Injury and inflammation from resuscitation of the preterm infant

Area of Science:

• Neonatal physiology
• Respiratory medicine
• Pediatric critical care

Background:

• The preterm infant lung is vulnerable to injury during mechanical ventilation initiated at birth.
• Multiple ventilation parameters (pressure, tidal volume, PEEP, gas type) may contribute to lung injury, but their relative impact remains unclear.

Purpose of the Study:

• To review current understanding of preterm lung injury from mechanical ventilation.
• To explore mechanisms by which ventilation may harm the developing lung.

Main Methods:

• Review of existing literature on mechanical ventilation and preterm infant lung injury.
• Analysis of factors contributing to lung injury, including tidal volume and inflation models.

Main Results:

• Initial high tidal volume ventilation exacerbates lung injury.
• A fluid-filled lung inflation model suggests even low tidal volumes can injure the preterm lung, particularly small airways.
• The precise contribution of individual ventilation variables to lung injury is not fully established.

Conclusions:

• Mechanical ventilation poses a risk of injury to the preterm lung.
• Further research is needed to develop safer ventilation strategies for preterm infants.
• Understanding lung inflation dynamics is crucial for minimizing ventilator-induced lung injury.