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Book Details
Abstract
Dr. Richard Polin’s Neonatology Questions and Controversies series highlights the most challenging aspects of neonatal care, offering trustworthy guidance on up-to-date diagnostic and treatment options in the field. In each volume, renowned experts address the clinical problems of greatest concern to today’s practitioners, helping you handle difficult practice issues and provide optimal, evidence-based care to every patient.
- Stay fully up to date in this fast-changing field with The Newborn Lung, 3rd Edition.
- The most current clinical information throughout, including key management strategies that may reduce some of the chronic sequelae of neonatal respiratory failure.
- New content on the role of microbiome in lung injury and lung development.
- Current coverage of non-invasive respiratory support, perinatal events and their influence on lung development and injury, cell-based lung therapy, automation of respiratory support, and oxygenation targeting in preterm infants.
- Consistent chapter organization to help you find information quickly and easily.
- The most authoritative advice available from world-class neonatologists who share their knowledge of new trends and developments in neonatal care.
Purchase each volume individually, or get the entire 7-volume set! Gastroenterology and Nutrition Hematology, Immunology and Genetics Hemodynamics and Cardiology Infectious Disease and Pharmacology New Volume! Nephrology and Fluid/Electrolyte Physiology Neurology The Newborn Lung
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Neonatology Questions and Controversies | i | ||
| Series Page | ii | ||
| Neonatology Questions and Controversies | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Preface | ix | ||
| Series Foreword | xi | ||
| Contents | xiii | ||
| A - Lung Developmentand Injury | 1 | ||
| 1 - Molecular Bases for Lung Development, Injury, and Repair | 3 | ||
| Overview of Lung Developmental Stages | 4 | ||
| Embryonic Stage | 5 | ||
| Molecular Regulation of Lung Bud Initiation and Tracheoesophageal Separation | 5 | ||
| Pseudoglandular Stage | 6 | ||
| Epithelial-Mesenchymal Interactions Control Branching Morphogenesis | 7 | ||
| FGF10-FGFR2b Signaling: Driving Force for Branching Morphogenesis | 7 | ||
| Control of FGF10-FGFR2 Signaling by SHH and Sprouty | 8 | ||
| BMP Signaling Regulates Branching Morphogenesis | 8 | ||
| TGF-β Signaling Inhibits Branching | 8 | ||
| Wnt Signaling: Autocrine and Paracrine Effects on Branching Morphogenesis | 9 | ||
| Hox5 Genes Control Lung Patterning by Regulating Wnt/BMP4 Signaling | 9 | ||
| Canalicular Stage | 10 | ||
| Saccular Stage | 10 | ||
| Alveolar Stage | 10 | ||
| Regulatory Mechanisms of Alveologenesis | 11 | ||
| Myofibroblast Differentiation and Elastin Deposition: Key Events for Alveolar Septation | 11 | ||
| Development of Airway Epithelial Lineages | 13 | ||
| The Surfactant System | 13 | ||
| Regulation of Pulmonary Vascular Development | 13 | ||
| Vascular Morphogenesis | 13 | ||
| VEGF-Mediated Epithelial-Endothelial Interaction in Vascular and Alveolar Development | 14 | ||
| Additional Angiogenic Factors in Vascular Development | 15 | ||
| Lung Injury and Repair: Disruption of Normal Lung Development | 15 | ||
