Goldsmith’s Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care

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Front matter
	Goldsmith’s assisted ventilation of the neonate: An evidence-based approach to newborn respiratory care
Copyright
Contributors
Foreword
Preface
Table of Contents
Section 1 History, Pulmonary Physiology, and General Considerations
	1 Introduction and historical aspects
		History of neonatal ventilation: Earliest reports
		Sixteenth and seventeenth centuries
		Eighteenth and nineteenth century
		Twentieth century
		Breakthroughs in ventilation
		Recent advances and outcomes
		Key references
	2 Physiologic principles
		Basic biochemistry of respiration: Oxygen and energy
		Ontogeny recapitulates phylogeny: A brief overview of developmental anatomy
			Lung development
				Phases of lung development
				Embryonic phase (weeks 3 to 6): Development of proximal airways
				Pseudoglandular phase (weeks 6 to 16): Development of lower conducting airways
				Canalicular phase (weeks 16 to 26): Formation of gas-exchanging units or acini
				Terminal sac phase (weeks 26 to 36): Refinement of acini
				Alveolar phase (week 36 to 3 years): Alveolar proliferation and development
		Mechanics
			Compliance
				Static compliance
				Dynamic compliance
			Resistance
				Flow rate
				Airway or tube length
				Airway or tube diameter
				Viscosity and density
			Work of breathing
			Time constant
		Gas transport
			Mechanisms of gas transport
		Oxygenation
			Effects of altering ventilator settings on oxygenation
		Ventilation
		Perfusion
		Control of ventilation
		Conclusion
		Acknowledgments
		Selected readings
	3 Control of ventilation
		Introduction
		Pathogenesis of apnea of prematurity
			Central carbon dioxide chemosensitivity
			Peripheral (hypoxic) chemosensitivity
			Role of mechanoreceptor (laryngeal) afferents
		Genesis of central, mixed, and obstructive apnea
		Relationship between apnea, bradycardia, and desaturation
		Cardiorespiratory events in intubated infants
		Therapeutic approaches
			Optimization of mechanosensory inputs
			Optimization of blood gas status
			Role of gastroesophageal reflux
			Xanthine therapy
			Continuous positive airway pressure
		Long-term consequences of neonatal apnea
		Key references
	4 Ethical issues in assisted ventilation of the neonate
		Introduction
		An ethical basis for decision making
		Withdrawing and withholding assisted ventilation
		Nonescalation and “heroic measures”
		Moral distress
			Who makes the call? Shared decision making in the neonatal intensive care unit
			Quality of life considerations
		Coming to a consensus: When is withholding or withdrawal of assisted ventilation ethically permissible?
		Chronic ventilation and tracheostomy
		Conclusion
		Key references
	5 Evidence-based respiratory care
		Background
		The technical steps of evidence-based medicine
			Formulating the question
			Searching for the evidence
			Evaluating evidence about therapy
				Evaluating the quality (certainty) of evidence
				Determining the quantitative effects of a therapy
				Noninferiority trials
				Systematic reviews of therapeutic interventions and meta-analyses
				Weighing risks, benefits, and costs
			Evaluating evidence about diagnostic tests
				Evaluating the certainty of evidence for diagnostic tests
				Determining diagnostic test accuracy
			Bayesian reasoning in diagnostic testing
			Special considerations in applying evidence to respiratory interventions
		Cognitive skills for evidence-based practice
			Critical thinking
			Clinical reasoning and decision making
		Translating evidence into practice
		Summary
		Suggested readings
	6 Quality and safety in respiratory care
		Quality and safety: Background
			Donabedian’s triad
			The institute of medicine’s domains of quality
		Assessing and monitoring the quality of care
		Quality indicators for comparative performance measures
		Quality indicators for improvement
		Improving the quality of care
		The improvement team
		Collaboration
		Aim: What are we trying to accomplish?
		Measurement: How will we know that a change is an improvement?
		What changes can we make that will result in an improvement?
		Plan–do–study–act cycles
		Ensuring the success of quality improvement projects
		Leadership and unit culture
		Why is quality improvement important in neonatal respiratory care?
		Examples of quality and safety improvement in neonatal respiratory care
			Quality improvement projects in individual units
			Collaborative quality improvement projects
		Conclusion
		Key references
	7 Medical and legal aspects of respiratory care
		Disclaimer
		General legal principles
		Supervision of others
		Malpractice
			Duty
			Breach
			The expert witness
			Causation
			Damages
			Burden of proof
		Malpractice issues specific to neonatology and neonatal respiratory care
			Resuscitation
			Prematurity/periventricular leukomalacia
		Respiratory failure/mechanical ventilation
			Patient safety/culture of safety
		Decreasing the risk of a malpractice lawsuit
			Competency
			Communication
			Documentation
		The future of malpractice litigation
		Conclusion
		Key references
Section 2 Patient Evaluation and Monitoring
	8 Physical examination
		Historical aspects
		Importance of the physical examination
		Technique of the physical examination
			Overview
			Performing the neonatal respiratory physical examination
		Interpretation of the findings of physical examination
			General physical examination findings
			Special technique of examination: Transillumination
		Physical examination findings in specific clinical situations
			Examination at birth
			Examination of an infant receiving face mask or laryngeal mask ventilation
			Examination of the ventilated infant
			Conventional ventilation
			High-frequency ventilation: Oscillation
			High-frequency ventilation: Jet ventilation
			Examination of an infant on constant positive airway pressure
		Conclusion
		Key references
	9 Imaging: Radiography, lung ultrasound, and other imaging modalities
		Introduction
		Radiation exposure
		Imaging modalities
			Chest radiograph
			Ultrasound
			Computed tomography
			Fluoroscopy
			Magnetic resonance imaging
		Invasive support devices
			Endotracheal tube
			Vascular catheters
		Common etiologies of respiratory distress in infants
			Respiratory distress syndrome
			Transient tachypnea of the newborn
			Meconium aspiration syndrome
			Pneumonia
			Air leak syndromes
				Pneumothorax
				Pneumomediastinum
				Pneumopericardium
				Pulmonary interstitial emphysema
			Pulmonary hemorrhage
			Pleural effusion
