Manual of Neonatal Respiratory Care

Steven M. Donn ● Sunil K. SinhaEditors

Manual of Neonatal Respiratory Care

Third Edition

EditorsSteven M. Donn, MD, FAAPProfessor of PediatricsDivision of Neonatal–Perinatal MedicineC.S. Mott Children’s HospitalFaculty Associate, Center for Global HealthSchool of Public HealthUniversity of Michigan Health SystemAnn Arbor, MI, USA

Sunil K. Sinha, MD, PhD, FRCP, FRCPCH Professor of Pediatrics University of Durham Consultant in Pediatrics and Neonatal MedicineThe James Cook University HospitalDepartment of Neonatal MedicineMiddlesbrough, Marton-in-Cleveland, UK

ISBN 978-1-4614-2154-2 e-ISBN 978-1-4614-2155-9DOI 10.1007/978-1-4614-2155-9Springer New York Dordrecht Heidelberg London

Library of Congress Control Number: 2012930134

© Springer Science+Business Media, LLC 2012All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com)

To all those parents in the past 30 years who have entrusted me with the care of their most precious possessions

Steven M. Donn

To all those who have pursued careers in the care of newborn infants

Sunil K. Sinha

vii

F oreword

A successful transition from fetal to neonatal life is dependent upon the profound cardiorespiratory adaptations occurring at this time. Unfortunately, these events frequently require medical intervention, especially in preterm infants. The conse-quences of the resultant pathophysiologic changes and therapeutic interventions in such neonates may have long lasting effects on the developing respiratory system and even the neurodevelopmental outcome of this high-risk population.

Recognition of the importance of neonatal respiratory management was an early milestone in the history of neonatology. The role of surfactant defi ciency in the etiology of neonatal respiratory distress syndrome was sealed over 50 years ago, and this paved the way for the introduction of assisted ventilation for this population in the 1960s. I was privileged to be introduced to neonatal pediatrics in the early 1970s at a time when the advent of continuous positive airway pressure demon-strated how physiologic insight can be translated into effective therapy. The decade of the 1970s offered so many other innovations in neonatal respiratory care. These included noninvasive blood gas monitoring, xanthine therapy for apnea, and our fi rst real understanding of the pathogenesis and management of meconium aspira-tion syndrome, group B streptococcal pneumonia, and persistent fetal circulation or primary pulmonary hypertension of the newborn, three frequently interrelated con-ditions. The decade ended in remarkable fashion with the introduction of exogenous surfactant therapy and recognition that the novel new technique of high-frequency ventilation allows effective gas exchange in sick neonates.

The last 30 years have enabled us to build drastically on the foundation of this earlier period in neonatal respiratory management. The improved survival of extremely low birth weight infants has been nothing short of spectacular. For pre-term infants, the focus is now clearly to reduce the unacceptably high incidence of bronchopulmonary dysplasia. However, many key questions in neonatal respiratory care still need to be addressed. What constitutes optimal ventilatory strategy and optimal targets for gas exchange as refl ected in levels of PaO

2 and PaCO

2 ? What is

the risk/benefi t ratio of current and future pharmacologic adjuncts to ventilatory

viii Foreword

support, such as inhaled nitric oxide, xanthine, or antioxidant therapy, to name a few? How can we safely support ventilation and provide pharmacotherapy in the most noninvasive manner?

For preterm or term infants with malformations of the respiratory system, advances in pre- and postnatal imaging and surgical techniques hold promise for improved outcome. Great strides are being made simultaneously in our understand-ing of the molecular basis for normal and abnormal lung development. Furthermore, it is being increasingly recognized that genotypic characteristics may greatly infl u-ence the consequences of subsequent environmental exposures on lung develop-ment. These scientifi c advances need to be translated into improving adverse neonatal outcomes, such as the unacceptably high rate of wheezing disorders and asthma in the survivors of neonatal intensive care. As care providers to neonates, it is our responsibility to encourage clinical trials and other patient-based investiga-tion that will allow us to optimize the outcome of neonatal respiratory care.

The third edition of the Manual of Neonatal Respiratory Care is comprehensive and provides an important educational tool to address many of these challenges. It is, again, thoroughly edited by the accomplished trans-Atlantic team of Steven Donn and Sunil Sinha. Once again, they have assembled physician/scientist leaders in the fi eld of Developmental Pulmonology who provide a true international perspective to neonatal respiratory care. Both prior and new contributors provide a concise overview that spans neonatal physiology, pathogenesis of disease, and unique approaches to management of both simple and complex neonatal respiratory disorders. The result is a comprehensive text that provides a strongly international insight into neonatal respiratory care in a user-friendly, practical format.