| Innate Immunity, IL-1β, and the Development of BPD | 16 | ||
| Increased TGF-β Signaling in Neonatal Lung Injury and BPD | 18 | ||
| Decreased VEGF Signaling in Neonatal Lung Injury and BPD | 20 | ||
| MicroRNA in Lung Development and Injury Repair | 21 | ||
| Conclusions | 21 | ||
| REFERENCES | 21 | ||
| 2 - Perinatal Events and Their Influence on Lung Development and Injury | 31 | ||
| Overview of Lung Development and Perinatal Events | 31 | ||
| Lung Development: The Substrate for Adverse Events | 32 | ||
| Lung Maturation | 33 | ||
| Antenatal Corticosteroids | 34 | ||
| Antenatal Infection/Inflammation | 39 | ||
| Overview of Fetal Inflammation | 39 | ||
| Diagnosis of Chorioamnionitis | 39 | ||
| Clinical Pulmonary Outcomes of Fetal Exposure to Inflammation/Infection | 41 | ||
| Experimental Results: The Link Between Fetal Exposure to Inflammation and Lung Maturation and Lung Remodeling | 44 | ||
| Mediators That Induce Fetal Lung Inflammatory Responses | 46 | ||
| Early Gestational Fetal Lung Responses to Inflammation | 47 | ||
| Mechanisms of Inflammation-Mediated Lung Maturation | 48 | ||
| Experimental Chronic Chorioamnionitis | 49 | ||
| Immune Response and Modulation from Fetal Exposures to Inflammation | 50 | ||
| Immune Changes in Preterm Infants Exposed to Chorioamnionitis | 52 | ||
| Inflammatory Mediators and BPD | 52 | ||
| Antenatal Corticosteroid Treatments and Chorioamnionitis | 53 | ||
| Intrauterine Growth Restriction/Small for GA | 55 | ||
| Environmental Factors and Lung Disease | 56 | ||
| Summary: The Complexities | 57 | ||
| REFERENCES | 58 | ||
| 3 - Pulmonary Vascular Development and the Neonatal Circulation | 65 | ||
| Development of the Fetal Pulmonary Circulation | 65 | ||
| Physiology of the Fetal Pulmonary Circulation | 65 | ||
| Mediators of Early Pulmonary Vascular Development | 67 | ||
| Mediators of Early Pulmonary Vascular Function | 70 | ||
| Transitional Circulation and Postnatal Pulmonary Vascular Development | 71 | ||
| Features of Abnormal Pulmonary Vascular Development | 72 | ||
| Factors That Disrupt Fetal Pulmonary Vascular Development | 74 | ||
| Genetic Factors | 74 | ||
| Antenatal Ductal Closure | 75 | ||
| Placental Insufficiency | 75 | ||
| Oligohydramnios/PH in Preterm Infants | 75 | ||
| Maternal Drug Exposures | 76 | ||
| Congenital Diaphragmatic Hernia | 76 | ||
| Alveolar Capillary Dysplasia | 78 | ||
| Factors That Disrupt Postnatal Pulmonary Vascular Development | 78 | ||
| Asphyxia | 78 | ||
| Preterm Birth | 78 | ||
| Pulmonary Vein Stenosis | 79 | ||
| Hypoxia | 79 | ||
| Hyperoxia | 79 | ||
| Conclusions | 80 | ||
| REFERENCES | 80 | ||
| 4 - The “-Omics” of the New Bronchopulmonary Dysplasia | 87 | ||
| -Omics of Disease Processes | 88 | ||
| Genomics | 89 | ||
| Transcriptomics | 90 | ||
| Proteomics | 91 | ||
| Metabolomics | 91 | ||
| Microbiomics | 92 | ||
| Economics | 93 | ||
| Conclusion | 93 | ||
| REFERENCES | 93 | ||
| 5 - Role of Microbiome in Lung Injury | 97 | ||
| Role of Genital Mycoplasmas in Intrauterine Infection and Neonatal Lung Injury | 102 | ||
| Ureaplasma Species: Are There Species- or Serovar-Specific Virulence Factors? | 102 | ||
| Potential Role of Ureaplasma Species in Preterm Birth and Intrauterine Inflammation | 103 | ||
| Ureaplasma spp. and Neonatal Lung Injury | 104 | ||
| Human and Experimental Evidence for Role of Ureaplasma spp. in BPD | 105 | ||