			Bronchopulmonary dysplasia
		Congenital and surgical causes of respiratory distress
			Congenital lung lesions
				Pulmonary agenesis, aplasia, and hypoplasia
				Bronchial atresia or stenosis
				Congenital pulmonary airway malformation
				Bronchopulmonary sequestration
				Congenital lobar emphysema
			Congenital diaphragmatic hernia
		Key references
	10 Blood gases: Technical aspects and interpretation
		Introduction
		Blood gas physiology
			Oxygen transport
			Understanding the oxyhemoglobin dissociation curve
			Considerations regarding fetal hemoglobin
			Hypoxemia and hypoxia
			Carbon dioxide transport
			Metabolic acidosis
			Metabolic alkalosis
		Techniques for obtaining blood samples
			Umbilical artery catheters
				Subumbilical cutdown
				Complications of umbilical artery catheterization
			Other indwelling catheter sites
			Infusion of fluids through arterial catheters
			Arterial puncture
			Arterialized capillary blood
			Continuous invasive monitoring
			Noninvasive estimation of blood gases
				Pulse oximetry
				Near-infrared spectroscopy
		Choice of monitoring methods
			Transcutaneous monitoring
			Capnography
		Blood gas analyzers
			Measuring principle of a blood gas analyzer
			Blood gas analyzer quality assurance
		Clinical interpretation of blood gases
		Components of blood gas testing that are measured directly
			pH
			Carbon dioxide
			Partial pressure of oxygen
		Components of blood gas testing that are not measured directly
			Bicarbonate
			Base excess
			Oxygen saturation
			Lactate
		Errors in blood gas measurements
		Assessing the accuracy of a blood gas result
		Final thoughts
		Acknowledgment
		Key references
	11 Noninvasive monitoring of gas exchange
		Noninvasive monitoring of oxygenation
			Pulse oximetry
				Indications for pulse oximetry
				Delivery room resuscitation
				Limitations of pulse oximetry
				Functional versus fractional saturation
				Additional considerations
			Transcutaneous oxygen monitoring
		Noninvasive assessment of partial pressure of carbon dioxide
			Capnography and end-tidal carbon dioxide monitoring
				Mainstream and sidestream capnography
				Carbon dioxide monitoring in the neonatal intensive care unit
				Capnography during neonatal anesthesia
				Colorimetric carbon dioxide detectors
				Optimizing ventilation settings with capnography
				Limitations of capnography
			Transcutaneous carbon dioxide monitoring
		Tissue oxygen saturation monitoring using near-infrared spectroscopy
			Normal values
			Application of near-infrared spectroscopy in newborns
				Management of hypotension
				Resuscitation and stabilization in the delivery room
				Patent ductus arteriosus
				Cerebral perfusion with changes in mean airway pressure and ventilation
				Mesenteric ischemia and risk of necrotizing enterocolitis
			Limitations of near-infrared spectroscopy
		Conclusion
		Key references
	12 Pulmonary function and graphics
		Introduction
		Technical aspects
			Airflow measurement
			Pressure measurement
			End tidal CO₂ measurement
			Volume measurement
		Respiratory physiology and pathophysiology of respiratory diseases
		Display of respiratory signals
			Airway pressure
				Peak inflation pressure, positive end expiratory pressure, continuous positive airway pressure
				Mean airway pressure: five different ways to change map during conventional ventilation: Change in peak inflation pressure, positive end expiratory pressure, inspiratory time, inspiratory slope, and rate
				Positive End Expiratory Pressure,Inspiratory Time, Inspiratory Slope, and Rate
			Effect of inspiratory and expiratory time on tidal volume: Effect of the time constant on flow and volume
			Measurement of airflow
				Recognizing spontaneous respiratory efforts
				Checking for synchronization
				Cycling off the mechanical inflation (flow cycling)
			Measurement of volume
				Tidal volume—minute ventilation
				Tidal volume—effect of endotracheal tube leaks
				Effect of mechanical characteristics of the respiratory system on tidal volume
		Display of pulmonary graphics using loops
			Pressure-volume loops
			Flow-volume loops
		Pulmonary mechanics
			Lung compliance
				Clinical implications
			Resistive properties
				Clinical implications
		End tidal CO₂ curve
		Role of pulmonary graphics in daily ventilator management—optimizing ventilator settings
			Optimizing peak inflation pressure
			Optimizing positive end expiratory pressure
			Optimizing inspiratory and expiratory flow by adjusting inspiratory and expiratory time
			Optimizing tidal volume
			Optimizing synchrony
			Optimizing oxygen exposure
			Optimizing gas exchange—permissive hypercapnia
			Determining the relative contribution of spontaneous breaths versus mechanical inflations to minute ventilation
			Special circumstances
		Pitfalls of graphics monitoring—troubleshooting
		Evidence for the use of respiratory function monitoring to improve neonatal outcome
		Acknowledgments
		Key references
	13 Airway evaluation: Bronchoscopy, laryngoscopy, and tracheal aspirates
		Introduction
		Flexible nasopharyngolaryngoscopy in the neonate
			Indications
			Risks, contraindications, and limitations
			Equipment
		Direct microlaryngoscopy and rigid bronchoscopy in the neonate
			Indications
			Risks, contraindications, and limitations
			Equipment
		Fiberoptic flexible bronchoscopy
			Indications
			Risks, contraindications, and limitations
			Equipment
		Bronchoalveolar lavage and tracheal aspirates
		Summary
		Suggested readings
Section 3 Delivery Room Stabilization, Oxygen Therapy, and Respiratory Support
	14 Delivery room stabilization and respiratory support
		Introduction
		Physiology of transition, asphyxia, and resuscitation
			Physiology of normal transition
			Physiology of asphyxia
			Physiology of resuscitation
		Anticipation and preparation for resuscitation
			Training
			Teamwork
			Anticipation
			Preparation
		Clinical assessment, apgar score, saturation, and heart rate monitoring
			Clinical evaluation
			Pulse oximetry and electrocardiograph
		Intervention basics: Cord clamping, warmth, position, suction, stimulation
			Management of the umbilical cord
			Warmth
			Position
			Suction
			Meconium-stained amniotic fluid
			Stimulation
		Oxygen
		Ventilation
		Pressure sources
		Interfaces
		Endotracheal intubation
		Intubation equipment and procedure
		Laryngeal mask airway
		Monitoring
		Chest compressions
		Epinephrine
		Volume expansion
		Special cases
			Preterm neonates
			Congenital diaphragmatic hernia
			Fetal hydrops
		Ethics
			Deciding whether to commence resuscitation
