Mandhir S. Suri

Sharp Mary Birch Hospital for Women & Newborns; Rady Children’s Hospital, USA

Abstract Title:

The Right Breath at the Right Time: Modern Strategies in Neonatal Non-Invasive Ventilation

Biography:

Dr. Mandhir S. Suri is a neonatologist at Sharp Mary Birch Hospital for Women & Newborns and Rady Children’s Hospital in San Diego, California. He has more than two decades of experience caring for critically ill newborns, with clinical interests in non-invasive ventilation, bubble CPAP, neonatal hemodynamics, and practical bedside respiratory strategies. He has contributed to the implementation of neonatal respiratory protocols and education programs focused on improving outcomes while minimizing harm in vulnerable preterm and term infants.

Research Interests:

Modern neonatal respiratory care increasingly requires precision in choosing the appropriate non-invasive support for the right infant at the right time. This presentation reviews contemporary strategies in neonatal non-invasive ventilation, focusing on the complementary roles of nasal high flow therapy and continuous positive airway pressure. Nasal high flow offers a gentler, dynamic form of support through dead space washout, reduced inspiratory resistance, humidified gas delivery, and limited distending pressure, with strong evidence supporting its use after estuation in infants above 28 weeks’ gestation. Across major trials and meta-analyses, high flow demonstrates similar therapeutic efficacy to CPAP in selected populations while significantly reducing nasal trauma and improving infant comfort, handling, and parental bonding. However, pressure remains essential when lung recruitment, functional residual capacity, and predictable end-expiratory pressure are required. CPAP continues to be the gold standard for extremely preterm infants, early respiratory distress syndrome, recurrent apnea, and infants who fail high flow support. The session emphasizes a physiology-based approach: use pressure to open and stabilize the immature lung, and use flow to gently support recovery once stability is achieved. Practical implementation points include correct interface selection, appropriate prong sizing, Fio-based escalation thresholds, and the need for rescue CPAP pathways. Ultimately, flow and pressure are not competing therapies, but sequential and complementary tools in modern neonatal care.