| Developmental Deficiencies in Innate Immunity Contribute to Susceptibility to Ureaplasma Infection and Dysregulated Inflammation... | 107 | ||
| Can BPD Be Prevented by Ureaplasma Eradication? | 107 | ||
| REFERENCES | 108 | ||
| 6 - Definitions and Diagnostic Criteria of Bronchopulmonary Dysplasia: Clinical and Research Implications | 115 | ||
| Clinical Presentation of BPD | 115 | ||
| BPD Diagnosis | 116 | ||
| Diagnosis Based on Various Supplemental Oxygen Criteria | 117 | ||
| Continuous Oxygen Use for the First 28 Days | 117 | ||
| Supplemental Oxygen at Day 28 | 117 | ||
| Oxygen at 36 Weeks Postmenstrual Corrected Age | 117 | ||
| Cumulative Oxygen Supplementation Combined With Oxygen Requirement at 36 Weeks PMA | 119 | ||
| Impact of the Arterial Oxygenation Targets | 121 | ||
| Competing Outcomes | 121 | ||
| Predicting BPD | 121 | ||
| Risk Factors for BPD Before Birth | 122 | ||
| Antenatal Steroids, Chorioamnionitis, and Fetal Growth Restriction | 122 | ||
| Infant Demographics | 122 | ||
| Postnatal Risk Factors | 122 | ||
| Mechanical Ventilation, Patent Ductus Arteriosus, and Oxygen Use | 122 | ||
| Predictive Models of BPD | 124 | ||
| Defining the Populations at Risk | 124 | ||
| Prognosis for Long-Term Impairment | 125 | ||
| REFERENCES | 127 | ||
| 7 - Patent Ductus Arteriosus and the Lung: Acute Effects and Long-Term Consequences | 131 | ||
| Why Does the Ductus Arteriosus Remain Open in Preterm Infants? | 132 | ||
| Systemic Consequences of a PDA | 132 | ||
| Pulmonary Consequences of a PDA | 133 | ||
| Acute Effects | 133 | ||
| Long-Term Consequences | 134 | ||
| Effects of Increased Pulmonary Blood Flow on Vascular and Alveolar Development | 134 | ||
| PDA and BPD | 135 | ||
| Management of the PDA and Respiratory Outcome | 136 | ||
| Respiratory Management of Infants With PDA | 139 | ||
| REFERENCES | 140 | ||
| 8 - Ventilator-Associated Pneumonia | 147 | ||
| Introduction | 147 | ||
| Definition | 148 | ||
| Epidemiology | 148 | ||
| Pathogenesis | 149 | ||
| Treatment | 152 | ||
| Prevention | 154 | ||
| Outcomes | 156 | ||
| Future Research Directions | 157 | ||
| Conclusion | 157 | ||
| REFERENCES | 157 | ||
| 9 - Long-Term Pulmonary Outcome of Preterm Infants | 161 | ||
| Controversies | 161 | ||
| What Are the Long-Term Pulmonary Outcomes for Late Preterm Infants? | 162 | ||
| What Are the Long-Term Pulmonary Outcomes for Very Preterm Infants, and What Is the Effect of BPD on These Outcomes? | 163 | ||
| Hospital Readmissions for Respiratory Illness | 163 | ||
| Respiratory Health Problems | 163 | ||
| Pulmonary Function in Childhood | 163 | ||
| Pulmonary Function in Adolescence or Early Adulthood | 165 | ||
| Trends in Pulmonary Function With Increasing Age | 166 | ||
| Exercise Tolerance | 167 | ||
| What Are the Effects of Exogenous Surfactant? | 167 | ||
| What Are the Effects of Cigarette Smoking? | 167 | ||
| What Further Research Is Required? | 168 | ||
| Summary | 168 | ||
| REFERENCES | 168 | ||
| B - Management of RespiratoryProblems | 171 | ||
| 10 - Respiratory and Cardiovascular Support in the Delivery Room | 173 | ||
| Understanding the Transition to Newborn Life | 173 | ||
| Anticipating the Need for Resuscitation | 176 | ||
| Preparation | 176 | ||
| Initial Assessment | 177 | ||