			Deciding whether to stop resuscitation
		Postresuscitation care
			Examination/monitoring
			Therapeutic hypothermia for hypoxic ischemic encephalopathy
		Key references
	15 Exogenous surfactant therapy
		History
		Surfactant function, composition, and metabolism
			Function
			Composition
			Secretion and metabolism
		Types of surfactant
			Animal-derived surfactants
			Synthetic surfactants without protein components
			Protein-containing synthetic surfactants
		Acute pulmonary and cardiac effects of surfactant therapy
			Immediate pulmonary effects of surfactant therapy
			Immediate effects on pulmonary circulation
			Radiographic changes
		Clinical trials of surfactant therapy
			Surfactant therapy compared with placebo or no therapy
			Prophylactic surfactant administration compared with post-birth stabilization on continuous positive airway pressure and selective surfactant administration
			Early surfactant administration followed immediately by extubation to nasal continuous positive airway pressure
			Targeted surfactant therapy
			Single versus multiple surfactant doses
			Criteria for repeat doses of surfactant
		Methods of administration of surfactant
			Administration through catheter, side port, or suction valve
			Administration through dual-lumen endotracheal tube
			Administration through a laryngeal mask airway
			Nasopharyngeal administration of surfactant
			Thin catheter endotracheal administration (less invasive surfactant administration)
			Other methods
			Chest position during administration of surfactant
			Summary of administration methods
		Choice of surfactant product
			Comparison of animal-derived surfactant extract versus protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome
			Comparison of protein-containing synthetic surfactant versus animal-derived surfactant extract for the prevention and treatment of respiratory distress syndrome
			Comparison of protein-containing synthetic surfactant versus protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome
			Comparison of different types of bovine surfactants
			Comparison of porcine and bovine surfactants
		Adverse effects of surfactant therapy
		Economic aspects of surfactant therapy
		Factors affecting the response to surfactant therapy
		Long-term outcomes after surfactant therapy
			Neurodevelopmental outcomes
			Long-term respiratory outcomes
			Physical growth
			Outcomes of prophylactic versus rescue treatment strategies
		Exogenous surfactant therapy for conditions other than respiratory distress syndrome
			Meconium aspiration syndrome
			Acute respiratory distress syndrome
			Other conditions
		Conclusion
		Key references
	16 Oxygen therapy
		History of the use of oxygen in clinical medicine
		Basic principles of oxygen physiology
			Aerobic metabolism
			Reactive oxygen species, redox regulation, and antioxidant enzymes
			Redox regulation
			Antioxidant defenses
			Biomarkers of oxidative stress
			Oxygen-sensing mechanisms and physiologic response
		Oxygen in the fetal-to-neonatal transition and postnatal adaptation
			Fetal-to-neonatal transition
			Arterial oxygen saturation nomogram
		Oxygen saturation in preterm infants with positive pressure ventilation and air
			Oxygen administration in the delivery room
		Oxygen during neonatal care in the neonatal intensive care unit
		Evolving oxygen needs in the first weeks of life and new metabolic indices
		Going home on oxygen
		Oxygen saturation recommendations
		Key references
	17 Respiratory gas conditioning
		Physiology and pathophysiology
			Basics of the physical relationships among temperature, water vapor, and energy content of gases
		Standards on humidification of medical gases for use with artificial respiratory support modalities
		Procedures and devices for respiratory gas conditioning
			Cold passover, bubble-through, and heated water humidifiers for use with nasal cannula therapy
			Heated humidifiers with heated wire tubing circuitry
			Heat and moisture exchangers (“artificial noses”)
			Aerosol application
			Irrigation of the airway
		Estimation and measurement of the efficiency of respiratory gas conditioning device brands
		Key references
	18 Noninvasive respiratory support
		Introduction
			History of noninvasive respiratory support
			What are the clinical indications and how does noninvasive respiratory support help?
				Respiratory distress syndrome
				Apnea of prematurity
				Postextubation care
			An overview of equipment used to provide noninvasive respiratory support
				Interfaces
				Pressure generators
		Continuous positive airway pressure
			Indications for continuous positive airway pressure support
				Continuous positive airway pressure support for preterm infants from birth
				Continuous positive airway pressure support for preterm infants postextubation
				Continuous positive airway pressure support for apnea of prematurity
				Continuous positive airway pressure support for other conditions
				Contraindications to continuous positive airway pressure support
			Continuous positive airway pressure devices and interfaces
				Ventilator-generated continuous positive airway pressure
				Bubble continuous positive airway pressure
				Variable-flow continuous positive airway pressure
				Benveniste gas-jet valve continuous positive airway pressure
			Comparison of continuous positive airway pressure devices
				Ventilator continuous positive airway pressure versus variable-flow (infant flow) continuous positive airway pressure
				Ventilator continuous positive airway pressure versus bubble continuous positive airway pressure
				Variable-flow continuous positive airway pressure versus bubble continuous positive airway pressure
			Continuous positive airway pressure interfaces
				Mononasal prongs, cut-down endotracheal tubes, and binasal nasopharyngeal prongs
				Short binasal prongs
				Future nasal prong development
				Nasal masks
				Nasal cannulae
			Comparison between nasal interfaces
				Comparison between nasal prong types
				Comparison between nasal masks and nasal prongs
				Comparison between standard interfaces and nasal cannulae
			Optimal continuous positive airway pressure
			Supportive care during continuous positive airway pressure
			Administration of surfactant to infants on continuous positive airway pressure
				Oropharyngeal, nebulized, and laryngeal mask airway surfactant administration
				Less invasive surfactant administration and minimally invasive surfactant treatment: Surfactant administration via thin catheter
			When has treatment with continuous positive airway pressure “failed?”
