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Book Details
Abstract
The Newborn Lung, a volume in Dr. Polin’s Neonatology: Questions and Controversies Series, offers expert authority on the toughest challenges in neonatal pulmonology and respiratory care. This medical reference book will help you provide better evidence-based care and improve patient outcomes with research on the latest advances.
- Reconsider how you handle difficult practice issues with coverage that address these topics head on, offering opinions from the leading experts in the field, supported by the best available evidence.
- Find information quickly and easily with a consistent chapter organization.
- Get the most authoritative advice available from world-class neonatologists who have the inside track on new trends and developments in neonatal care.
- Stay current in practice with in-depth coverage of presentation, pathogenesis, epidemiology, and prevention of bronchopulmonary dysplasia; short and long-term outcomes of oxygenation strategies in preterm infants; and many other hot topics in neonatal respiratory care.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half title page | i | ||
| Series page | ii | ||
| The Newborn Lung: Neonatology Questions and Controversies | iii | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Series Foreword | ix | ||
| Preface | xi | ||
| Table Of Contents | xiii | ||
| A Normal and Abnormal Lung Development | 1 | ||
| 1 Molecular Bases for Lung Development, Injury, and Repair | 3 | ||
| Stages of Lung Development | 4 | ||
| Embryonic Stage | 4 | ||
| Pseudoglandular Stage | 5 | ||
| Canalicular Stage | 5 | ||
| Saccular Stage | 6 | ||
| Alveolar Stage | 6 | ||
| Molecular Regulation of Lung Bud Initiation and Tracheal-Esophageal Separation | 6 | ||
| Epithelial-Mesenchymal Interactions Control Branching Morphogenesis | 8 | ||
| FGF10-FGFR2b Signaling: Driving Force for Branching Morphogenesis | 8 | ||
| Control of FGF10-FGFR2b Signaling by Shh and Sprouty | 8 | ||
| BMP Signaling: Controversial Role in Regulating Branching Morphogenesis | 8 | ||
| TGF-β Signaling Inhibits Branching | 9 | ||
| Wnt Signaling: Autocrine and Paracrine Effects on Branching Morphogenesis | 10 | ||
| Summary | 10 | ||
| Regulatory Mechanisms of Alveologenesis | 11 | ||
| Myofibroblast Differentiation and Elastin Deposition: Key to Alveolar Septation | 11 | ||
| VEGF Signaling Mediates Alveolar Epithelial-Endothelial Interaction in Alveolarization | 12 | ||
| Regulation of Pulmonary Vascular Development | 13 | ||
| Vascular Morphogenesis | 13 | ||
| VEGF-Mediated Epithelial-Endothelial Interaction in Vascular Development | 14 | ||
| Additional Angiogenic Factors in Vascular Development | 14 | ||
| Lung Injury and Repair: Disruption of Normal Lung Development | 16 | ||
| Increased TGF-β Signaling in Neonatal Lung Injury and Bronchopulmonary Dysplasia | 16 | ||
| Decreased VEGF Signaling in Neonatal Lung Injury and Bronchopulmonary Dysplasia | 18 | ||
| Imbalance of MMPs and Tissue Inhibitors of Metalloproteinases in Neonatal Lung Injury and Bronchopulmonary Dysplasia | 19 | ||
| Conclusions | 20 | ||
| References | 20 | ||
| 2 Genetic Influences in Lung Development and Injury | 29 | ||
| Genetic Influences in Lung Development: Animal Models | 29 | ||
