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25 years of respiratory support of newborn infants
1Department of Pediatrics, Benjamin Franklin University Hospital, Free University of Berlin, Fed. Rep. of Germany.
Insights
Respiratory support for newborns has advanced significantly, reducing mortality and morbidity in premature infants. Modern techniques offer sophisticated care, improving outcomes for even the most vulnerable infants.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Historical "blow in--suck out" methods led to high infant mortality and morbidity.
- Advances in understanding respiratory pathophysiology and controlled therapy studies were crucial.
- The development of specialized perinatal centers enhanced newborn respiratory care.
Observation:
- Continuous distending pressure improved outcomes in surfactant-deficient lungs.
- High-frequency positive pressure ventilation (HFPPV) allowed for precise adjustments.
- Artificial surfactant substitution became a viable therapeutic option.
Findings:
- Sophisticated respiratory support has dramatically reduced mortality and morbidity in newborns.
- Very-low-birth-weight infants, previously with poor prognoses, now have improved survival rates.
- Key milestones include CPAP, optimized HFPPV, and surfactant replacement therapy.
Implications:
- Future innovations like high-frequency oscillation (HFO), NO-inhalation, proportional assist ventilation, and liquid ventilation are under investigation.
- The evolution of respiratory support has transformed neonatal intensive care.
- Continued research promises further improvements in respiratory outcomes for neonates.
Abstract:
Respiratory support of newborn infants has changed in the last 25 years, because of new knowledge of patho-physiology, controlled studies of respiratory therapy and the realisation of perinatal centers. Respiratory support has changed from the "blow in--suck out" approach, inevitably leading to severe atelectasis, high morbidity and mortality to a now very sophisticated therapy with reduced mortality and morbidity also in very-low-birth-weight infants, who were hopeless patients 25 years ago. Major milestones of this development were the introduction of continuous distending pressure to surfactant deficient lungs, the high-frequency positive pressure ventilation with fine tuning of inspiratory and expiratory times, adjusted to individual time constants and the substitution of artificial surfactant. Techniques for the future, like HFO, NO-inhalation, proportional assist ventilation and liquid ventilation are presently investigated.