			Complications of continuous positive airway pressure
				Gaseous intestinal distension
				Pneumothorax or other air leak
				Nasal skin trauma
			Continuous positive airway pressure weaning
		Nasal ventilation
			Physiologic mechanisms
			Clinical trials
				Nasal intermittent positive pressure ventilation
				Synchronized nasal intermittent positive pressure ventilation
		High-frequency nasal ventilation
			Mechanisms of gas exchange
			Clinical trials
			Future directions
		Nasal high flow
			Clinical trials in preterm infants
				Primary (early) respiratory support
				Postextubation/surfactant respiratory support
			Future directions
		Conclusion
		Acknowledgments
		Key references
	19 Overview of assisted ventilation
		Introduction
		Unique challenges in mechanical ventilation of newborn infants
			Lung mechanics
			Uncuffed endotracheal tubes
			Measurement of tidal volume
		Basic ventilator mode classification
		Initiation of mechanical ventilation
			Indications for mechanical ventilation
			Choosing the ventilator mode
			Initial settings for pressure controlled ventilation
			Assessment after starting ventilation
			Subsequent ventilator adjustments
				Oxygenation
				Ventilation/carbon dioxide elimination
		Monitoring and documentation during mechanical ventilation
		Ventilation protocols
		Key references
	20 Basic modes of synchronized ventilation
		Introduction
		Trigger technology
		Patient-ventilator interactions with synchronized ventilation
		Synchronized intermittent mandatory ventilation
			Assist control
				Pressure support ventilation
		Choice of assisted ventilation modes
		Guidelines for clinical application
			Synchronized intermittent mandatory ventilation
			Assist control
			Pressure support ventilation
		Conclusion
		Key references
	21 Principles of lung-protective ventilation
		Introduction
		Neonatal respiratory failure
		Ventilator-induced lung injury
			Risk factors for ventilator-induced lung injury
				Volutrauma
				Atelectrauma
				Oxygen toxicity
			Pulmonary and systemic consequences of ventilator-induced lung injury
				Structural injury
				Biotrauma
				Surfactant dysfunction
				Lung development
			Susceptibility of newborn lungs to ventilator-induced lung injury
		Lung-protective ventilation: Basic principles
			Minimizing volutrauma
			Minimizing atelectrauma
		Lung-protective ventilation: Conventional mechanical ventilation
			Low tidal volume ventilation
			Tidal volume stabilization
			Permissive hypercarbia
			Open lung ventilation
		Lung-protective ventilation: High-frequency ventilation
		Lung-protective ventilation: Weaning and extubation
		Implications for practice and research
		Key references
	22 Volume-targeted ventilation
		Rationale for tidal volume-targeted ventilation
		Volume-controlled versus volume-targeted ventilation
		Neonatal tidal volume-targeted ventilation
		Volume guarantee
		Suggested clinical guidelines (see also table 22.3)
		Pressure-regulated volume control
		Volume ventilation plus
		Volume targeted ventilation/adaptive pressure ventilation
		Targeted tidal volume
		Importance of open lung strategy
		Alarms/troubleshooting
		Conclusion
		Key references
	23 Special techniques of respiratory support
		Introduction
		Automated control of inspired oxygen
		Ventilation techniques that provide support proportional to patient effort
			Proportional assist ventilation
			Neurally adjusted ventilatory assist
			Airway pressure release ventilation
		Ventilation techniques designed to maintain minute ventilation
			Targeted minute ventilation
			Mandatory minute ventilation
			Apnea backup ventilation
			Adaptive backup ventilation
			Adaptive support ventilation
		Conclusion
		Key references
	24 High-frequency ventilation
		Types of high-frequency ventilators
			High-frequency jet ventilators
			High-frequency oscillators
			High-frequency flow interrupters/percussive ventilators
		Evidence base for clinical applications of high-frequency ventilation
			Elective versus rescue high-frequency ventilation
		Lung protective strategies with HFV: Limiting pressure while optimizing volume
		Clinical applications of high-frequency ventilation in specific diseases
			Respiratory distress syndrome
				High-frequency oscillatory ventilation strategy in respiratory distress syndrome
				High-frequency jet ventilation strategy in respiratory distress syndrome
			Air-leak syndromes
				High-frequency jet ventilation strategy in air-leak syndromes
				High-frequency oscillatory ventilation strategy in air leak
			Pulmonary hypoplasia and congenital diaphragmatic hernia
				High-frequency oscillatory ventilation strategy in congenital diaphragmatic hernia and other lung hypoplasia conditions
				High-frequency jet ventilation strategy congenital diaphragmatic hernia and other lung hypoplasia conditions
			Hypoxemic respiratory failure in term infants
		Knowledge gaps and research directions
		Summary
		Key references
	25 Mechanical ventilation: Disease-specific strategies
		Introduction
		Respiratory distress syndrome
			Key pathophysiologic features
				Lung surfactant
				Lung liquid
				Developmental lung biology
			Relevant principles of ventilation
				High-frequency ventilation
				Conventional ventilation
				Extubation
			Evidenced-based recommendations
			Gaps in knowledge
		Meconium aspiration syndrome
			Key pathophysiologic features
				Surfactant dysfunction
				Airway resistance
				Pulmonary hypertension
			Relevant principles of ventilation
				High-frequency ventilation
				Conventional ventilation
			Evidenced-based recommendations
			Gaps in knowledge
		Lung hypoplasia disorders
			Key pathophysiologic features
				Lung hypoplasia
				Pulmonary vascular bed
			Relevant principles of ventilation
			Pulmonary hypertension
			Evidenced-based recommendations
			Gaps in knowledge
		Bronchopulmonary dysplasia
			Key pathophysiologic features
				Lung pathology
				Lung mechanics and function
			Relevant general principles of mechanical ventilation
				Tracheostomy
				Pulmonary hypertension
			Evidenced-based recommendations
			Gaps in knowledge
		Conclusion
		Key references
	26 Weaning and extubation from mechanical ventilation
		Background
		Weaning from ventilatory support
		Weaning from pressure-controlled ventilation
		Weaning from high-frequency ventilation
		General strategies to facilitate weaning
			Permissive hypercarbia
			Permissive hypoxemia
			Weaning protocols
			Adjunctive therapies
				Caffeine
				Diuretics
				Closure of patent ductus arteriosus
				Avoidance of routine sedation
				Nutritional support
				Chest physiotherapy
				Systemic corticosteroids
				Inhaled and intratracheal corticosteroids
		Assessment of extubation readiness
			Clinical predictors
			Extubation readiness tests
				Physiological assessments
				Clinical assessments
				Analysis of the dynamics of physiologic signals before extubation
		Postextubation management
			Adjunctive therapies
				Caffeine
				Nebulized racemic epinephrine and dexamethasone
				Postnatal corticosteroids for the prevention and treatment of postextubation stridor
				Chest physiotherapy
		Extubation failure
		Summary
		Suggested readings
	27 Common devices used for mechanical ventilation
		Introduction to ventilators
			Power inputs
			Power conversion and control
				Flow control valves
				Control subsystems
			Power outputs
				Idealized pressure, volume, and flow waveforms
				Ventilator alarm systems
			Operator–ventilator interface: Displays
				Alphanumeric values
				Trends
				Waveforms and loops
			Patient–ventilator interface: Circuits
		Understanding modes of ventilation
			Defining a breath/inflation
			Defining assisted breath
			Assistance with volume or pressure control
			Trigger and cycle events
			Machine versus patient trigger and cycle events
			Spontaneous versus mandatory breaths/inflations
			Breath sequences
			Ventilatory patterns
			Targeting schemes
			Full mode taxonomy
			How to classify a mode of ventilation
		Universal intensive care ventilators used for neonatal ventilation
			AVEA CVS
				Modes
					Airway pressure release ventilation/biphasic.
					Continuous positive airway pressure/pressure support.
					Continuous positive airway pressure/pressure support with volume limit.
					Infant nasal continuous positive airway pressure.
					Infant nasal intermittent mandatory ventilation.
					Pressure assist-control.