| Adenosine Triphosphate–Binding Cassette Transporter A3 | 29 | ||
| β-Catenin | 30 | ||
| Bone Morphogenetic Protein 4 | 30 | ||
| Bone Morphogenetic Protein Receptor Type 1A | 30 | ||
| Coactivator-Associated Arginine Methyltransferase 1 | 30 | ||
| CCAAT Enhancer–Binding Protein α | 31 | ||
| Cytidylyltransferase-α | 31 | ||
| Endothelial Nitric Oxide Synthase | 31 | ||
| Epidermal Growth Factor Receptor | 31 | ||
| ErbB4 | 32 | ||
| Eyes Absent | 32 | ||
| Fibroblast Growth Factor 8 | 32 | ||
| Fibroblast Growth Factor 18 | 32 | ||
| Forkhead Box f1 | 32 | ||
| Forkhead Box m1 | 32 | ||
| Gata6 | 32 | ||
| Glucocorticoid Receptor | 33 | ||
| G Protein–Coupled Receptor 4 | 33 | ||
| Hepatocyte Nuclear Factor-3β | 33 | ||
| Homeobox a-5 | 33 | ||
| Kruppel-Like Factor 5 | 33 | ||
| Lysophosphatidylcholine Acyltransferase 1 | 34 | ||
| Macrophage Migration Inhibitory Factor | 34 | ||
| GlcNac N-Deacetylase/N-Sulfotranferase-1 | 34 | ||
| Nmyc | 34 | ||
| Platelet-Derived Growth Factor-A | 34 | ||
| Platelet-Derived Growth Factor-C | 34 | ||
| Prophet of Pit 1 | 34 | ||
| Pten | 35 | ||
| Retinoic Acid Receptor β | 35 | ||
| Sonic Hedgehog | 35 | ||
| Surfactant Protein-B | 35 | ||
| Thyroid Transcription Factor-1 | 35 | ||
| Transforming Growth Factor-β1 | 35 | ||
| Transforming Growth Factor-β3 | 36 | ||
| Transforming Growth Factor-β Receptor II | 36 | ||
| Vascular Endothelial Growth Factor | 36 | ||
| Wingless-Int 7b | 36 | ||
| Summary | 36 | ||
| Genetic Influences in Lung Development: Clinical Context of RDS | 37 | ||
| Twin Studies in RDS | 37 | ||
| Candidate Genes and RDS | 37 | ||
| ABCA3 | 37 | ||
| Endothelial Nitric Oxide Synthase | 38 | ||
| Surfactant Proteins A, B, C, and D | 38 | ||
| G Protein–Coupled Receptor A (GPRA) | 38 | ||
| Miscellaneous | 39 | ||
| Conclusion | 39 | ||
| Genetic Influences in Injury to the Developing Lung | 39 | ||
| Animal Models | 39 | ||
| Angiopoietin 1 | 39 | ||
| Connective Tissue Growth Factor | 40 | ||
| Fas-Ligand | 40 | ||
| Fibroblast Growth Factors 3 and 4 | 40 | ||
| Fibroblast Growth Factor Receptor 2 | 40 | ||
| Interferon-γ | 40 | ||
| Interleukin-1β | 40 | ||
| Interleukin-6 | 41 | ||
| Interleukin-11 | 41 | ||
| Platelet-Derived Growth Factor-A | 41 | ||
| Stroma-Derived Factor 1 | 41 | ||
| Thy-1 (CD90) | 41 | ||
| Tissue Inhibitor of Metalloproteinase 3 | 41 | ||
| Transforming Growth Factor-α | 41 | ||
| Transforming Growth Factor-β1 | 42 | ||
| Thyroid Transcription Factor-1 | 42 | ||
| Vascular Endothelial Growth Factor | 42 | ||
| Summary | 42 | ||
| Genetic Influences in Injury to the Developing Lung: Clinical Context of BPD | 42 | ||
| Twin Studies in Bronchopulmonary Dysplasia | 43 | ||
| Candidate Genes and Bronchopulmonary Dysplasia | 43 | ||
| Adhesion Molecules | 43 | ||
| Dystroglycan | 43 | ||
| L-Selectin | 44 | ||
| Antioxidants | 44 | ||
| Glutathione-S-Transferase | 44 | ||
| Microsomal Epoxide Hydrolases | 44 | ||
| Inflammatory Mediators | 44 | ||
| Interleukin-4 | 44 | ||
| Interleukin 10 | 44 | ||
| Interferonγ | 44 | ||
| Mannose-Binding Lectin 2 | 44 | ||
| Macrophage Migration Inhibitory Factor | 45 | ||
| Monocyte Chemoattractant Protein-1 | 45 | ||
| Transforming Growth Factor-β1 | 45 | ||
| Tumor Necrosis Factor | 45 | ||
| Surfactant Proteins A, B, and D | 45 | ||
| Miscellaneous | 46 | ||