| Initial Steps for Nonvigorous and Preterm Newborns | 177 | ||
| Provide Warmth and Maintain Normal Temperature | 177 | ||
| Position | 179 | ||
| Additional Steps: Clear the Airway If Needed, Dry, and Stimulate | 179 | ||
| Assessing the Infant’s Response to the Initial Steps | 180 | ||
| Effective Ventilation: The Key! | 180 | ||
| Continuous Positive Airway Pressure | 182 | ||
| Alternative Airways: Endotracheal Tube or Laryngeal Mask Airway | 182 | ||
| Oxygenation | 183 | ||
| Chest Compressions During Delivery Room Resuscitation | 185 | ||
| Chest Compression Technique | 185 | ||
| Compression-to-Ventilation Ratio | 186 | ||
| Coordination of Compressions and Ventilations | 187 | ||
| Capnography During Cardiac Compressions | 187 | ||
| Medications During Delivery Room Resuscitation | 187 | ||
| Special Situations | 189 | ||
| REFERENCES | 190 | ||
| 11 - Noninvasive Ventilation of Preterm Infants: An Alternative to Mechanical Ventilation | 197 | ||
| Why Do Preterm Infants Experience Respiratory Failure and How Can Noninvasive Ventilation Help? | 197 | ||
| Respiratory Distress Syndrome | 197 | ||
| Apnea of Prematurity | 198 | ||
| The Role of CPAP | 198 | ||
| Why Might NIV Be Superior to Mechanical Ventilation via an Endotracheal Tube? | 198 | ||
| A Brief History of Invasive and Noninvasive Neonatal Ventilation | 198 | ||
| Nasal Continuous Positive Airway Pressure | 199 | ||
| Nasal Continuous Positive Airway Pressure Devices | 199 | ||
| How Much Supporting Pressure Should Be Used? | 201 | ||
| Nasal CPAP for Infants With RDS or at Risk of Developing RDS | 201 | ||
| CPAP in the Surfactant Era | 202 | ||
| Is CPAP an Alternative to Routine Intubation of Very Preterm Infants at Birth? | 202 | ||
| Is CPAP With Early Intubation for Surfactant and Brief Mechanical Ventilation Better Than CPAP Alone? | 203 | ||
| Less Invasive Surfactant Administration | 204 | ||
| Nasal CPAP for Postextubation Support | 204 | ||
| CPAP Failure: When Should Preterm Infants Be Intubated? | 204 | ||
| Complications of Nasal CPAP | 205 | ||
| Weaning CPAP | 205 | ||
| Nasal Intermittent Positive-Pressure Ventilation | 206 | ||
| Noninvasive High-Frequency Nasal Ventilation | 207 | ||
| Factors Affecting Gas Exchange During HFNV | 207 | ||
| Laryngeal Effects of HFNV | 208 | ||
| Clinical Reports on Neonatal HFNV | 208 | ||
| Current Use of HFNV in the NICU | 208 | ||
| Device-Specific Comments Regarding HFNV | 209 | ||
| Nasal High-Flow Therapy for Preterm Infants | 209 | ||
| How Does NHFT Work? | 210 | ||
| Evidence from Randomized Trials for NHFT Use in Preterm Infants | 210 | ||
| Stabilization in the Delivery Room | 210 | ||
| Nasal HFT as Primary Respiratory Support After Admission to the Neonatal Unit | 211 | ||
| Nasal HFT Versus CPAP | 211 | ||
| NHFT Versus NIPPV | 211 | ||
| NHFT to Prevent Extubation Failure in Preterm Infants | 211 | ||
| Safety of NHFT | 212 | ||
| Potential Concerns With Use of NHFT in Neonates | 212 | ||
| Should NHFT Be Used to Treat Preterm Infants? | 213 | ||
| Future Directions | 213 | ||
| REFERENCES | 213 | ||
| 12 - Newer Strategies for Surfactant Delivery | 221 | ||
| Techniques of Surfactant Administration Without an Endotracheal Tube | 222 | ||
| Aerosolization | 223 | ||
| Pharyngeal Instillation of Surfactant | 223 | ||
| Delivery of Surfactant by Laryngeal Mask Airway | 224 | ||