Cleveland, OH, USA Richard J. Martin, MBBS, FRACP

ix

Preface

It is indeed a privilege for us to edit the third edition of the Manual of Neonatal Respiratory Care , and we were honored when Springer Science+Business Media approached us to do this.

In the years that have passed since the second edition, much has transpired, some technological and some philosophical. Microprocessor-based technology continues to refi ne the equipment at our disposal and to offer us almost limitless ways to man-age neonatal respiratory failure. At the same time, there has been a resurgence in the philosophy of minimal intervention, giving rise to the new popularity of continuous positive airway pressure and noninvasive ventilation. We have entered the age of evidence-based medicine, emphasizing the importance of the randomized, con-trolled trial. We have seen enormous growth in information technology and world-wide access to it. Therapeutic options also continue to expand, but greater care must be taken as survival of even more premature babies accentuates their toxicities and complications.

We have maintained the same outline format for the third edition, appreciating the positive feedback we have received from many that this is conducive to bedside use. We have not only updated previous chapters, we have added newer ones to refl ect changes in practice, equipment, and science. Some of these include an expanded focus on oxygen toxicity, control of oxygen delivery, use of nasal cannula therapy, noninvasive ventilation, newer ventilators, management of hemodynamics, home ventilation, interpreting medical literature, medico-legal issues, and an expan-sive contemporary bibliography on neonatal respiratory care.

Our list of contributors represents a world-class group of scientists, clinicians, and experts in their respective fi elds. We are indebted to them for taking the time and effort to provide their insights and knowledge. The Manual of Neonatal Respiratory Care would also not have been possible without the efforts of many “behind the scenes” individuals, including our development editor, Mike Griffi n, and our acquisi-tions editor, Shelley Reinhardt, both of Springer; Vicky Hall in Middlesbrough; and Susan Peterson in Ann Arbor, who coordinated the efforts of more than 50 contributors,

x Preface

and somehow managed to get all 85 chapters formatted the same way (an incredible feat!). Lastly, we acknowledge our wives, Paula Donn, and Lalita Dean, for their patience and sacrifi ces while we put the Manual together.

Change will continue to occur at a rapid pace. What we hope this edition accom-plishes is the establishment of fundamentals that will enable the clinician to develop the ability to assimilate change in a physiologically sound way while providing the best possible care to his or her patients.

Ann Arbor, MI, USA Steven M. DonnMiddlesbrough, UK Sunil K. Sinha

xi

Contents

List of Abbreviations ..................................................................................... xxv

Part I Lung Development and Maldevelopment

1 Development of the Respiratory System .............................................. 3Vinod K. Bhutani

2 Developmental Lung Anomalies ........................................................... 17Mohammad A. Attar and Subrata Sarkar

Part II Principles of Mechanical Ventilation

3 Spontaneous Breathing .......................................................................... 27Emidio M. Sivieri and Vinod K. Bhutani

4 Pulmonary Gas Exchange ..................................................................... 39Vinod K. Bhutani

5 Oxygen Therapy ..................................................................................... 49Win Tin

6 Oxygen Toxicity ...................................................................................... 55Ola Didrik Saugstad

7 Pulmonary Mechanics ........................................................................... 61Emidio M. Sivieri and Vinod K. Bhutani

8 Basic Principles of Mechanical Ventilation ......................................... 73Waldemar A. Carlo, Namasivayam Ambalavanan, and Robert L. Chatburn

9 Classifi cation of Mechanical Ventilation Devices ................................ 87Waldemar A. Carlo, Namasivayam Ambalavanan, and Robert L. Chatburn

xii Contents

10 Ventilator Parameters ............................................................................ 93Waldemar A. Carlo, Namasivayam Ambalavanan, and Robert L. Chatburn

11 Respiratory Gas Conditioning and Humidifi cation ............................ 99Andreas Schulze

Part III Procedures and Techniques

12 Clinical Examination ............................................................................. 109Avroy A. Fanaroff and Jonathan M. Fanaroff

13 Neonatal Resuscitation .......................................................................... 121Janet M. Rennie

14 Laryngoscopy and Endotracheal Intubation....................................... 129Karen Wiseman and Steven M. Donn

15 Vascular Access ...................................................................................... 137Steven M. Donn

16 Tracheostomy ......................................................................................... 143Steven M. Donn

Part IV Monitoring the Ventilated Patient

17 Continuous Monitoring Techniques ..................................................... 149Christian F. Poets

18 Pulse Oximetry ....................................................................................... 155Win Tin and Samir Gupta