| Adenosine Triphosphate–Binding Cassette Transporter A3 | 46 | ||
| Angiotensin-Converting Enzyme | 46 | ||
| Factor VII | 46 | ||
| Factor-XIII | 46 | ||
| Human Leukocyte AntigenA2 | 46 | ||
| Insulin-Like Growth Factor-I and its Receptor | 47 | ||
| Matrix Metalloproteinase-16 | 47 | ||
| 5,10-Methylenetetrahydrofolate reductase | 47 | ||
| Vascular Endothelial Growth Factor | 47 | ||
| Transporter Associated with Antigen Processing | 47 | ||
| Urokinase | 47 | ||
| Summary | 47 | ||
| Conclusions | 50 | ||
| Acknowledgments | 50 | ||
| References | 50 | ||
| 3 Perinatal Events and Their Influence on Lung Development and Function | 57 | ||
| Overview of Lung Development and Perinatal Events | 57 | ||
| Lung Development: The Substrate for Adverse Events | 58 | ||
| Lung Maturation | 59 | ||
| Antenatal Corticosteroids | 60 | ||
| Antenatal Infection/Inflammation | 65 | ||
| Overview of Fetal Inflammation | 65 | ||
| Diagnosis of Chorioamnionitis | 65 | ||
| Clinical Pulmonary Outcomes of Fetal Exposure to Inflammation/Infection | 67 | ||
| Experimental Results: The Link between Fetal Exposure to Inflammation and Lung Maturation | 69 | ||
| Mediators that Induce Fetal Lung Responses | 72 | ||
| Early Gestational Fetal Lung Responses to Inflammation | 73 | ||
| Mechanisms of Inflammation-Mediated Lung Maturation | 73 | ||
| Experimental Chronic Chorioamnionitis | 75 | ||
| Immune Modulation from Fetal Exposures to Inflammation | 76 | ||
| Antenatal Corticosteroid Treatments and Chorioamnionitis | 78 | ||
| Intrauterine Growth Restriction/Small for Gestational Age | 81 | ||
| Environmental Factors and Lung Disease | 83 | ||
| Summary: The Complexities | 84 | ||
| References | 84 | ||
| 4 Hypoxia and Hyperoxia: | 91 | ||
| Overview of Reactive Oxygen Species | 91 | ||
| Cellular Sources of Reactive Oxygen Species | 92 | ||
| Mitochondrial Electron Transport Chain | 92 | ||
| NADPH Oxidases | 93 | ||
| Nitric Oxide Synthase | 94 | ||
| Xanthine Oxidase | 94 | ||
| Peroxynitrite | 94 | ||
| ROS Scavengers | 95 | ||
| Hypoxia and the Pulmonary Circulation | 96 | ||
| Acute Hypoxic Vasoconstriction | 96 | ||
| Chronic Hypoxia–Induced Pulmonary Hypertension | 96 | ||
| Hyperoxia and the Pulmonary Circulation | 98 | ||
| Short-Term Effects of Hyperoxia | 98 | ||
| Chronic Hyperoxia | 101 | ||
| Therapeutic Implications | 102 | ||
| NO/cGMP Modulation | 102 | ||
| Antioxidants | 103 | ||
| Acknowledgments | 105 | ||
| References | 105 | ||
| 5 The Role of Nitric Oxide in Lung Growth and Function | 111 | ||
| Fetal Lung Development | 111 | ||
| Angiogenic Factors and Their Receptors | 114 | ||
| Nitric Oxide and Lung Development | 115 | ||
| Role of Nitric Oxide in Lung Repair | 117 | ||
| Role of Nitric Oxide in Maintaining the Lung Structure during Postnatal Life | 121 | ||
| Regulation of NOS Catalytic Function and Its Alteration in Lung Injury | 121 | ||
| Role of BH4 in the Regulation of NOS Activity | 123 | ||
| Regulation of NOS Activity through l-Arginine Availability | 123 | ||
| Interaction of Antioxidant Enzyme Systems with Endogenous Nitric Oxide | 124 | ||
| Relationship of Oxygen Tension with NOS Function and Lung Growth during Fetal Life | 124 | ||
| Physiologic Role of Nitric Oxide in the Gas Exchange Function of the Lung | 125 | ||
| Altered Lung Architecture in BPD and Its Relation to NOS Signaling | 125 | ||
