Normal development of pulmonary vascular structure and function through prenatal and early postnatal life prepares the lung to perform its basic physiologic function of gas exchange across a thin blood–gas interface. Survival of the newborn is dependent upon rapid adaptation…
Introduction Congenital heart defects (CHDs) affect about 1% of all live births around the world, with variations in reporting depending on birth rates and access to medical care. The care of children with CHDs has increasingly become a neonatal specialty,…
Assisted ventilation and oxygen therapy remain the standard of care for neonatal respiratory failure. A few term and late preterm infants with a wide range of diagnoses develop intractable cardiorespiratory failure despite maximal ventilatory support. In these patients, severe pulmonary…
The introduction of mechanical ventilation for the management of premature infants with severe respiratory distress syndrome (RDS) in the 1960s changed the natural course of the disease, resulting in increased survival of smaller and sicker infants, many of whom had…
A spectrum of pathologic conditions can affect the neonatal upper airway, resulting in respiratory distress at birth or within the first few weeks of life. The clinical presentations of these disorders, however, are often quite similar. The most common symptom…
Breathing results in the exchange of oxygen and carbon dioxide between the lungs and the environment while maintaining homeostasis and control of blood pH. Energy-consuming breathing movements do occur in utero. Maturation of breathing is a continuous process that bridges…
Multiple pathophysiologic mechanisms can present with pulmonary manifestations in term and preterm infants. The clinical picture is most commonly dominated by respiratory distress, which presents as tachypnea, grunting, flaring, retractions, cyanosis, and hypoxemia. However, apnea and hypoventilation are also common.…
Mechanical ventilation has been used to treat neonatal respiratory failure for more than a half century. The earliest applications began as modifications of adult ventilators, treating babies of modest size and prematurity by today's standards. Most devices were time-cycled, pressure-limited…
Enormous strides have been made in understanding the pathophysiology of respiratory distress syndrome (RDS) and the role of surfactant in its cause and treatment (see Chapter 62 ). Nevertheless, RDS, formerly referred to as hyaline membrane disease, remains a dominant…
Most neonates requiring intensive care present with respiratory symptoms. Although standard techniques for assessing pulmonary function can be applied in a healthy infant, special limitations and problems are encountered in very small or sick neonates. Methods have been developed to…