					Pressure assist-control with flow cycle.
					Pressure assist-control with machine volume.
					Pressure assist-control with volume guarantee.
					Pressure-regulated volume control assist-control (not available for neonatal ventilation).
					Pressure-regulated volume control assist-control with flow cycle (not available for neonatal ventilation).
					Pressure-regulated volume control synchronized intermittent mandatory ventilation with flow cycle (not available for neonatal ventilation).
					Pressure-regulated volume control synchronized intermittent mandatory ventilation (not available for neonatal ventilation).
					Pressure synchronized intermittent mandatory ventilation.
					Pressure synchronized intermittent mandatory ventilation with volume guarantee (available for neonatal patient size setting only).
					Time-cycled pressure-limited assist-control (available for neonatal patient size setting only).
					Time-cycled pressure-limited assist-control with flow cycle.
					Time-cycled pressure-limited assist-control with flow cycle and volume guarantee.
					Time-cycled pressure-limited assist-control with volume guarantee (available for neonatal patient size setting only).
					Time-cycled pressure-limited synchronized intermittent mandatory ventilation (available for neonatal patient size setting only).
					Time-cycled pressure-limited synchronized intermittent mandatory ventilation with volume guarantee (available for neonatal patient size setting only).
					Volume assist-control (with demand flow).
					Volume assist-control with Vsync.
					Volume assist-control with Vsync and flow cycle.
					Volume synchronized intermittent mandatory ventilation.
					Volume synchronized intermittent mandatory ventilation with Vsync.
			PB 980
				Modes
					Assist-control pressure control.
					Assist-control volume ventilation plus.
					Assist-control volume control.
					Bilevel + pressure support.
					Bilevel + tube compensation.
					Synchronized intermittent mandatory ventilation pressure control + pressure support.
					Synchronized intermittent mandatory ventilation pressure control + tube compensation.
					Synchronized intermittent mandatory ventilation volume control + pressure support.
					Synchronized intermittent mandatory ventilation volume ventilation plus + pressure support.
					Synchronized intermittent mandatory ventilation volume control plus + tube compensation.
					Spont pressure support.
					Spont volume support.
					Neonatal ventilation.
			Bellavista 1000
				Modes
					Adaptive ventilation mode.
					Airway pressure release ventilation.
					beLevel.
					Continuous positive airway pressure.
					Nasal continuous positive airway pressure.
					Nasal intermittent positive pressure ventilation.
					Pressure control-synchronized intermittent mandatory ventilation.
					Pressure control-synchronized intermittent mandatory ventilation + targetvent.
					Pressure assist-control ventilation.
					Pressure assist-control + targetvent.
					Pressure-controlled ventilation.
					Pressure support ventilation.
					Pressure support ventilation + targetvent.
					Spontaneous.
					Spontaneous + targetvent.
					Spontaneous/timed.
					Spontaneous/timed + targetvent.
					Timed.
					Volume assist-control.
			Evita infinity V500, V600/800
				Modes
					Pressure control assist-control.
					Pressure control airway pressure release ventilation.
					Pressure control continuous mandatory ventilation.
					Pressure control pressure support.
					Pressure control synchronized intermittent mandatory ventilation.
					Smartcare/pressure support.
					Spontaneous continuous positive airway pressure.
					Spontaneous continuous positive airway pressure/pressure support.
					Spontaneous continuous positive airway pressure/variable support.
					Spontaneous continuous positive airway pressure/volume support.
					Spontaneous/proportional pressure support.
					Volume control assist-control.
					Volume control assist-control + autoflow/volume guarantee.
					Volume control assist-control + pressure limitation.
					Volume control continuous mandatory ventilation.
					Volume control continuous mandatory ventilation + autoflow.
					Volume control continuous mandatory ventilation + pressure limitation.
					Volume control mandatory minute volume ventilation.
					Volume control mandatory minute volume ventilation + autoflow/volume guarantee.
					Volume control continuous positive airway pressure.
					Volume control synchronized intermittent mandatory ventilation + autoflow/volume guarantee.
					Volume control synchronized intermittent mandatory ventilation + pressure limitation.
				Neonatal ventilation
			Evita infinity V600/800
			SERVO-I and SERVO-U
				Modes
					Automode (pressure control to pressure support).
					Automode (pressure-regulated volume control to volume support).
					Automode (volume control to volume support).
					BiVent.
					Neurally adjusted ventilatory assist.
					Pressure control.
					Pressure-regulated volume control.
					Pressure support.
					Synchronized intermittent mandatory ventilation (volume control).
					Synchronized intermittent mandatory ventilation (pressure-regulated volume control).
					Synchronized intermittent mandatory ventilation (pressure control).
					Spontaneous/continuous positive airway pressure.
					Volume control.
					Volume support.
					Neonatal ventilation with SERVO-I.
			SERVO-n and SERVO-U
			Carescape R860
				Modes
					Assist-control pressure control.
					Assist-control pressure regulated volume control.
					Assist-control volume control.
					Assist-control volume control + pressure limit.
					Airway pressure release ventilation.
					Bilevel airway pressure ventilation.
					Bilevel airway pressure ventilation + volume guaranteed.
					Continuous positive airway pressure/pressure support.
					Noninvasive ventilation.
					Synchronized intermittent mandatory ventilation pressure controlled.
					Synchronized intermittent mandatory ventilation pressure regulated volume control.
					Synchronized intermittent mandatory ventilation volume control.
					Synchronized intermittent mandatory ventilation volume control + pressure limit.
					Spontaneous breathing trial.
					Volume support.
					Neonatal ventilation.
			Hamilton G5
				Modes
					Adaptive support ventilation.
					Airway pressure release ventilation.
					Adaptive pressure ventilation continuous mandatory ventilation (APVCMV).
					Adaptive pressure ventilation intermittent mandatory ventilation (APVIMV).
					DuoPositive airway pressure.
					INTELLiVENT adaptive support ventilation.
					Nasal continuous positive airway pressure/pressure support.
					Noninvasive ventilation.
					Noninvasive ventilation-spontaneous/timed.
					Positive-continuous mandatory ventilation.
					Positive-synchronized intermittent mandatory ventilation.
					Synchronized continuous mandatory ventilation.
					Synchronized intermittent mandatory ventilation.
					Spontaneous.
					Volume support.
		Specialized neonatal ventilators
			Babylog VN500 and 600/800
				Modes
					Pressure control-assist-control.
					Pressure control-assist-control + volume guarantee.
					Pressure control-airway pressure release ventilation.
					Pressure control-continuous mandatory ventilation.
					Pressure control-continuous mandatory ventilation + volume guarantee.