19 Interpretation of Blood Gases ............................................................... 159David J. Durand

20 Neonatal Pulmonary Graphics ............................................................. 167Joanne Nicks

21 Radiography ........................................................................................... 181Ramon Sanchez and Peter J. Strouse

22 Transillumination ................................................................................... 211Steven M. Donn

23 Echocardiography .................................................................................. 213Jonathan Wyllie

24 Bronchoscopy ......................................................................................... 225Neil N. Finer

xiiiContents

Part V Non-invasive Ventilatory Techniques

25 Nasal Cannula Therapy ......................................................................... 231Andrea L. Lampland and Mark C. Mammel

26 Continuous Positive Airway Pressure .................................................. 237Colin J. Morley

27 Non-invasive Ventilation ........................................................................ 247Brigitte Lemyre and Haresh Kirpalani

Part VI Ventilatory Modes and Modalities

28 Positive End-Expiratory Pressure ........................................................ 255Sarvin Ghavam and Haresh Kirpalani

29 Intermittent Mandatory Ventilation .................................................... 261Steven M. Donn and Sunil K. Sinha

30 Synchronized Intermittent Mandatory Ventilation ............................ 267Steven M. Donn and Sunil K. Sinha

31 Assist/Control Ventilation ..................................................................... 271Steven M. Donn and Sunil K. Sinha

32 Volume-Targeted Ventilation ................................................................ 275Steven M. Donn and Sunil K. Sinha

33 Pressure Control Ventilation ................................................................. 281Steven M. Donn

34 Pressure Support Ventilation ................................................................ 285Sunil K. Sinha and Steven M. Donn

35 Proportional Assist Ventilation ............................................................. 291Andreas Schulze

Part VII High-Frequency Ventilation

36 High-Frequency Ventilation: General Concepts ................................. 301J. Bert Bunnell

37 High-Frequency Jet Ventilation ............................................................ 319Martin Keszler

38 High-Frequency Oscillatory Ventilation .............................................. 327Reese H. Clark

xiv Contents

Part VIII Commonly Used Neonatal Ventilators

39 VIP Bird Gold Ventilator ...................................................................... 341Michael A. Becker and Steven M. Donn

40 AVEA Ventilator ..................................................................................... 349Michael A. Becker and Steven M. Donn

41 Bear Cub 750PSV ...................................................................................... 357Joanne Nicks

42 Newport Wave ........................................................................................ 363Robert L. Chatburn and Teresa A. Volsko

43 Newport e360 .......................................................................................... 369Cyndy Miller

44 Dräger Babylog VN500 Infant and Pediatric Ventilator .................... 379Donald M. Null, Jr.

45 SERVO-i Ventilator and Neurally Adjusted Ventilatory Assist (NAVA) ..................................................................... 387Jennifer Beck and Louis Fuentes

46 SLE5000 and SLE4000 Infant Ventilators ........................................... 397Barbara Pilgrim and Sunil K. Sinha

47 Bunnell Life Pulse High-Frequency Jet Ventilator ............................. 403Martin Keszler

48 Sensormedics 3100A High-Frequency Oscillatory Ventilator ........... 407David J. Durand and Jeanette M. Asselin

Part IX Adjunctive Therapies

49 Hemodynamic Support .......................................................................... 417Keith J. Barrington

50 Nutritional Support of the Ventilated Infant ....................................... 425David Adamkin

51 Surfactant Replacement Therapy ........................................................ 443Fernando Moya and Maria-Cristina Javier

52 Pharmacologic Agents ........................................................................... 455Varsha Bhatt-Mehta and Steven M. Donn

53 Automatic Control of Oxygen Delivery ................................................ 469Nelson Claure and Eduardo Bancalari

54 Sedation and Analgesia.......................................................................... 473Elaine M. Boyle and Neil McIntosh

xvContents

55 Inhaled Nitric Oxide Therapy............................................................... 485John P. Kinsella

56 Extracorporeal Membrane Oxygenation ............................................. 497Robert E. Schumacher

57 Liquid Ventilation for Neonatal Respiratory Failure ......................... 505Ronald B. Hirschl

Part X Management of Common Neonatal Respiratory Diseases

58 Mechanisms of Respiratory Failure ..................................................... 513Anne Greenough and Anthony D. Milner

59 Tissue Hypoxia ....................................................................................... 517Anne Greenough and Anthony D. Milner

60 Indications for Mechanical Ventilation ................................................ 521Anne Greenough and Anthony D. Milner

