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Neonatal Lung Diseases

  • Thordur ThorkelssonEmail author
  • Gunnlaugur Sigfusson
Chapter
  • 2.2k Downloads

Abstract

Lung diseases are one of the main causes of neonatal morbidity and mortality. The majority of them result from lung immaturity and difficulties in the transition from intrauterine to extrauterine life. Respiratory distress syndrome occurs primarily due to surfactant deficiency and is the most common cause of respiratory distress in the preterm infant, but can also be seen in infants born at term. Transient tachypnea of the newborn is a common cause of neonatal respiratory dysfunction and results from delayed absorption of fetal lung fluid. Bronchopulmonary dysplasia is a form of chronic lung disease which is today primarily seen in the most preterm infants and is characterized by the need for prolonged respiratory support and oxygen supplementation. Other lung diseases affecting the newborn infant include pneumonias, aspiration of meconium stained amniotic fluid and congenital anomalies. These conditions are sometimes further complicated by persistent pulmonary hypertension, which is more commonly seen in the term than the preterm infant. Advances in the management of lung diseases affecting the newborn infant have resulted in marked improvement in their survival. These therapies include the administration of pulmonary surfactant, the use of nitric oxide for persistent pulmonary hypertension and extracorporeal membrane oxygenation therapy. Advances in respiratory support have resulted in decreased ventilatory-induced lung injury and thus improved pulmonary outcome.

This chapter gives an overview of fetal lung development, neonatal respiratory physiology and the clinical presentation of respiratory dysfunction in the neonate. The etiology and pathophysiology of the most common neonatal lung diseases and their management are also discussed.

Keywords

Newborn Preterm Lung diseases Respiratory distress syndrome Persistent pulmonary hypertension of the newborn Surfactant Bronchopulmonary dysplasia Congenital diaphragmatic hernia 

