Aerosol administration during nasal CPAP in newborns can be optimized.

Aerosols have proven to be an effective form of drug delivery. Nevertheless, the development of devices as well as medical agents for aerosolization to treat mechanically ventilated newborns still presents a substantial challenge.1 Low tidal volumes and functional residual capacity, high breathing frequency, short aerosol particle residence time, and small airway diameters cause low aerosol deposition in the lower airways in infants.2-4 There are few clinical deposition studies in the neonatal population, because of the inability to use radio-labeled aerosols.5 However, despite the paucity of clinical data, aerosols have been used to treat critically ill newborn infants without a clear understanding of the optimal aerosol delivery system, the drug deposition pattern in the lung, and the dose/response relationship for aerosolized medications. A multi-center questionnaire-based study showed that aerosolized medications (eg, albuterol) are administered to infants with ventilator support as part of routine therapy.6 Nevertheless, none of the Cochrane Reviews recommend aerosol therapies to newborns during any type of ventilatory support.7-9