The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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J. Matern. Fetal. Neonatal. Med. · Nov 2004
ReviewRespiratory management of the premature infant in the delivery room.
The preterm surfactant-deficient lung is highly susceptible to tissue injury with the initiation of ventilation. The respiratory management of preterm infants in the delivery room may be the key to minimizing acute lung injury and its sequelae, including chronic lung disease. Volume-targeted ventilation, optimization of the alveolar recruitment with positive end-expiratory pressure and prophylaxis with surfactant in infants with small volumes of lung gas and delicate lung tissue might help in limiting acute damage during resuscitation in the delivery room. It is desirable to monitor oxygen saturation and tailor oxygen supplementation when resuscitating premature infants.
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J. Matern. Fetal. Neonatal. Med. · Nov 2004
ReviewPerspectives for use of surfactant in children and adults.
After impressive results in the treatment of respiratory failure in premature babies, natural surfactant has been proposed in lung pathologies involving suspected surfactant deficiency. Apart from bronchiolitis, in which surfactant was used to stabilize small airways and for its possible antiviral action, research was directed towards pneumonia and sepsis, aspiration and chest trauma, which can lead to adult respiratory distress syndrome. Surfactant bronchoalveolar lavage has been used to 'cleanse' lungs, remove inhibitors and provide sufficient functional surfactant. Failure of surfactant therapy can be caused by insufficient dose, delayed administration, excessive inhibition and catabolism, or by type, severity and complexity of the lung disease (multi-organ failure).
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The fetus and the neonate are particularly vulnerable to injury caused directly by immunologic mechanisms or inflicted by infectious agents that take advantage of their relatively immature and inexperienced immune system. With increasing survival of high-risk neonates in the surfactant era, prevention/treatment of sepsis and chronic lung disease (CLD) has emerged as an area of priority in neonatal research. Considering the role of inflammatory mediators in the pathogenesis of sepsis and CLD, the clinical application of immunomodulator therapy to neonatology is perhaps more important at present than ever. ⋯ As in the case of sepsis, development of a single magic bullet for prevention/management of a multi-factorial illness like CLD may be difficult, as prevention of prematurity - the single most important high-risk factor for CLD - is an unachievable goal at present. As new frontiers are being explored, older, well-established therapies like antenatal anti-D immunoglobulin prophylaxis continue to emphasize the tremendous potential of immunomodulator therapy in neonatology/perinatology. The current immunomodulators/immunotherapeutic agents with established/potential clinical applications in the perinatal period are reviewed.