References

  1. 1.
    Wert SE. Normal and abnormal structural development of the lung. In: Polin RA, Fox WF, Abam SH, editors. Fetal and neonatal physiology. Philadelphia: Saunders; 2004. p. 783–801.CrossRefGoogle Scholar
  2. 2.
    Barker PM, Southern KW. Regulation of liquid secretion and absorption by the fetus and neonatal lung. In: Polin RA, Fox WF, Abam SH, editors. Fetal and neonatal physiology. Philadelphia: Saunders; 2004. p. 822–34.CrossRefGoogle Scholar
  3. 3.
    Turi JL, Cheifetz IM. Acute respiratory failure. In: Wheeler DE, Wong HR, Shanley PS, editors. Resuscitation and stabilization of the critically Ill child. Philadelphia: Springer; 2008. p. 115–23.Google Scholar
  4. 4.
    Askie LM, Henderson-Smart DJ, Ko H. Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Cochrane Database Syst Rev. 2009;(1):CD001077.Google Scholar
  5. 5.
    Carlo WA, et al. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010;362(21):1959–69.PubMedCrossRefGoogle Scholar
  6. 6.
    Binder N, et al. Measurement of transcutaneous carbon dioxide in low birthweight infants during the first two weeks of life. Am J Perinatol. 1994;11(3):237–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Molloy EJ, Deakins K. Are carbon dioxide detectors useful in neonates? Arch Dis Child Fetal Neonatal Ed. 2006;91(4):F295–8.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Hibbard JU, et al. Respiratory morbidity in late preterm births. JAMA. 2010;304(4):419–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. HiFO Study Group. J Pediatr. 1993. 122(4):609–19.Google Scholar
  10. 10.
    Courtney SE, et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. N Engl J Med. 2002;347(9):643–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Bjorklund LJ, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res. 1997;42(3):348–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Kattwinkel J, et al. Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S909–19.Google Scholar
  13. 13.
    Morley CJ, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358(7):700–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Rabi Y, Singhal N, Nettel-Aguirre A. Room-air versus oxygen administration for resuscitation of preterm infants: the ROAR study. Pediatrics. 2011;128(2):e374–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Dani C, et al. Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. Italian Group of Neonatal Pneumology. Eur Respir J. 1999;14(1):155–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Vivian-Taylor J, et al. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. BJOG. 2011;118(13):1601–7.Google Scholar
  17. 17.
    El Shahed AI, et al. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev. 2007;(3):CD002054.Google Scholar
  18. 18.
    Kinsella JP, Abman SH. Inhaled nitric oxide and high frequency oscillatory ventilation in persistent pulmonary hypertension of the newborn. Eur J Pediatr. 1998;157 Suppl 1:S28–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Gupta A, et al. Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn–a single-center, 5-year experience. J Perinatol. 2002;22(6):435–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995;102(2):101–6.PubMedCrossRefGoogle Scholar
  21. 21.
    American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 394, December 2007. Cesarean delivery on maternal request. Obstet Gynecol. 2007;110(6):1501.CrossRefGoogle Scholar
  22. 22.
    Roberts D. Antenatal corticosteroids to reduce neonatal morbidity and mortality. The Royal College of Obstetricians and Gynaecologists. (Green-top Guideline; no. 7); 2010.Google Scholar
  23. 23.
    Jacobstein MD, et al. Neonatal circulatory changes following elective cesarean section: an echocardiographic study. Pediatrics. 1982;69(3):374–6.PubMedGoogle Scholar
  24. 24.
    Bibby JG, et al. Prostaglandins in umbilical plasma at elective caesarean section. Br J Obstet Gynaecol. 1979;86(4):282–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Keszler M, et al. Severe respiratory failure after elective repeat cesarean delivery: a potentially preventable condition leading to extracorporeal membrane oxygenation. Pediatrics. 1992;89(4 Pt 1):670–2.PubMedGoogle Scholar
  26. 26.
    Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1–36.PubMedGoogle Scholar
  27. 27.
    Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am. 2009;56(3):579–600. Table of Contents.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    The Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med. 1997;336(9):597–604.CrossRefGoogle Scholar
  29. 29.
    Kelly LK, et al. Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide. J Pediatr. 2002;141(6):830–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2011;(8):CD005494.Google Scholar
  31. 31.
    Bassler D et al. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010;(11):CD007802.Google Scholar
  32. 32.
    Shennan AT, et al. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988;82(4):527–32.PubMedGoogle Scholar
  33. 33.
    Stoll BJ, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443–56.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967;276(7):357–68.PubMedCrossRefGoogle Scholar
  35. 35.
    Kugelman A, Durand M. A comprehensive approach to the prevention of bronchopulmonary dysplasia. Pediatr Pulmonol. 2011;46(12):1153–65.PubMedCrossRefGoogle Scholar
  36. 36.
    Brion LP, Primhak RA, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2002;(1):CD001817.Google Scholar
  37. 37.
    Ng GY, da S, Ohlsson A. Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2001;(3):CD003214.Google Scholar
  38. 38.
    Watterberg KL. Policy statement–postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics. 2010;126(4):800–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Pantalitschka T, Poets CF. Inhaled drugs for the prevention and treatment of bronchopulmonary dysplasia. Pediatr Pulmonol. 2006;41(8):703–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Farquhar M, Fitzgerald DA. Pulmonary hypertension in chronic neonatal lung disease. Paediatr Respir Rev. 2010;11(3):149–53.PubMedCrossRefGoogle Scholar
  41. 41.
    Northway Jr WH, et al. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med. 1990;323(26):1793–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Furman L, et al. Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. J Pediatr. 1996;128(4):447–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Short EJ, et al. Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes. Pediatrics. 2003;112(5):e359.PubMedCrossRefGoogle Scholar
  44. 44.
    Miller MJ, Martin RJ. Apnea of prematurity. Clin Perinatol. 1992;19(4):789–808.PubMedGoogle Scholar
  45. 45.
    Marchal F, Bairam A, Vert P. Neonatal apnea and apneic syndromes. Clin Perinatol. 1987;14(3):509–29.PubMedGoogle Scholar
  46. 46.
    Walther-Larsen S, Rasmussen LS. The former preterm infant and risk of post-operative apnoea: recommendations for management. Acta Anaesthesiol Scand. 2006;50(7):888–93.PubMedCrossRefGoogle Scholar
  47. 47.
    Kuhns LR, et al. Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination. Pediatrics. 1975;56(3):355–60.PubMedGoogle Scholar
  48. 48.
    Keszler M, et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr. 1991;119(1 Pt 1):85–93.PubMedCrossRefGoogle Scholar
  49. 49.
    Alfaraj MA, et al. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol. 2011;205(1):43.e1–8.CrossRefGoogle Scholar
  50. 50.
    Mullassery D, et al. Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2010;35(5):609–14.PubMedCrossRefGoogle Scholar
  51. 51.
    Murthy V, et al. Impact of neuromuscular blockade on lung function during the initial resuscitation of infants with congenital diaphragmatic hernia. Pediatr Res. 2011;70:536.CrossRefGoogle Scholar
  52. 52.
    Wung JT, et al. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg. 1995;30(3):406–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Bohn D. Congenital diaphragmatic hernia. Am J Respir Crit Care Med. 2002;166(7):911–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Antonoff MB, et al. Protocolized management of infants with congenital diaphragmatic hernia: effect on survival. J Pediatr Surg. 2011;46(1):39–46.PubMedCrossRefGoogle Scholar
  55. 55.
    Mohseni-Bod H, Bohn D. Pulmonary hypertension in congenital diaphragmatic hernia. Semin Pediatr Surg. 2007;16(2):126–33.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of NeonatologyChildren’s Hospital IcelandReykjavikIceland
  2. 2.Department of PediatricsChildren’s Hospital IcelandReykjavikIceland

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