The management of chronic lung disease

Abstract 

Lung injury leading to chronic respiratory problems is a consequence of ventilation of the immature, surfactant deficient lung, and starts as soon as the baby is born. Strategies to minimize lung damage are an important part of the management of chronic lung disease (CLD). Prevention of overdistension of the lung, application of positive end expiratory pressure (PEEP) during resuscitation and prophylactic surfactant have been shown to reduce lung injury. The treatment of maternally acquiredUreaplasma urealyticum has not been shown to affect CLD.

Ventilator strategies must aim to reduce lung injury and continuous on-line flow measurements, particularly measurement of tidal volume, can help. Oxygen is essential but can also be toxic and there is uncertainty about optimum saturation levels. Diuretics, bronchodilators and methylxanthines have short-term effects but have not been shown to affect outcome. Postnatal steroids improve lung function but they have been associated with cerebral palsy. Their use should be limited to very severe cases, and only after discussion with parents. The place of routine prophylaxis against respiratory syncytial virus (RSV) remains controversial.

Keywords: chronic lung disease, bronchopulmonary dysplasia, management

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

• f1 Correpondence to: AL. Tel: 0131 536 4213; Fax: 0131 536 4297; E-mail: andy.lyon@ed.ac.uk