| Application of Inhaled Nitric Oxide to Restore Lung Growth in Premature Neonates | 126 | ||
| Summary | 128 | ||
| Acknowledgments | 129 | ||
| References | 129 | ||
| B Lung Injury—Bronchopulmonary Dysplasia | 133 | ||
| 6 Prenatal and Postnatal Microbial Colonization and Respiratory Outcome in Preterm Infants | 135 | ||
| Introduction | 135 | ||
| Antenatal Infection and Pulmonary Outcomes | 135 | ||
| Histologic Chorioamnionitis and Pulmonary Outcomes | 137 | ||
| Role of Infection-Mediated Cytokine Signaling in Bronchopulmonary Dysplasia | 139 | ||
| Chronic Inflammation in the Immature Lung Alters Developmental Signaling and Fibrosis | 139 | ||
| Role of Genital Mycoplasmas in Intrauterine Infection and Neonatal Lung Injury | 140 | ||
| Are There Ureaplasma Species- or Serovar-Specific Virulence Factors? | 141 | ||
| Potential Role of Ureaplasma Species in Preterm Birth and Intrauterine Inflammation | 141 | ||
| Ureaplasma Species and Neonatal Lung Injury | 143 | ||
| Human and Experimental Evidence for the Role of Ureaplasma Species in Bronchopulmonary Dysplasia | 144 | ||
| Developmental Deficiencies in Innate Immunity Contribute to Susceptibility to Ureaplasma Infection and Dysregulated Inflammation | 148 | ||
| Ureaplasma Diagnostic Methods | 149 | ||
| Can Bronchopulmonary Dysplasia Be Prevented by Eradication of Ureaplasma? | 150 | ||
| Other Perinatally Acquired Microbes and Pulmonary Outcomes | 150 | ||
| Postnatal Microbial Colonization and Adverse Pulmonary Outcomes | 151 | ||
| Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit | 151 | ||
| Diagnostic Criteria | 151 | ||
| Risk Factors | 152 | ||
| Microbiology | 153 | ||
| Pathogenesis | 153 | ||
| Outcomes | 154 | ||
| Prevention | 154 | ||
| Effects of Antenatal Infection/Inflammation on Long-Term Pulmonary Outcomes | 154 | ||
| Acknowledgments | 155 | ||
| References | 155 | ||
| 7 Influence of Nutrition on Neonatal Respiratory Outcomes | 163 | ||
| Preterm Infant Nutrition | 164 | ||
| Undernutrition, Growth Failure, and Pulmonary Consequences | 166 | ||
| Effect of Undernutrition on Lung Growth and Development | 166 | ||
| Effect of Undernutrition on Respiratory Muscle Function | 168 | ||
| Effect of Undernutrition on Lung Function | 168 | ||
| Effect of Undernutrition on the Antioxidant System | 169 | ||
| Effect of Undernutrition on Infection Susceptibility | 169 | ||
| Effect of Undernutrition on Alveolar Fluid Balance | 170 | ||
| Effect of Undernutrition on Control of Breathing | 170 | ||
| Adequate Nutrition to Support Lung Growth and Function | 170 | ||
| Energy | 170 | ||
| Water and Fluid Volume | 170 | ||
| Macronutrients | 171 | ||
| Carbohydrates | 171 | ||
| Fats | 171 | ||
| Proteins | 172 | ||
| Micronutrients | 173 | ||
| Vitamins | 173 | ||
| Vitamin A | 173 | ||
| Vitamin D | 173 | ||
| Vitamin E | 173 | ||
| Vitamin C | 174 | ||
| Trace Elements | 174 | ||
| Other Nutrients | 175 | ||
| Calcium/Phosphorus | 175 | ||
| Surfactant Precursors | 175 | ||
| Individual Amino Acids | 175 | ||
| Conclusion | 176 | ||
| References | 176 | ||
| 8 Patent Ductus Arteriosus and the Lung: | 181 | ||
| Why Does the Ductus Arteriosus Remain Open in Preterm Infants? | 181 | ||
| Surfactant Treatment and PDA | 183 | ||
| Systemic Consequences of PDA | 183 | ||
