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Achieving and maintaining lung volume in the preterm infant: from the first breath to the NICU

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Abstract

The main goal for the neonatologist is to facilitate the adaptation to extra-uterine life during initial transition, while minimizing lung injury opening and protecting the premature lung from the first breath onwards. An appropriate management from birth should lead to the achievement of an early functional residual capacity (FRC), and the following steps should aim at maintaining an adequate lung volume. To date, different strategies are available to optimize fetal-neonatal transition and promote lung recruitment. New ventilation approaches, such as sustained lung inflation (SLI) and “open lung strategy”, well-established ventilation techniques with a more tailored application and less invasive modalities to administer surfactant have been recently introduced in clinical practice with promising results.

Conclusions: given the current status of neonatal care, it seems that lung injury and BPD could be reduced with multiple strategies starting early in the delivery room. Literature underlines the importance of a respiratory tailored management of preterm infants from birth and during the whole NICU stay.

What is Known:

• Experimental and clinical studies have shown that the transition from fetal to adult type cardiorespiratory circulation needs an adequate lung ventilation. An appropriate management in the delivery room should lead to the achievement of an early FRC, and through the following steps, the neonatologist should aim at maintaining an adequate lung volume.

• Literature underlines the importance of a respiratory tailored management of preterm infants during the whole NICU stay to maintain the benefits of a successful postnatal adaption.

What is New:

• Herewith, we describe the most relevant and recent interventions which can be performed from the delivery room to the NICU stay to guarantee an adequate tradition to postnatal life and an effective cardiorespiratory stability.

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Abbreviations

BPD:

bronchopulmonary dysplasia

CPAP:

continuous positive airway pressure

ELGAN:

extremely low gestational age neonate

FRC:

functional residual capacity

GA:

gestational age

HFNC:

high-flow nasal cannula

HFV:

high-frequency ventilation

LISA:

less invasive surfactant administration

LRM:

lung recruitment maneuver

MIST:

minimally invasive surfactant therapy

MV:

mechanical ventilation

N-CPAP:

nasal continuous positive airway pressure

NIPPV:

nasal intermittent positive pressure ventilation

PEEP:

positive end expiratory pressure

RDS:

respiratory distress syndrome

RFM:

respiratory function monitor

SI:

sustained inflation

SIMV:

synchronized intermittent mechanical ventilation

VILI:

ventilator-induced lung injury

VLBW:

very low birth weight

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Author information

Authors and Affiliations

  1. NICU “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, Via Castelvetro, 32, 20154, Milan, Italy

    Gianluca Lista

  2. Division of Neonatology, Clínica Alemana, Santiago, Chile

    Andrés Maturana

  3. Coastal Carolina Neonatology, Coastal Children’s Services, PLLC, Wilmington, NC, 28401, USA

    Fernando R. Moya

Authors
  1. Gianluca Lista
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  2. Andrés Maturana
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  3. Fernando R. Moya
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Contributions

Dr. Gianluca Lista conceptualized this paper, drafted the initial manuscript, and revised the final version. Dr. Andres Maturana conceptualized this paper and reviewed the manuscript. Dr. Fernando Moya conceptualized the paper and wrote the final manuscript. All authors agree with the final paper as submitted.

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Correspondence to Gianluca Lista.

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The authors declare that they have no conflict of interest.

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Communicated by Patrick Van Reempts

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Lista, G., Maturana, A. & Moya, F.R. Achieving and maintaining lung volume in the preterm infant: from the first breath to the NICU. Eur J Pediatr 176, 1287–1293 (2017). https://doi.org/10.1007/s00431-017-2984-y

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  • DOI: https://doi.org/10.1007/s00431-017-2984-y

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