature delivery is often a failure of transition to create an early Functional Residual Capacity (FRC). In fact many very early preterm babies, even if spontaneously breathing at birth, frequently need a respiratory support because of multiple gaps (i.e. poor respiratory diaphragm muscle strength, poor inspiratory pressure, high chest wall compliance, low lung compliance due to surfactant deficiency, neurological impairment and inefficient fluid clearance, etc) [1] . To reduce the occurrence or severity of respiratory distress, neonatologists have to plan an optimal respiratory strategy from the first breath and the nurses play a crucial role within the “working-team”. At birth, in the delivery room, nurses can help physicians in many ways: by preparing the infant warmer with the adequate temperature level or covering the newly-born in plastic wrapping (if very low birth weight -VLBW- infants, <1.5 Kg) to avoid loss of body-temperature that may worsen the respiratory distress; by suctioning the newly born with obvious obstruction to spontaneous breathing or if positive pressure ventilation (PPV) is required; by setting the humidification and blender devices for eventual oxygen supplementation guided by references value of pre-ductal saturation monitored