Weaning from mechanical ventilation in neonates

assisted ventilation in neonates is a measure used to support pulmonary function until the patient can breathe adequately without help. Mechanical ventilation of preterm and term newborns with respiratory failure is now accepted as a life-saving intervention, but without cost of multiple potential complications.Early weaning from the ventilator to less invasive forms of assisted ventilation, ,such as nasal continuous positive airway pressure (NCPAP), is now a top priority for practicing neonatologists to decrease the possibility of these complications. Therefore, every effort should be made to discontinue mechanical ventilation as soon as the patient can protect the airway and sustain spontaneous ventilation.During the process of weaning the clinician should have a good understanding of the physiological processes involved with weaning as pulmonary mechanics and respiratory muscle loads and capacity and its implication in successful weaning. Also there are some peculiar aspects of weaning in newborns due to immature lung capacities and respiratory drive.Of the pharmacologic agents, it is now clear that methylxanthines have a positive effect on extubation success. Steroids remain a dilemma for use, but the evidence support its use only in high risk group patient. When steroids are used peri-extubation, it is beneficial mainly for the newborns who are at high risk for airway narrowing. It can also in patients of high risk developing BPD to facilitate extubation after one week of life.After all, the weaning from mechanical ventilation in newborns remain an area which need scientific knowledge, clinical experience, and some art. It is important to practice thinking of the whole process considering every detail to have it to work.