61 Respiratory Distress Syndrome ............................................................ 523Steven M. Donn and Sunil K. Sinha (Case Study by Brooke D. Vergales and Jay P. Goldsmith)

62 Pneumonia .............................................................................................. 533Elvira Parravicini and Richard A. Polin

63 Meconium Aspiration Syndrome .......................................................... 555Thomas E. Wiswell(Case Study by Brooke D. Vergales and Jay P. Goldsmith)

64 Persistent Pulmonary Hypertension of the Newborn ......................... 565Robert E. Schumacher and Steven M. Donn(Case Study by Brooke D. Vergales and Jay P. Goldsmith)

65 Congenital Diaphragmatic Hernia ....................................................... 577Deepak Kalbigiri Vasudev and David Field(Case Study by Brooke D. Vergales and Jay P. Goldsmith)

66 Pulmonary Hypoplasia/Agenesis .......................................................... 587Deepak Kalbigiri Vasudev and David Field

67 Apnea Syndromes .................................................................................. 593Alan R. Spitzer

68 Weaning and Extubation ....................................................................... 609Steven M. Donn and Sunil K. Sinha(Case Study by Brooke D. Vergales and Jay P. Goldsmith)

xvi Contents

Part XI Bronchopulmonary Dysplasia

69 Etiology and Pathogenesis ..................................................................... 625Natasha Henner and Jonathan M. Davis

70 Management ........................................................................................... 633Eduardo Bancalari

71 Long-Term Outcome of Newborns with Bronchopulmonary Dysplasia ...................................................... 639Sumesh Thomas, Prashanth Murthy, and Saroj Saigal

Part XII Complications Associated with Mechanical Ventilation

72 Thoracic Air Leaks ................................................................................ 647Jennifer Dalton and Steven M. Donn

73 Patent Ductus Arteriosus ...................................................................... 659Jonathan Wyllie

74 Neonatal Pulmonary Hemorrhage ....................................................... 665Tonse N.K. Raju

75 Retinopathy of Prematurity .................................................................. 675Alistair R. Fielder

76 Neurologic Complications of Mechanical Ventilation ........................ 685Gillian Brennan and Jeffrey M. Perlman

Part XIII Other Considerations

77 Nursing Care of the Ventilated Infant .................................................. 693Kimberly LaMar

78 Transport of Ventilated Babies ............................................................. 705Steven M. Donn and Molly R. Gates

79 Home Ventilation .................................................................................... 717Wan Chong Tsai

80 Discharge Planning and Follow-Up of the NICU Graduate .............. 723Win Tin and Mithilesh Lal

Part XIV Ethical and Legal Considerations

81 Initiation of Life Support at the Border of Viability .......................... 733Naomi Laventhal, Joanne Lagatta, and William Meadow

82 Withdrawal of Ventilatory Support ..................................................... 739Malcolm L. Chiswick

xviiContents

83 Medical Liability, Documentation, and Risk Management ............... 747Steven M. Donn and Jonathan M. Fanaroff

Part XV Research and the Literature

84 Interpreting Medical Literature ........................................................... 753Omar Kamlin and Peter Davis

85 Contemporary Classics in Neonatal Respiratory Care ...................... 759Rachel L. Chapman and Lorelei Woody

Appendix ......................................................................................................... 767

Index ................................................................................................................ 769

xix

David Adamkin , MD Neonatal Department , University of Louisville Hospital , Louisville , KY , USA

Namasivayam Ambalavanan , MBBS, MD Division of Neonatology, Department of Pediatrics , University of Alabama at Birmingham , Birmingham , AL , USA

Jeanette M. Asselin , RRT, MS Neonatal/Pediatric Research Group, Children’s Hospital & Research Center Oakland , Oakland , CA , USA

Mohammad A. Attar , MD Department of Pediatrics , University of Michigan Health System , Ann Arbor , MI , USA

Eduardo Bancalari , MD Division of Neonatology, Department of Pediatrics , University of Miami Miller School of Medicine , Miami , FL , USA

Keith J. Barrington , MB, ChB Department of Neonatology , CHU Sainte Justine , Montreal , QC , Canada

Jennifer Beck , PhD Keenan Research Centre in the Li Ka Shing Knowledge Institute of St-Michael’s Hospital , Toronto , ON , Canada

Michael A. Becker , RRT Department of Critical Care Support Services , C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Varsha Bhatt-Mehta , MS (CRDSA), PharmD, FCCP Department of Pediatrics , C.S. Mott Children’s Hospital, College of Pharmacy, University of Michigan , Ann Arbor , MI , USA

