Related Experiment Video
Updated: Aug 18, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Pulmonary dysfunction in surgical conditions of the newborn infant
D K Nakayama1, R Mutich, E K Motoyama
1Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA.
Insights
Surgical newborns with respiratory insufficiency show reduced lung function, particularly in expiratory flow. Bronchodilators may improve outcomes for infants with reactive airways needing mechanical ventilation.
Area of Science:
- Neonatal surgery
- Pediatric respiratory medicine
- Pulmonary physiology
Background:
- Surgical conditions in newborns can lead to respiratory insufficiency.
- Understanding the pathophysiology is crucial for effective management.
Purpose of the Study:
- To describe the pathophysiology of surgical conditions causing respiratory insufficiency in newborn infants.
- To evaluate pulmonary function and airway reactivity in these infants.
Main Methods:
- Flow-volume curves and passive expiratory curves were measured in 24 newborn infants.
- Pulmonary function was assessed before and after bronchodilator administration.
- Term and preterm infants served as controls.
Main Results:
- Infants with surgical conditions exhibited decreased forced vital capacity (FVC) and maximal expiratory flow.
- Airway reactivity was indicated by a significant increase in maximal expiratory flow after bronchodilator use.
- Respiratory system compliance was significantly reduced in all surgical disease groups.
Conclusions:
- Bronchial reactivity contributes to reduced expiratory flow in surgical newborns, similar to premature infants with respiratory distress syndrome.
- Bronchodilators may benefit infants with reactive airways requiring postoperative ventilatory support.
Objective:
To describe the pathophysiology of surgical conditions that are associated with respiratory insufficiency in the newborn infant.
Design:
Survey.
Setting:
Newborn ICU in a children's hospital.
Patients:
Twenty-four newborn infants (1 to 28 days old) who required endotracheal intubation and mechanical ventilation for operative procedures or postoperative ventilatory support.
Interventions:
Flow-volume curves obtained by manual inflation of the lungs, followed by forced deflation by negative pressure, and by passive expiration, under sedation and pharmacologic paralysis.
Measurements:
Deflation flow-volume curves and passive expiratory curves were measured. Pulmonary function testing before and after bronchodilator administration (n = 11) began midway during the study period. Term and preterm groups served as controls.
Main Results:
Forced vital capacity (FVC) was decreased in all groups with surgical disease as follows: abdominal wall defects and necrotizing enterocolitis groups to 48.3% and 62.1% that of preterm, respectively; pulmonary hypoplasia group to 55.5% that of term (p less than .05). Maximal expiratory flow at 25% of FVC decreased in all groups: abdominal wall defects and necrotizing enterocolitis group, to 36.8% and 37.9% that of preterm, respectively (p less than .05); pulmonary hypoplasia group, 20.0% that of term (p less than .05). The ratio of maximal expiratory flow at 25% of FVC divided by FVC was significantly decreased in necrotizing enterocolitis and pulmonary hypoplasia groups compared with that of preterm and term groups, respectively, but not in the abdominal wall defects group. Maximal expiratory flow at 25% of FVC, but not FVC, increased significantly (36%, p less than .05) after bronchodilator nebulization, indicating the presence of airway reactivity. Respiratory system compliance was decreased significantly (p less than .05) in all surgical disease groups compared with the term group.
Conclusions:
Bronchial reactivity contributes to decreased maximal expiratory flow at 25% of FVC, a feature also seen in premature infants with respiratory distress syndrome who later develop bronchopulmonary dysplasia. Babies who require chronic ventilatory support after operation and who have developed reactive airways may benefit from the administration of bronchodilators during postoperative ventilatory management.
Related Concept Videos
01:05Breathing
01:17Pulmonary Cycle: Exhalation
01:30Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:25Pulmonary Function Tests
Pulmonary Function Tests are crucial diagnostic tools for assessing respiratory function, particularly in patients with chronic respiratory disorders. They comprehensively evaluate lung volumes, ventilatory function, breathing mechanics, diffusion, and gas exchange. These tests help diagnose pulmonary diseases and play a significant role in monitoring disease progression, evaluating disability, and assessing response to therapy.
PFTs involve using a spirometer, a...
01:10Atelectasis II: Pathophysiology