					Pressure control-mandatory minute volume ventilation + volume guarantee.
					Pressure control-pressure support ventilation.
					Pressure control-pressure support ventilation + volume guarantee.
					Pressure control-synchronized intermittent mandatory ventilation.
					Pressure control-synchronized intermittent mandatory ventilation + volume guarantee.
					Spontaneous continuous positive airway pressure/pressure support.
					Spontaneous continuous positive airway pressure/volume support.
					Spontaneous proportional pressure support.
					Automatic tube compensation (ATC).
					High-frequency oscillatory ventilation (with volume guarantee).
			Babylog VN600/800
			SERVO-n and SERVO-U
			Fabian high-frequency oscillatory
				Modes
					Intermittent positive-pressure ventilation (continuous mandatory ventilation).
					Intermittent positive-pressure ventilation (continuous mandatory ventilation) + volume guarantee.
					Synchronized intermittent positive pressure ventilation (ASSIST).
					Synchronized intermittent positive pressure ventilation (ASSIST) + volume guarantee.
					Synchronized intermittent mandatory ventilation.
					Synchronized intermittent mandatory ventilation + pressure support ventilation.
					Pressure support ventilation.
					Pressure support ventilation + volume guarantee.
					High-frequency oscillatory ventilation.
					Continuous positive airway pressure.
					Nasal continuous positive airway pressure/duo positive airway pressure.
			Leoni plus
				Modes
					Continuous positive airway pressure.
					High-frequency oscillation.
					Intermittent positive-pressure ventilation/intermittent mandatory ventilation.
					Intermittent positive-pressure ventilation/intermittent mandatory ventilation + volume guarantee.
					Nasal continuous positive airway pressure.
					Nasal intermittent positive pressure ventilation.
					Pressure support-intermittent mandatory ventilation.
					Pressure support-intermittent mandatory ventilation + volume guarantee.
					Pressure support-S intermittent positive pressure ventilation.
					Pressure support-intermittent positive pressure ventilation + volume guarantee.
					S-intermittent mandatory ventilation.
					S-intermittent mandatory ventilation + volume guarantee.
					S-intermittent positive pressure ventilation.
					S-I intermittent positive pressure ventilation + volume guarantee.
			Vyaire infant flow SiPAP
				Modes
					BiPhasic.
					BiPhasic tr.
					Continuous positive airway pressure.
		Summary
		Key references
	28 Extracorporeal membrane oxygenation
		Introduction
		History of cardiopulmonary bypass
		Development of membrane oxygenators
			Development of a pump
			Vascular access
		Physiology of extracorporeal circulation
			Membrane lung
			Oxygen and carbon dioxide transfer
		Patient selection
			Disease states
			Selection criteria
			Alveolar-arterial oxygen gradient
			Oxygenation index
			Acute deterioration
			Ventilator-associated lung injury
			Contraindications
			Evaluation before extracorporeal membrane oxygenation
		Technique for beginning extracorporeal membrane oxygenation
			Before cannulation
			Venoarterial versus venovenous cannulation
			Operative procedure
		Daily management
		Weaning
		Decannulation
		Outcome
		Key references
Section 4 Bedside Care, Nutritional and Pharmacologic Support
	29 Respiratory care of the newborn
		Introduction
		Techniques to provide positive-pressure ventilation
			Manual ventilation
			Face masks for ventilation
			Endotracheal intubation
			Routes of intubation
			Equipment
			Types of tubes
			Depth of tube insertion
			Determination of placement
			Tube fixation
			Acquisition and maintenance of intubation skills
			Laryngeal mask airway
		Noninvasive ventilation and continuous positive airway pressure
		Heated humidified high-flow nasal cannula
		Monitoring during respiratory support
			Monitoring during noninvasive respiratory support
			Monitoring during conventional and high-frequency ventilation
		Humidification and warming during respiratory support
		Airway clearance techniques
			Chest physiotherapy
			Positioning of the patient
			Percussion and vibration
		Administration of medications into the respiratory tract
			Surfactant treatment
			Surfactant administration
			Optimization of aerosol drug delivery
		Clinician-based ventilator and weaning protocols
		Resuscitation and stabilization at delivery
		Key readings
	30 Nursing care
		Introduction
		Assessment of the neonate
		Pain assessment
		Respiratory care
			Oxygen saturation monitoring
			Positioning and containment
			Noninvasive ventilation
			Mechanical ventilation
				Airway security
				Endotracheal tube movement and malposition
				Suctioning
				Ventilator-associated pneumonia
			High-frequency ventilation
			Inhaled nitric oxide
			Sudden deterioration
		General care of the neonate
			Thermal instability
			Nutrition
			Skin care
				Adhesive application and removal
				Pressure ulcers and skin injury
			Managing pain
			Developmental care
			Skin-to-skin holding
		Care of the family
		Conclusion
		Key references
	31 Nutritional support
		The importance of nutrition during critical stages of lung development
		Nutritional requirements
			Water requirement
				Insensible water loss
				Renal function and water excretion
			Energy requirement
			Protein requirement
			Lipid requirement
			Carbohydrate requirement
			Mineral requirements
			Vitamin requirements
		Parenteral nutrition
			Composition of total parenteral nutrition
		Enteral nutrition
			Advantages of enteral nutrition
			Methods of gavage feeding
			Minimal enteral feedings and enteral feeding advancement
			Human milk
			Donor human milk
			Human milk fortification
			Formulas
		Special nutritional considerations for infants with established bronchopulmonary dysplasia
		Key references
	32 Pharmacologic therapies
		Introduction
		Steroids
			Early postnatal (<8 days) steroid therapy for prevention of bronchopulmonary dysplasia
			Late (≥8 days) postnatal steroid therapy for prevention or therapy of bronchopulmonary dysplasia in preterm infants
		Sedation and analgesia
			Opioids
				Morphine
				Fentanyl
				Dexmedetomidine
			Benzodiazepines
				Midazolam
				Lorazepam
				Diazepam
			Other sedative agents
		Muscle relaxants
			Pancuronium
			Vecuronium
			Rocuronium
			Cisatracurium
		Bronchodilators and mucolytic agents
			Albuterol (salbutamol)
			Cromoglycic acid
			Ipratropium bromide
			Racemic epinephrine
			N-acetylcysteine
			Combination therapies
		Diuretics
			Furosemide
			Bumetanide
			Thiazides and potassium-sparing diuretics
		Respiratory stimulants
			Theophylline
			Caffeine
			Doxapram
		Summary
		Key readings
	33 Common hemodynamic problems in the neonate requiring respiratory support
		Introduction
		Normal transition
		Hemodynamic problems in the neonate
			Persistent pulmonary hypertension of the newborn
				Clinical evaluation
				Intervention
					Specific therapy.
