In utero, the ductus arteriosus provides a connection between the pulmonary artery and descending aorta through which deoxygenated blood returning to the right heart is diverted to the placenta for reoxygenation. Although essential to normal fetal physiology, it normally constricts,…
Introduction Congenital heart disease (CHD) affects 6-8 per 1000 live births. However, only 20% of babies with congenital heart disease would be identified if the examination of the fetal heart were confined to traditional high-risk groups such as increased nuchal…
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…