Key points Antenatal steroids (ANS) are one of the oldest and most effective therapies in perinatal medicine. The randomized controlled trials (RCTs) are dated and do not necessarily apply for current clinical populations in high-resource environments where treatments reduce mortality.…
Key points The immature lungs of extremely preterm infants are susceptible to damage from a variety of factors that are potentially modifiable by the use of lung-protective strategies of respiratory support. Avoidance of mechanical ventilation (MV), optimal delivery room stabilization,…
Key points The respiratory and cardiac systems are integrally related both anatomically and functionally, and as a result there are significant interactions, particularly in the newborn period. Inappropriately high airway pressure during mechanical ventilation leads to adverse hemodynamic effects including…
Key points Understanding the physiology of neonatal respiratory control has served as an effective guide to common therapeutic approaches. Both the acute and longer-term consequences of intermittent hypoxemia and apnea of prematurity are subjects of intense interest. Intermittent hypoxemia may…
Key points As fewer preterm infants are managed with an endotracheal tube (ETT) in early life, the usual conduit for surfactant delivery is lacking. With this approach has come a dilemma regarding how and when to deliver surfactant to those…
Key points Continuous positive airway pressure (CPAP) provides effective respiratory support for preterm infants for a range of indications, especially when delivered via binasal prongs or nasal masks at set pressures equal to or greater than 5 cm H 2…
Key points Invasive mechanical ventilation of neonates increases their risk of developing bacterial infection of the lower airways and lung parenchyma, which is termed “ventilator-associated pneumonia” (VAP). VAP is diagnosed on the basis of defined clinical, radiographic, and laboratory criteria.…
Key points Contrary to conventional teaching, culture-independent molecular techniques have confirmed that the healthy lung is not sterile and the lung microbiome is likely established in early life, influences development of immune responses and pulmonary function, and is altered in…
Key points Lung vascular development occurs as highly choreographed sequence, regulated by hypoxia inducible factors, vascular endothelial growth factor, nitric oxide, and other transcription factors and mediators. In addition to arterial vessels, pulmonary veins are highly reactive vessels that contribute…
Key points After birth, lung aeration and an increase in pulmonary blood flow are closely linked. Although it is possible to identify deliveries of infants at increased risk of requiring resuscitation, appropriately trained personnel should be present at every birth.…