					Cardiovascular support.
				Research needs
			Septic shock
				Clinical evaluation
				Research needs
			Hypoxic ischemic encephalopathy
			Cardiogenic shock
			Hypotension in the extremely low gestational age newborn
				Research needs
		Conclusion
		Key references
Section 5 Treatment of Specific Conditions, Surgical Interventions and Other Considerations
	34 Diagnosis and management of persistent pulmonary hypertension of the newborn
		Introduction
		Etiology
		Clinical features
		Hypoxemia in persistent pulmonary hypertension of the newborn
			Diagnosis
		Echocardiography and hemodynamic assessment in persistent pulmonary hypertension of the newborn²⁰
			Severity of persistent pulmonary hypertension of the newborn
			Ventricular function
			Shunt direction
			Precapillary versus pulmonary venous hypertension
			Supportive management
		Asphyxia, hypothermia, and persistent pulmonary hypertension of the newborn
			Oxygen
			Carbon dioxide and pH targets
			Noninvasive ventilation
			Invasive ventilation
		Surfactants in persistent pulmonary hypertension of the newborn
		Inhaled nitric oxide
			Initiation of inhaled nitric oxide
			Weaning inhaled nitric oxide
		Sildenafil
		Milrinone
		Prostaglandin E1
		Endothelin receptor antagonists
		Management of systemic hypotension in persistent pulmonary hypertension of the newborn
			Fluid management
			Sodium bicarbonate
			Vasoactive infusions
				Hydrocortisone
		Preterm infants with early pulmonary hypertension (preterm persistent pulmonary hypertension of the newborn)
		Conclusion
		Key references
	35 Care of the infant with congenital diaphragmatic hernia
		Introduction
		Antenatal assessment of severity and fetal management
		Initial treatment and procedures in the delivery room
		Transport from delivery room to neonatal intensive care unit
		Initial ventilation in congenital diaphragmatic hernia
		Gentle ventilation in congenital diaphragmatic hernia
		Supportive measures
			Echocardiogram
		Pulmonary vasodilator therapy
			Inhaled nitric oxide
			Milrinone
			Prostaglandin infusion
			Sildenafil
		Extracorporeal membrane oxygenation
		Surgical repair
		Pulmonary and nutritional outcome
		Discharge and follow-up
		Conclusion
		Acknowledgment
		Key references
	36 Management of the infant with bronchopulmonary dysplasia
		Introduction
		Epidemiology, pathophysiology, and diagnosis of bronchopulmonary dysplasia
		Prevention of bronchopulmonary dysplasia
		Clinical presentation and evaluation of infants with established bronchopulmonary dysplasia
			Clinical presentation of severe bronchopulmonary dysplasia
				Severe lung parenchymal disease as the leading feature of severe bronchopulmonary dysplasia
				Pulmonary hypertension as the leading feature of severe bronchopulmonary dysplasia
				Airway disease as the leading feature of severe bronchopulmonary dysplasia
			Evaluation of infants with severe bronchopulmonary dysplasia
		Physiologic basis for respiratory support in infants with established bronchopulmonary dysplasia
			Ventilatory control in infants with bronchopulmonary dysplasia
			Pulmonary mechanics in infants with bronchopulmonary dysplasia
		Management of infants with established bronchopulmonary dysplasia
			Keys to successful bronchopulmonary dysplasia management
			Respiratory management in infants with established bronchopulmonary dysplasia
				Noninvasive ventilation
				Mechanical ventilation
					Conventional mechanical ventilation.
					High-frequency ventilation.
		Adjunctive respiratory support therapies in infants with established bronchopulmonary dysplasia
			Heliox
			Pharmacotherapies
			Management of pulmonary hypertension
			Management of persistent ductus arteriosus
			Nutritional support
			Minimizing pulmonary micro-aspiration
			Role of tracheostomy in infants requiring long-term support
		Pulmonary outcomes in infants with bronchopulmonary dysplasia
		Conclusion
		Selected readings
	37 Medical and surgical interventions for respiratory distress and airway management
		Introduction
		Medical management of the neonatal airway
		Anatomic disadvantages of the neonatal airway
		Medical management of neonates with common respiratory disorders requiring surgical intervention
			Congenital airway disorders
			Acquired airway disorders
		Surgical management of the neonatal airway
		The pediatric surgeon/otolaryngologist as diagnostician and therapist
			Developmental abnormalities of the airway
				Nasopharyngeal obstruction
				Choanal atresia
				Oropharyngeal obstruction
					Macroglossia.
					Beckwith-Wiedemann syndrome.
					Metabolic disorders.
					Trisomy 21 (Down syndrome).
					Severe bronchopulmonary dysplasia.
					Lingual thyroid.
					Craniofacial Dysmorphology syndromes.
					Pierre Robin sequence.
					Treacher Collins syndrome.
					Hallermann-Streiff syndrome.
					Möbius syndrome.
					Freeman-Sheldon syndrome.
					Nager syndrome.
				Laryngeal anomalies
					Laryngeal atresia.
					Laryngeal web.
					Congenital vocal cord paralysis.
					Laryngomalacia.
					Congenital subglottic stenosis.
					Acquired subglottic stenosis.
					Laryngeal cleft.
					Subglottic hemangioma.
				Tracheal anomalies
					Intrinsic tracheal compression.
						Tracheomalacia.
						Tracheal stenosis.
						Necrotizing tracheobronchitis.
					Extrinsic tracheal compression.
						Cystic hygroma.
						Vascular rings.
