Oxygen may be given using a nasal cannula or face mask. Oxygen concentration should be set to achieve an oxygen saturation of 85 to 95% after 10 minutes of life during neonatal resuscitation ( 1 ). Lower oxygen saturations are expected in the first minutes of life (see figure Algorithm for Resuscitation of Neonates) and improve as pulmonary vascular resistance decreases and pulmonary blood flow increases. After initial resuscitation, oxygen may be administered to target PaO2 of 50 to 70 mm Hg in preterm infants and 50 to 80 mm Hg in term infants or an oxygen saturation of 90 to 94% in preterm infants and 92 to 96% in term infants.

In CPAP, constant positive end expiratory pressure (PEEP) is maintained throughout the respiratory cycle, usually 5 to 7 cm H2O, but with no additional inspiratory pressure support. CPAP keeps alveoli open and improves oxygenation by reducing atelectasis and thereby the amount of blood shunted through atelectatic areas while the infant breathes spontaneously. CPAP can be provided via nasal prongs or masks and various apparatuses to provide the positive pressure; it also can be provided via an endotracheal tube connected to a conventional ventilator with the rate set to zero.

NIPPV (see also Noninvasive Positive Pressure Ventilation [NIPPV] ) delivers positive pressure ventilation via nasal prongs or a nasal mask connected to a ventilator. It can be synchronized (ie, triggered by the infant's inspiratory effort) or nonsynchronized. NIPPV can provide a back-up rate and can augment an infant's spontaneous breaths. Peak pressure can be set to desired limits.

Endotracheal tubes (ETT) are required for mechanical ventilation (see also Tracheal Intubation ) and can be used to administer surfactant. Intubation is safer if oxygen is provided during the procedure. Orotracheal intubation is preferred over nasotracheal intubation.

ECMO is a form of pulmonary or cardiopulmonary bypass used for infants with respiratory failure who cannot be oxygenated or ventilated adequately with conventional or oscillating ventilators. Eligibility criteria vary by center, but, in general, infants should have reversible disease (eg, persistent pulmonary hypertension of the newborn , congenital diaphragmatic hernia , overwhelming pneumonia ) and should have been on mechanical ventilation < 7 days. Primary cardiac compromise may also be an indication for ECMO.