| Delivery of Surfactant Via a Thin Catheter | 224 | ||
| Surfactant Administration Via Brief Tracheal Catheterization | 224 | ||
| Methods of Surfactant Delivery Via a Thin Catheter | 224 | ||
| Depth of Catheter Insertion | 225 | ||
| Observational and Cohort Studies of Surfactant Delivery | 225 | ||
| Clinical Trials of Surfactant Administration Via Tracheal Catheterization | 225 | ||
| Avoid Mechanical Ventilation Trial | 225 | ||
| Take Care Study | 225 | ||
| Bao et al | 228 | ||
| Mohammadizadeh et al | 228 | ||
| Mirnia et al | 229 | ||
| NINSAPP Trial | 229 | ||
| Summation of the Clinical Trials, and Findings of Meta-Analyses | 229 | ||
| Scientific and Practical Considerations | 230 | ||
| Effectiveness of Surfactant Delivery and Distribution | 230 | ||
| Laboratory Studies of Surfactant Distribution | 230 | ||
| Use of Premedication for Tracheal Catheterization | 231 | ||
| Minimization of Discomfort | 231 | ||
| Maintenance of Respiratory Effort and Avoidance of Bradycardia | 232 | ||
| Procedural Complications | 232 | ||
| Repeated Catheterization Attempts | 232 | ||
| Hypoxia and Bradycardia | 232 | ||
| Surfactant Reflux | 232 | ||
| Recommendations | 232 | ||
| Selection of Infants | 232 | ||
| Gestational Age Range | 232 | ||
| Inclusion Criteria | 232 | ||
| Exclusion Criteria | 233 | ||
| Future Research Directions | 233 | ||
| Longer-Term Outcomes After Surfactant Delivery Via a Thin Catheter | 233 | ||
| Clinical Advantages of Surfactant Via a Thin Catheter Versus No Surfactant (i.e., Continuation of CPAP) | 233 | ||
| The Role of Spontaneous Breathing in Surfactant Distribution | 234 | ||
| Optimal Premedication for Infants at Different Gestation Ranges | 234 | ||
| Methods for Determining That the Catheter Is Correctly Positioned in the Trachea | 234 | ||
| REFERENCES | 235 | ||
| 13 - Respiratory Control and Apnea in Premature Infants | 239 | ||
| Biologic Challenges in Characterizing Neonatal Respiratory Control | 239 | ||
| Central Respiratory Control | 239 | ||
| Central and Peripheral Chemosensitivity | 240 | ||
| Contribution from Inflammatory Mechanisms | 241 | ||
| Clinical Challenges in Defining Neonatal Apnea | 241 | ||
| Association Between Apnea of Prematurity, Intermittent Hypoxemia, and Bradycardia and Neonatal Outcomes | 242 | ||
| Association Between Apnea of Prematurity, Intermittent Hypoxemia, and Bradycardia and Longer-Term Outcomes | 243 | ||
| Mechanistic Insights Into Morbidity | 243 | ||
| Controversies in Therapy | 244 | ||
| Accepted Treatments | 244 | ||
| Caffeine | 244 | ||
| Noninvasive Ventilation | 245 | ||
| Oxygen Administration | 245 | ||
| Positioning | 245 | ||
| Controversial Approaches | 246 | ||
| Kangaroo Care | 246 | ||
| Blood Transfusions | 246 | ||
| Mechanosensory Stimulation | 246 | ||
| Carbon Dioxide Therapy | 246 | ||
| Doxapram | 246 | ||
| Discharge Practice | 247 | ||
| REFERENCES | 247 | ||
| 14 - Oxygenation Instability in the Premature Infant | 251 | ||
| Mechanisms of Oxygenation Instability in Ventilated Infants | 251 | ||
| Oxygenation Instability in Spontaneously Breathing Infants After Mechanical Ventilation | 253 | ||
| Management of Oxygenation Instability | 254 | ||
| Ventilatory Strategies | 254 | ||
| Supplemental Oxygen | 255 | ||
| Reducing Environmental Disturbances | 256 | ||
