Respiratory muscle function in the newborn: a narrative review

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Diagnostic Imaging

Background:

• Respiratory muscles, primarily the diaphragm, are vital for breathing in newborns.
• Newborns, particularly premature infants, are susceptible to diaphragmatic dysfunction due to physiological immaturity.
• Factors like congenital anomalies and infections can impair respiratory muscle function.

Purpose of the Study:

• To review current evidence and methods for assessing respiratory muscle function in newborns.
• To explore the clinical applications of these assessment methods.
• To highlight recent technological advancements in the field.

Main Methods:

• Review of existing literature on respiratory muscle function assessment in neonates.
• Inclusion of methods such as electromyography, maximal respiratory pressures, and thoraco-abdominal asynchrony.
• Emphasis on emerging techniques like bedside ultrasonography and neurally adjusted ventilator assist.

Main Results:

• Respiratory muscle function is often impaired in premature neonates and those with congenital anomalies.
• Prolonged mechanical ventilation, hypoxia, hypercapnia, and infections negatively impact respiratory muscle function.
• Caffeine and synchronized/volume-targeted ventilation positively influence respiratory muscle function.

Conclusions:

• Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist represent significant advancements.
• These novel technologies offer substantial clinical applicability for managing respiratory function in newborns.
• Optimizing respiratory support and utilizing adjunct therapies like caffeine are key to improving outcomes.