| Pulmonary Consequences of PDA | 183 | ||
| Acute Effects | 183 | ||
| PDA and Lung Inflammation | 184 | ||
| Long-Term Consequences | 185 | ||
| Effects of Increased Pulmonary Blood Flow on Vascular and Alveolar Development | 185 | ||
| PDA and Bronchopulmonary Dysplasia | 186 | ||
| Management of PDA and Respiratory Outcome | 187 | ||
| Respiratory Management of Infants with PDA | 189 | ||
| Summary | 190 | ||
| References | 190 | ||
| 9 Role of Stem Cells in Neonatal Lung Injury | 197 | ||
| Stem Cells | 197 | ||
| Exogenous Stem Cells for Lung Repair | 199 | ||
| Embryonic Stem Cells | 199 | ||
| Induced Pluripotent Stem Cells | 200 | ||
| Umbilical Cord Stem Cells | 200 | ||
| Bone Marrow–Derived Stem cells | 201 | ||
| Type of Bone Marrow–Derived Stem Cells | 201 | ||
| Hematopoietic Stem Cells | 201 | ||
| Mesenchymal Stem Cells | 201 | ||
| Endothelial Progenitor Stem Cells | 202 | ||
| Bone Marrow–Derived Stem Cells and Lung Disease | 202 | ||
| Efficacy in Lung Injury | 202 | ||
| Lung Fibrosis | 203 | ||
| Pulmonary Hypertension | 204 | ||
| Airway Disease | 204 | ||
| Chronic Obstructive Pulmonary Disease | 205 | ||
| Mechanisms of Stem Cell Repair | 205 | ||
| Engraftment or Paracrine | 205 | ||
| Lung Bioengineering | 205 | ||
| Endogenous Lung Stem Cells | 206 | ||
| Endogenous Circulating Stem Cells | 207 | ||
| Conclusion | 209 | ||
| Acknowledgments | 209 | ||
| References | 209 | ||
| 10 New Developments in the Pathogenesis and Prevention of Bronchopulmonary Dysplasia | 217 | ||
| New Developments in Clinical Presentation | 217 | ||
| New Developments in Understanding of BPD Pathogenesis | 218 | ||
| Role of Inflammation in BPD Pathogenesis | 219 | ||
| Role of Arrest of Alveolar Development and the Vascular Hypothesis in Pathogenesis of BPD | 220 | ||
| Role of Alterations in Growth Factors in BPD Pathogenesis | 221 | ||
| Role of Hyperoxia and Hypoxia in BPD Pathogenesis | 221 | ||
| Role of Genetics in BPD Pathogenesis | 222 | ||
| New Developments in Prevention and Management of BPD | 222 | ||
| Approach to Oxygen Therapy and BPD Prevention and Management | 222 | ||
| Potential Role for Exogenous Antioxidants in BPD Prevention or Therapy | 223 | ||
| Modalities of Ventilator Support and BPD Prevention and Management | 224 | ||
| Inhaled Nitric Oxide and Prevention of BPD | 225 | ||
| Nutritional Approaches to BPD Treatment and Prevention | 225 | ||
| Caloric and Protein Nutrition | 225 | ||
| Lipid Nutrition | 225 | ||
| Inositol | 226 | ||
| Vitamin A | 226 | ||
| BPD Therapies to Reduce Lung Inflammation | 226 | ||
| Corticosteroids | 226 | ||
| Methylxanthines and BPD Prevention | 227 | ||
| Caffeine | 227 | ||
| Future Directions in Prevention of BPD | 228 | ||
| Pentoxifylline | 228 | ||
| Mesenchymal Stem Cells | 228 | ||
| Conclusion | 228 | ||
| References | 229 | ||
| 11 Long-Term Pulmonary Outcome of Preterm Infants | 235 | ||
| Controversies | 235 | ||
| What Are the Long-Term Pulmonary Outcomes for Late Preterm Infants? | 236 | ||
| What are the Long-Term Pulmonary Outcomes for Very Preterm Infants, and What Is the Effect of Having BPD on These Outcomes? | 236 | ||
| Hospital Readmissions for Respiratory Illness | 236 | ||
| Respiratory Health Problems | 237 | ||
| Pulmonary Function in Childhood | 237 | ||
| Pulmonary Function in Adolescence or Early Adulthood | 238 | ||