| Consequences of Oxygenation Instability | 257 | ||
| Summary | 257 | ||
| REFERENCES | 258 | ||
| 15 - Optimal Oxygenation in Extremely Preterm Infants | 261 | ||
| Background | 261 | ||
| Observational Studies of Oxygenation Targeting | 262 | ||
| The Support Trial | 263 | ||
| Other Randomized Controlled Trials | 263 | ||
| Meta-Analyses of the Oxygen Saturation Targeting Trials | 264 | ||
| Subgroup Analyses | 265 | ||
| Achieved Oxygen Saturations in the Randomized Controlled Trials | 265 | ||
| Guidelines for Practice | 266 | ||
| Conclusions | 266 | ||
| REFERENCES | 266 | ||
| 16 - Patient-Ventilator Interaction | 269 | ||
| Patient-Ventilator Interaction During Conventional Mechanical Ventilation | 270 | ||
| Infant-Ventilator Asynchrony | 270 | ||
| Patient-Ventilator Interaction During Synchronized Mechanical Ventilation | 272 | ||
| Methods of Synchronization | 273 | ||
| Modalities of Synchronized Ventilation | 273 | ||
| Synchronized IMV | 273 | ||
| Assist/Control Ventilation | 274 | ||
| Pressure-Support Ventilation | 274 | ||
| Infant-Ventilator Maladaptation | 275 | ||
| Long Inspiratory Time and End-Inspiratory Asynchrony | 275 | ||
| Trigger Delay | 277 | ||
| Trigger Failure | 278 | ||
| Autotriggering | 278 | ||
| Excessive or Insufficient Circuit Flow | 278 | ||
| Excessive Peak Inflation Pressure | 279 | ||
| Excessive Positive End-Expiratory Pressure | 279 | ||
| Patient-Ventilator Interaction During Volume Targeted Ventilation | 280 | ||
| Patient-Ventilator Interaction During Neurally Adjusted Ventilatory Assist | 281 | ||
| Patient-Ventilator Interaction During Noninvasive Ventilation | 283 | ||
| Summary | 285 | ||
| REFERENCES | 286 | ||
| 17 - Pulmonary-Cardiovascular Interaction | 289 | ||
| Cardiorespiratory Interactions at Birth | 290 | ||
| The Physiology of Cardiovascular and Respiratory Interaction | 292 | ||
| Preload | 293 | ||
| Contractility | 294 | ||
| Afterload | 294 | ||
| Effect of the Respiratory System on the Cardiovascular System | 295 | ||
| Mechanical Ventilation | 295 | ||
| Effects of PEEP, CPAP, and MAP | 295 | ||
| Effect of Tidal Volume | 296 | ||
| Effect of Acidosis and Permissive Hypercapnia | 296 | ||
| Effect of the Cardiovascular System on the Respiratory System | 297 | ||
| Pulmonary Hypertension | 298 | ||
| Patent Ductus Arteriosus | 298 | ||
| Asphyxia | 299 | ||
| Congenital Diaphragmatic Hernia | 299 | ||
| Congenital Heart Disease | 299 | ||
| Interaction During Early Transition and Potential Clinical Implications | 300 | ||
| Surfactant | 300 | ||
| Carbon Dioxide, Cerebral Blood Flow, and Brain Injury | 300 | ||
| Interaction After Transition and Potential Clinical Implications | 301 | ||
| Conclusions | 302 | ||
| REFERENCES | 302 | ||
| 18 - Ventilator Strategies to Reduce Lung Injury and Duration of Mechanical Ventilation | 307 | ||
| Ventilator-Associated Lung Injury | 307 | ||
| How Can VALI Be Reduced? | 309 | ||
| Delivery Room Stabilization | 309 | ||
| Noninvasive Respiratory Support | 310 | ||
| Mechanical Ventilation Strategies | 310 | ||
| Basic Modes of Synchronized Ventilation | 311 | ||
| Synchronized Intermittent Mandatory Ventilation | 311 | ||
| Assist/Control | 311 | ||
| Pressure-Support Ventilation | 311 | ||
| Choice of Assisted Ventilation Modes | 312 | ||
| Volume-Targeted Ventilation | 312 | ||
