Understanding the sequence of pulmonary injury in the extremely low birth weight, surfactant-deficient infant

Steven W Peterson1

  • 1Pediatrics/Pediatric IntensiveCare, Stormont-Vail HealthCare, 1500 Sw 10th Street, Topeka, KS 66604, USA. stpeters@stormontvail.org

Neonatal Network : NN
|July 14, 2009
PubMed

Insights

Human lung development is complex and vulnerable to injury, especially in premature infants. Understanding acute lung injury is key to preventing chronic lung disease and bronchopulmonary dysplasia in neonates.

Area of Science:

  • Neonatal medicine
  • Pediatric pulmonology
  • Developmental biology

Background:

  • Human lung development spans from postconception to early childhood.
  • Altered lung development can result in significant morbidities and mortality.
  • Neonatal lung injury poses critical challenges for extremely low birth weight infants.

Purpose of the Study:

  • To provide foundational information on acute lung injury.
  • To explain the sequence of events leading to neonatal chronic lung disease.
  • To guide bedside clinicians in managing neonatal lung conditions.

Main Methods:

  • Literature review of human lung development and injury.
  • Pathophysiological analysis of neonatal lung injury.
  • Clinical information synthesis for bedside application.

Main Results:

  • Identified critical developmental windows susceptible to lung injury.
  • Outlined the progression from acute injury to chronic lung disease.
  • Highlighted the importance of early management in extremely low birth weight neonates.

Conclusions:

  • Understanding lung development pathophysiology is crucial for neonatal care.
  • Early recognition and management of acute lung injury can mitigate long-term consequences.
  • This information supports clinicians in preventing bronchopulmonary dysplasia.

Related Concept Videos

Breathing01:05

Breathing

The process of breathing, inhaling and exhaling, involves the coordinated movement of the chest wall, the lungs, and the muscles that move them. Two muscle groups with important roles in breathing are the diaphragm, located directly below the lungs, and the intercostal muscles, which lie between the ribs. When the diaphragm contracts, it moves downward, increasing the volume of the thoracic cavity and creating more room for the lungs to expand. When the intercostal muscles contract, the ribs...
Pulmonary Cycle: Exhalation01:17

Pulmonary Cycle: Exhalation

In terms of human respiration, the act of expelling air, known as exhalation (or expiration), operates on the principle of pressure gradients. During expiration, the pressure within the lungs exceeds that of the surrounding atmosphere. Under normal conditions, quiet breathing involves passive exhalation and is free of muscular contractions. This is because the exhalation process is driven by the natural elastic recoil of the lungs and chest wall, both of which have an inherent tendency to...
Atelectasis II: Pathophysiology01:10

Atelectasis II: Pathophysiology

Atelectasis develops when alveoli lose their air and collapse inward. Because lung tissue is naturally elastic, these air sacs shrink rather than remaining open. Collapsed alveoli are no longer ventilated, reducing their role in gas exchange. Blood flow may continue in these regions, creating a ventilation–perfusion mismatch. Clinical findings include decreased breath sounds, dullness to percussion, reduced chest expansion, and decreased tactile fremitus as sound transmission through collapsed...
Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Pulmonary Edema II: Pathophysiology01:18

Pulmonary Edema II: Pathophysiology

Pulmonary edema is the accumulation of fluid in the interstitial and alveolar spaces of the lungs, impairing gas exchange and oxygen delivery. It may be cardiogenic or noncardiogenic, but both reduce oxygenation and lung compliance.Cardiogenic Pulmonary EdemaCardiogenic edema results from increased hydrostatic pressure in pulmonary capillaries, usually due to left ventricular dysfunction from myocardial infarction, heart failure, or valvular disease. Ineffective cardiac pumping causes blood to...
Factors Affecting Pulmonary Ventilation01:19

Factors Affecting Pulmonary Ventilation

Besides the pressure difference between the external environment and the lungs, the airflow rate and ease of pulmonary ventilation are also influenced by three other factors: surface tension of the fluid in the alveoli, compliance of the lungs, and airway resistance.
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...