Worsening respiratory failure in the newborn: considerations and therapeutic options

Abstract 

Worsening of respiratory failure of the newborn is a common situation in neonatal intensive care units. Any textbook on neonatology has chapters on this topic, but there is still a surprising lack of general accepted guidelines for what to do in that situation. Although such guidelines will depend on local traditions and strategies for initial treatment, as well as the degree of centralization of the treatment of the sick newborn. This article will provide suggestions for some basic considerations to be modified for each unit. It will also focus on the important topic of how to avoid iatrogenic injury by overly aggressive treatment. Guidelines for patients treated with nasal continous positive airway pressure and patients intubated and put on any kind of conventional positive pressure ventilation are described. Guidelines for high-frequency oscillatory ventilation, negative pressure ventilation, extracorporal membrane oxygenation and more experimental approaches, such as liquid ventilation, are not part of this article. Additive treatments like surfactant, nitric oxide and prostacyclin are only mentioned briefly.

Keywords: hypoxia, hypercapnia, hypocapnia, respiratory failure, mean airway pressure, ventilatory support

No full text is available. To read the body of this article, please view the PDF online.

• f1 E-mail: Klu@dadlnet.dk