| Importance of the Open Lung Strategy | 313 | ||
| High-Frequency Ventilation | 314 | ||
| Evidence-Based Approach to Mechanical Ventilation | 315 | ||
| REFERENCES | 316 | ||
| 19 - Automation of Respiratory Support | 321 | ||
| Automation in Mechanical Ventilation | 321 | ||
| Volume-Targeted Ventilation | 322 | ||
| Targeted Minute Ventilation | 324 | ||
| Proportional Assist Ventilation | 325 | ||
| Neurally Adjusted Ventilatory Assist | 326 | ||
| Automated Adjustment of Supplemental Oxygen | 327 | ||
| Summary | 332 | ||
| REFERENCES | 332 | ||
| 20 - Prenatal and Postnatal Steroids and Pulmonary Outcomes | 335 | ||
| Antenatal Corticosteroids | 335 | ||
| Historical Overview | 335 | ||
| Mechanism of Action of ANS on Fetal Lungs | 336 | ||
| Dated Randomized Controlled Trials and Current Patient Populations | 336 | ||
| Non-RCT information Regarding ANS and Outcomes | 337 | ||
| Repeated ANS Treatments | 338 | ||
| ANS After 34 Weeks’ Gestational Age | 339 | ||
| Concerns Regarding Drug and Dose Choices for ANS | 339 | ||
| Long-Term Outcomes After ANS | 340 | ||
| Antenal Steroid Use in Low-Resource Environments | 340 | ||
| Postnatal Steroids | 340 | ||
| Historical Review | 340 | ||
| Pathophysiology of BPD: What Are We Treating With PNS? | 341 | ||
| Meta-Analyses of Early and Late Treatments | 341 | ||
| Drug, Dose, Route, and Duration of Therapy | 342 | ||
| How PNS Are Used | 342 | ||
| Four New Trials of Early PNS | 343 | ||
| Summary and Future Directions | 344 | ||
| REFERENCES | 344 | ||
| 21 - Cell-Based Therapy for Neonatal Lung Diseases | 347 | ||
| Stem Cells | 348 | ||
| Endogenous Lung Stem Cells | 348 | ||
| Airway Candidate Stem Cells | 350 | ||
| Alveolar Candidate Stem Cells | 350 | ||
| Lung Mesenchymal Stem Cells | 351 | ||
| Lung Endothelial Progenitors | 351 | ||
| Cell Therapies for Bronchopulmonary Dysplasia | 352 | ||
| Evidence from Preclinical Studies | 352 | ||
| Mechanisms of Repair | 353 | ||
| From Bench to Bedside: Evidence from a Phase I Clinical Trial | 355 | ||
| Barriers to Implementation | 356 | ||
| Optimal Cells | 356 | ||
| Right Patient | 356 | ||
| Right Time | 356 | ||
| Right Route | 357 | ||
| Right Dose | 357 | ||
| Conclusion | 357 | ||
| REFERENCES | 357 | ||
| 22 - A Physiology-Based Approach to the Respiratory Care of Children With Severe Bronchopulmonary Dysplasia | 363 | ||
| Definitions and Scope of Severe BPD | 364 | ||
| Pathogenesis of Severe BPD | 366 | ||
| Pathophysiology of Severe BPD | 368 | ||
| Respiratory Function | 368 | ||
| Lung Mechanics in Severe BPD | 369 | ||
| Lung Volumes in Severe BPD | 369 | ||
| Forced Flows in Severe BPD | 370 | ||
| Lung Imaging in Severe BPD | 370 | ||
| The Cardiovascular System in Severe BPD | 371 | ||
| Evaluation and Treatment of Severe BPD | 372 | ||
| Mechanical Ventilation | 373 | ||
| Drug Therapies | 377 | ||
| Treatment of Pulmonary Hypertension | 378 | ||
| Interdisciplinary Care | 379 | ||
| Long-Term Outcomes | 380 | ||
| REFERENCES | 380 | ||
| Index | 387 | ||
| A | 387 | ||
| B | 388 | ||
| C | 389 | ||
| D | 390 | ||
| E | 390 | ||
| F | 391 | ||
| G | 391 | ||
| H | 392 | ||
| I | 392 | ||
| K | 393 | ||
| L | 393 | ||
| M | 393 | ||
| N | 394 | ||
| O | 395 | ||
| P | 395 | ||
| R | 397 | ||
| S | 398 | ||
| T | 399 | ||
| U | 400 | ||
| V | 400 | ||
| W | 400 | ||
| IBC | ES2 |