Management of Hypoxemic Respiratory Failure in the Newborn During Therapeutic Hypothermia

Therapeutic hypothermia (TH) is the gold standard for the management of hypoxic ischemic encephalopathy (HIE) in newborns. Both hypoxia and TH may contribute to an increase in pulmonary vascular resistance (PVR), resulting in persistent pulmonary hypertension of the newborn. Infants with worsening hypoxemic respiratory failure in the setting of HIE and TH may require optimization of respiratory support to achieve adequate lung recruitment, surfactant, and inhaled nitric oxide to improve oxygenation and ventilation strategies to avoid acidosis and hypocapnia. Furthermore, management of systemic hypotension should be tailored to increase systemic vascular resistance without increasing PVR.