| Exercise Tolerance | 240 | ||
| What Are the Effects of Exogenous Surfactant? | 240 | ||
| What are the Effects of Cigarette Smoking? | 240 | ||
| What Further Research is Required? | 241 | ||
| Summary | 241 | ||
| References | 241 | ||
| C Management of Respiratory Failure | 245 | ||
| 12 Respiratory and Cardiovascular Support in the Delivery Room | 247 | ||
| Anticipate the Need for Resuscitation | 247 | ||
| Prepare | 248 | ||
| Initial Assessment: “The Golden Minute” | 248 | ||
| Initial Steps of Resuscitation | 249 | ||
| Provide Warmth | 249 | ||
| Position | 250 | ||
| Clear the Airway (Only If Needed) | 250 | ||
| Dry and Stimulate | 250 | ||
| Assess | 251 | ||
| Effective Ventilation: The Key! | 251 | ||
| CPAP | 252 | ||
| Intubation or Laryngeal Mask Airway | 252 | ||
| Oxygenation | 254 | ||
| Cardiac Compressions during Delivery Room Resuscitation | 255 | ||
| Two-Thumb Technique | 256 | ||
| Compression-to-Ventilation Ratio | 257 | ||
| Coordination of Compressions and Ventilations | 257 | ||
| Colorimetric ETCO2 Detectors during Cardiac Compressions | 258 | ||
| Capnography during Cardiac Compressions | 258 | ||
| Medications during Delivery Room Resuscitation | 258 | ||
| Special Situations | 260 | ||
| References | 260 | ||
| 13 Noninvasive Respiratory Support: | 265 | ||
| Physiological Principles | 265 | ||
| Why Do Preterm Infants Experience Respiratory Failure and How Can Noninvasive Support Help? | 265 | ||
| Respiratory Distress Syndrome | 265 | ||
| Apnea of Prematurity | 266 | ||
| The Role of NCPAP | 266 | ||
| Why Might Noninvasive Support Be Superior to Ventilation via an Endotracheal Tube? | 266 | ||
| A Brief History of Invasive and Noninvasive Neonatal Ventilation | 266 | ||
| NCPAP for Postextubation Care | 267 | ||
| Augmenting NCPAP: Nasal Intermittent Positive-Pressure Ventilation | 268 | ||
| NCPAP for Babies with RDS or at Risk of Developing RDS | 270 | ||
| Is Prophylactic CPAP Better than No Respiratory Support for Very Preterm Infants? | 270 | ||
| Is Continuous Distending Pressure (CDP) Better than No CDP for Treatment of RDS? | 271 | ||
| CPAP in the “Surfactant Era” | 272 | ||
| Is CPAP an Alternative to Routine Intubation of Very Preterm Infants at Birth? | 272 | ||
| Is CPAP with Early Intubation for Surfactant and Brief Ventilation Better than CPAP Alone? | 273 | ||
| Administering Surfactant to Infants Receiving CPAP without the Insertion of an Endotracheal Tube | 273 | ||
| NCPAP Devices | 274 | ||
| How Much Supporting Pressure Should Be Used? | 275 | ||
| Complications of NCPAP | 276 | ||
| When Has NCPAP Failed (i.e., When Should Infants be Intubated)? | 277 | ||
| Weaning CPAP | 277 | ||
| High-Flow Nasal Cannulae for Respiratory Support | 277 | ||
| How Much Distending Pressure Is Generated by HFNC? | 278 | ||
| Evidence for the Safety and Efficacy of HFNC Ventilation | 278 | ||
| Should HFNC Ventilation Be Used to Treat Preterm Infants? | 278 | ||
| Conclusions | 278 | ||
| For Clinicians | 278 | ||
| For Researchers | 279 | ||
| Acknowledgments | 279 | ||
| References | 279 | ||
| 14 Surfactant Replacement: | 283 | ||
| Introduction | 283 | ||
| Recommendations for Surfactant Use in 2010 | 283 | ||
| Which Surfactant Is Best? | 285 | ||
| What Dose Should Be Used? | 286 | ||
