Neonatal ventilation

Infants in the neonatal ICU require mechanical ventilation for a variety of reasons. Some of these infants are term babies who are undergoing surgical procedures with otherwise normal neonatal lungs, others are babies who are born with significant intrinsic or congenital lung disease or who are born prematurely. The overriding principle in the application of mechanical ventilation to any infant in these groups is to supply adequate oxygenation and carbon dioxide removal while minimizing the risk for injury and long-term lung impairment. The size of these patients, particularly ones born prematurely, and their still-developing lungs create challenges to mechanical ventilation in the neonatal population which are different from mechanical ventilation and an older pediatric or adult population.

In this review we will first provide an overview of the structural and functional differences between the neonatal and adult lungs. We will then discuss the mechanisms of lung injury that can arise through mechanical ventilation in this population. These mechanisms of lung injury provide guiding principles for the application of mechanical ventilation to neonates. We will discuss specifically the use of noninvasive ventilation, conventional mechanical ventilation, and high frequency oscillatory ventilation.

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