			Developmental abnormalities of the lung
				Pulmonary and lobar agenesis
				Pulmonary hypoplasia
				Congenital lobar emphysema
				Congenital pulmonary airway malformation
				Sequestration
				Pulmonary cystic lesions
			Developmental abnormalities of the diaphragm
				Diaphragmatic hernia of bochdalek
				Diaphragmatic paralysis/eventration
			Developmental abnormalities of the skeleton
		The pediatric surgeon/otolaryngologist as consultant
			Neonatal bronchoscopy
				Anatomic considerations
			Pathophysiology
			Evaluation of intubation
				Endoscopes
			Tracheostomy
				Procedure
				Anterior cricoid split procedure
				Tracheostomy tubes
		Key references
	38 Intraoperative management of the neonate
		Transitional physiology and pulmonary hypertension
		Pulmonary development and lung injury
		Anatomic considerations
			Intrathoracic masses
			Abdominal wall defects
		Location of operation
			Premedication for intubation
			Selection and placement of the endotracheal tube
		Operative management
			Ventilator mode
			Vital signs
			Intraoperative fluid management and electrolyte management
		Additional operative considerations
			Troubleshooting
			Temperature regulation
			Neonate pain perception
		Conclusion
		Key references
	39 Complications of respiratory support
		Complications of respiratory support
		Mechanical ventilation
		Endotracheal intubation
		Unplanned extubation
		Ventilator-induced lung injury
		Ventilator-associated pneumonia
		Ventilator-associated events and ventilator-associated conditions
		Noninvasive respiratory support
			Continuous positive airway pressure
			High-flow nasal cannula
			Positive pressure ventilation
			Nasal intermittent positive pressure ventilation
			Less invasive surfactant administration
		Suggested readings
	40 Neonatal respiratory care in resource-limited countries
		Introduction
		Scope of the need
		Limiting factors
		Current status
			Asia
				India
				Other countries
			Africa
			Latin America
		Establishing respiratory care programs
		Outcomes of neonatal ventilation
		Projected growth in neonatal ventilation: A global perspective
		Ethical dilemmas
		Conclusion
		Acknowledgment
		Key references
	41 Transport of the ventilated infant
		Important role of the transport team
		Regionalized care
		Transport team composition
		Transport education
		Transport physiology
			Hypoxia
			Air expansion
			Noise and vibration
			Thermoregulation
		Stabilization
		Clinical issues
		Equipment
			Transport ventilators
			High-frequency ventilation
			Continuous positive airway pressure
			Surfactant administration
			Inhaled nitric oxide
			Extracorporeal membrane oxygenation
			Hypothermia for hypoxic ischemic encephalopathy
		Future directions
		Key references
	42 Discharge and transition to home care
		Factors to consider when determining readiness for discharge
		Discharge team
		Predischarge needs assessment
		Home environment
		Equipment and supplies
		Personnel resources
		Home nursing
		Emergency planning
		Postdischarge follow-up
		Tracheostomy care
		Changing tracheostomy tubes
		Outpatient management of supplemental oxygen therapy
		Indications for home oxygen therapy
			Hypoxemia
			Growth failure
			Intermittent hypoxemia and pulmonary hypertension
		Oxygen delivery systems for home oxygen therapy
			Oxygen concentrator
			Liquid oxygen
			Compressed gas system
		Strategies for discontinuation of home oxygen therapy
		Key references
	43 Neurologic effects of respiratory support in the neonatal intensive care unit
		Introduction
		Cerebral blood flow in the neonate
			Cerebral autoregulation and pressure-passive circulation
		Brain injury in the preterm infant
			Periventricular-intraventricular hemorrhage
				Physiologic factors contributing to intraventricular hemorrhage
				Inflammation and intraventricular hemorrhage
				Antenatal corticosteroids and indomethacin
				Delayed cord clamping
				Diagnosis of intraventricular hemorrhage
			Periventricular hemorrhagic infarction (grade 4 intraventricular hemorrhage)
			Periventricular leukomalacia and diffuse white matter injury
				Pathogenesis of white matter injury
		Influence of oxygen concentration and carbon dioxide on cerebral blood flow
			Oxygen and hemoglobin
			Carbon dioxide
			Linking changes in carbon dioxide and oxygen concentration to hemorrhagic–ischemic injury
				Hypocarbia and white matter injury
				Hypercarbia and intraventricular hemorrhage
				Oxygen and brain injury
		Mode of ventilation and brain injury
			Continuous positive airway pressure
			Conventional mechanical ventilation
			High-frequency oscillatory ventilation
		Medications used to treat respiratory conditions
			Surfactant
			Methylxanthines
			Inhaled nitric oxide
			Postnatal steroids
		Summary
		Key references
	44 Pulmonary and neurodevelopmental outcomes following ventilation
		Introduction
		Incidence and definitions of bronchopulmonary dysplasia
		Pulmonary outcomes
			Pulmonary function testing and imaging
			Longer-term respiratory morbidity
		Health care utilization
		Neurodevelopmental outcomes of preterm infants with bronchopulmonary dysplasia
		Outcomes after neonatal hypoxic respiratory failure
			Inhaled nitric oxide
			Extracorporeal membrane oxygenation
		Conclusion
		Key references
	45 Gaps in knowledge and future directions for research
		Introduction
		Development and application of new methods of generating knowledge
			Basic and clinical study designs
		Respiratory care
			Delivery room management
			Mechanical ventilation
			Noninvasive respiratory support
			Exogenous surfactant administration
		Management of specific respiratory and nonrespiratory conditions requiring assisted ventilation
			Bronchopulmonary dysplasia
			Other conditions requiring ventilatory support
				Congenital diaphragmatic hernia
				Pulmonary hypertension of the newborn
		Ancillary support
			Nutritional support
		Development of devices
		Current research
			Ongoing clinical trials around the world
		Concluding comments
		Selected readings
Appendices
	Appendix 1
		Lung volumes in the infant
	Appendix 2
		Changes in respiratory system dimensions with growthª
	Appendix 3
		Effect of age on lung sizeª
	Appendix 4
		Normal lung function data for term newborns during the neonatal period
	Appendix 5
		Allen’s test
	Appendix 6
		Procedure for obtaining capillary blood gases
	Appendix 7
		Normal umbilical cord blood gas values
	Appendix 7a
		Arterial blood gas values in normal full-term infantsª
	Appendix 7b
		Arterial blood gas values in normal premature infantsª
	Appendix 8
		Capillary blood gas reference values in healthy term neonates
	Appendix 9
		Blood gas values in cord blood and in arterial blood at various ages during the neonatal period
			A. Oxygen tension
			B. Carbon dioxide tension
			C. pH
			D. Base excess
	Appendix 10
		Conversion tables
			A. Torr to kilopascal
			B. Kilopascal to torr
	Appendix 11
		Siggaard-Andersen alignment nomogram
	Appendix 12
		Systolic, diastolic, and mean blood pressure by birth weight and gestational age
	Appendix 13
		Systolic and diastolic blood pressure in the first 5 days of life
	Appendix 14
		Neonatal resuscitation record
	Appendix 15
		Effective FiO₂ conversion tables for infants on nasal cannula
	Appendix 16
		Neonatal indications and doses for administration of selected cardiorespiratory drugs
			Cardiorespiratory pharmacopeia for the newborn period
			Administration routes
	Appendix 17 apps
		Alveolar-arterial oxygen gradient
	Respiratory quotient and barometric pressure
	Information about alveolar–arterial oxygen gradient and PAO₂/FiO₂ ratio
	Complete ABG
		For metabolic alkalosis
	ETCO₂ tutor
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
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