| When Should Surfactant Be Given? | 287 | ||
| Should We Use More than One Dose of Surfactant in RDS? | 289 | ||
| Surfactant Administration and Ventilation | 290 | ||
| Surfactant without Intubation | 291 | ||
| Surfactant for Other Neonatal Respiratory Disorders | 292 | ||
| Surfactant for Meconium Aspiration | 292 | ||
| Surfactant for Congenital Pneumonia | 293 | ||
| Surfactant for Pulmonary Hypoplasia | 293 | ||
| Surfactant for Babies with Pulmonary Hemorrhage | 294 | ||
| Surfactant for Babies with Severe Respiratory Failure | 294 | ||
| The Future | 294 | ||
| References | 295 | ||
| 15 Oxygenation Targeting and Outcomes in Preterm Infants: | 301 | ||
| Historical Perspectives | 301 | ||
| Physiologic Considerations | 303 | ||
| Oxyhemoglobin Dissociation Curve | 303 | ||
| Fetal Oxygenation | 305 | ||
| The Critical Threshold of Fetal Oxygenation | 306 | ||
| Oxygenation during Fetal-to-Neonatal Transition | 306 | ||
| Oxygen Toxicity in Preterm Infants | 308 | ||
| Oxygen and the Eye | 308 | ||
| Oxygen and the Brain | 310 | ||
| Oxygen and the Lung | 311 | ||
| “Normal” Levels of Oxygenation in Newborns | 311 | ||
| Optimal Levels of Oxygenation in Preterm Infants: Neonatal Period | 312 | ||
| Optimal Levels of Oxygenation in Preterm Infants: Post-neonatal Period | 315 | ||
| Approaches to Oxygen Therapy and Clinical Outcomes | 316 | ||
| Neonatal Mortality and Morbidity Outcomes | 316 | ||
| Impact of Neonatal Morbidities on Long-Term Outcomes | 316 | ||
| Long-Term Outcomes at 18 Months and 10 Years | 317 | ||
| Controversies in Oxygen Therapy | 317 | ||
| Respiratory Support for Convalescent Preterm Infants: CPAP or Oxygen? | 318 | ||
| Continuous Noninvasive Monitoring: Oxygen Saturation or Oxygen Tension? | 318 | ||
| Optimum Oxygen Saturation in Preterm Infants: Does It Vary with Postnatal Age? | 319 | ||
| Resolving the Uncertainty: The Oxygen Saturation Trials | 319 | ||
| New Evidence on Oxygenation Targets in Preterm Infants | 321 | ||
| References | 323 | ||
| 16 Hypoxemic Episodes in the Premature Infant: | 329 | ||
| Mechanisms | 329 | ||
| Management of Hypoxemia Spells in Ventilated Infants | 331 | ||
| Ventilatory Strategies | 331 | ||
| Supplemental Oxygen | 332 | ||
| Behavioral Disturbances | 333 | ||
| Episodes of Hypoxemia after Extubation | 333 | ||
| Consequences of Hypoxemia Episodes in the Premature Infant | 334 | ||
| Summary | 335 | ||
| References | 335 | ||
| 17 Patient-Ventilator Interaction | 339 | ||
| Conventional Mechanical Ventilation | 339 | ||
| Infant-Ventilator Asynchrony | 340 | ||
| Synchronized Mechanical Ventilation | 342 | ||
| Methods of Synchronization | 342 | ||
| Flow Sensors | 343 | ||
| Graseby Pressure Capsule | 343 | ||
| Airway Pressure | 343 | ||
| Modalities of Synchronized Ventilation | 344 | ||
| Synchronized Intermittent Mandatory Ventilation | 344 | ||
| Assist/Control Ventilation | 344 | ||
| Pressure-Support Ventilation | 344 | ||
| Limitations and Potential Negative Infant-Ventilator Interaction with Synchronized Ventilation | 345 | ||
| Long Inspiration Time and End-Inspiratory Asynchrony | 345 | ||
| Delayed Triggering: | 347 | ||
| Trigger Failure | 347 | ||
| Autocycling | 347 | ||
| Excessive or Insufficient Circuit Flow | 348 | ||
| Peak Inspiratory Pressure | 348 | ||
| Excessive Positive End-Expiratory Pressure | 349 | ||
| Infant-Ventilator Interaction during Noninvasive Ventilation | 349 | ||
| Summary | 352 | ||
| References | 352 | ||
| 18 Strategies for Limiting the Duration of Mechanical Ventilation | 355 | ||
| Weaning Ventilator Settings | 355 | ||
| Permissive Hypercapnia | 357 | ||
| Respiratory Center Stimulants | 357 | ||
| Postnatal Steroids | 357 | ||
| Dead Space Reduction | 358 | ||
| Extubation from Intermittent or Continuous Positive Airway Pressure | 358 | ||
| Modes of Ventilation and Weaning | 358 | ||
| Synchronized or Patient-Triggered Ventilation | 358 | ||
| Nasal Continuous Positive Airway Pressure after Extubation | 360 | ||
| Nasal Ventilation after Extubation | 360 | ||
| Weaning from High-Frequency Ventilation | 361 | ||
| Prediction of Successful Extubation | 361 | ||
| Automatic Weaning | 362 | ||
| Volume-Targeted Ventilation | 362 | ||
| Targeted Minute Ventilation | 362 | ||
| Computer-Assisted Weaning | 363 | ||
| Automatic Weaning from Supplemental Oxygen | 363 | ||
| Conclusion | 363 | ||
| References | 363 | ||
| 19 Automation of Respiratory Support | 367 | ||
| Automation of Mechanical Ventilatory Support | 367 | ||
| Volume Targeted Ventilation | 368 | ||
| Targeted Minute Ventilation | 371 | ||
| Proportional Assist Ventilation | 373 | ||
| Neurally Adjusted Ventilatory Assist | 374 | ||
| Automated Adjustment of Supplemental Oxygen | 375 | ||
| Effects on Oxygenation, Inspired Oxygen Concentration, and Workload | 376 | ||
| Possible Limitations of Automated Fio2 Control | 376 | ||
| Summary | 378 | ||
| References | 379 | ||
| 20 Management of the Infant with Congenital Diaphragmatic Hernia | 381 | ||
| The Pathophysiology of Congenital Diaphragmatic Hernia | 381 | ||
| Acute Respiratory Management in the Patient with CDH | 382 | ||
| Approach to Mechanical Ventilation | 382 | ||
| Pulmonary Toilet | 389 | ||
| Surfactant | 389 | ||
| Extracorporeal Membrane Oxygenation Support | 390 | ||
| Cardiopulmonary Interactions in Infants with CDH | 392 | ||
| Assessment and Management of Pulmonary Hypertension | 393 | ||
| Assessment of Pulmonary Hypertension | 393 | ||
| Management of Pulmonary Hypertension | 394 | ||
| Approach to Patients with Congenital Heart Disease | 399 | ||
| Longer-Term Issues in Survivors of CDH | 400 | ||
| Antenatal Therapies | 400 | ||
| References | 401 | ||
| 21 Management of the Infant with Severe Bronchopulmonary Dysplasia | 407 | ||
| Pathophysiology of Severe BPD | 408 | ||
| Respiratory Function | 408 | ||
| Lung Mechanics | 409 | ||
| Lung Volumes | 410 | ||
| Forced Flows | 410 | ||
| Lung Imaging | 410 | ||
| The Cardiovascular System | 411 | ||
| Evaluation and Treatment | 413 | ||
| Mechanical Ventilation | 415 | ||
| Drug Therapies | 417 | ||
| Treatment of Pulmonary Hypertension | 419 | ||
| Interdisciplinary Care | 421 | ||
| Discharge and Follow-Up | 421 | ||
| Long-Term Outcomes | 422 | ||
| References | 422 | ||
| Index | 427 | ||
| A | 427 | ||
| B | 428 | ||
| C | 429 | ||
| D | 431 | ||
| E | 431 | ||
| F | 432 | ||
| G | 432 | ||
| H | 434 | ||
| I | 434 | ||
| K | 435 | ||
| L | 435 | ||
| M | 436 | ||
| N | 438 | ||
| O | 439 | ||
| P | 440 | ||
| R | 442 | ||
| S | 443 | ||
| T | 444 | ||
| U | 445 | ||
| V | 445 | ||
| W | 446 | ||
| X | 446 | ||
| Z | 446 | ||
| Endsheet 2 | ibc_i |