Vinod K. Bhutani , MD Department of Pediatrics , Stanford University, Lucile Packard Children’s Hospital , Palo Alto , CA , USA

Elaine M. Boyle , MBChB, MSc, PhD Department of Health Sciences , University of Leicester , Leicester , Leicestershire , UK

List of Contributors

xx List of Contributors

Gillian Brennan , MB, BCh, BAO Division of Newborn Medicine, Weill Cornell Medical Center , New York-Presbyterian Hospital , New York , NY , USA

J. Bert Bunnell , ScD Bunnell Inc. , Department of Bioengineering , University of Utah , Salt Lake City , UT , USA

Waldemar A. Carlo , MD Division of Neonatology, Department of Pediatrics , University of Alabama at Birmingham , Birmingham , AL , USA

Rachel L. Chapman , MD Division of Neonatal-Perinatal Medicine, Department of Pediatrics , C.S. Mott Children’s Hospital, University of Michigan School of Medicine , Ann Arbor , MI , USA

Robert L. Chatburn , MHHS, RRT-NPS, FAARC Cleveland Clinic, Respiratory Institute , Cleveland , OH , USA

Malcolm L. Chiswick , MD, FRCP(Lond), FRCPCH, FRCOG, DCH University of Manchester , Manchester , UK

Newborn Intensive Care Unit , St. Mary’s Hospital, Oxford Road , Manchester , UK

Reese H. Clark , MD Pediatrix Medical Group, Department of Pediatrics , Greenville Memorial Hospital , Greenville , SC , USA

Nelson Claure , MSc, PhD Division of Neonatology, Department of Pediatrics , University of Miami Miller School of Medicine , Miami , FL , USA

Jennifer Dalton , MD Division of Neonatal-Perinatal Medicine , C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Jonathan M. Davis , MD Department of Pediatrics , The Floating Hospital for Children at Tufts Medical Center , Boston , MA , USA

Peter Davis , MBBS, MD, FRACP Newborn Research , The Royal Women’s Hospital , Parkville , VIC , Australia

Steven M. Donn , MD, FAAP Division of Neonatal–Perinatal Medicine , C.S. Mott Children’s Hospital, F5790 Mott Hospital/5254, University of Michigan Health System , Ann Arbor , MI , USA

David J. Durand , MD Division of Neonatology, Department of Neonatology , Children’s Hospital & Research Center Oakland , Oakland , CA , USA

Avroy A. Fanaroff , MD, FRCPE, FRCPCH, FAAP Department of Pediatrics , Rainbow Babies and Children’s Hospital , Cleveland , OH , USA

Jonathan M. Fanaroff , MD, JD Division of Neonatology, Department of Pediatrics , Rainbow Babies & Children’s Hospital , Cleveland , OH , USA

xxiList of Contributors

David Field , MBBS, FRCPCH, FRCP(Ed), DM Leicester Royal Infi rmary, Neonatal Unit , Infi rmary Square, Leicester , UK

Alistair R. Fielder , FRCP, FRCS, FRCOphth Optometry & Visual Science , City University, Northampton Square , London , UK

Neil N. Finer , MD Pediatrics, Division of Neonatology , San Diego Medical Center, University of California, Hillcrest , San Diego , CA , USA

Louis Fuentes , RRT Maquet Critical Care , Wayne , NJ , USA

Molly R. Gates , MA, MSN, RN-C Perinatal Nursing, C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Sarvin Ghavam , MD Department of Neonatology , Children’s Hospital of Philadelphia , Philadelphia , PA , USA

Jay P. Goldsmith , MD Women’s and Children’s Hospital , Lafayette , LA , USA

Department of Neonatology , Tulane University , New Orleans , LA , USA

Anne Greenough , MD Division of Asthma, Allergy and Lung Biology , King’s College London, London , UK

Samir Gupta , DM, MRCP, MD, FRCPCH, FRCPI Department of Neonatal Paediatrics , University Hospital of North Tees , Stockton-on-Tees , Cleveland , UK

Natasha Henner , MD Department of Pediatrics , The Floating Hospital for Children at Tufts Medical Center , Boston , MA , USA

Ronald B. Hirschl , MD Department of Pediatric Surgery , C.S. Mott Children’s Hospital , Ann Arbor , MI , USA

Maria-Cristina Javier , MD Department of Neonatology , New Hanover Regional Medical Center, Coastal Carolina Neonatology, PLLC , Wilmington , NC , USA

Omar Kamlin , MRCP, MRCPCH, FRACP The Royal Women’s Hospital, Neonatal Services , Parkville , VIC , Australia

Martin Keszler , MBBS, FRACP MD Department of Pediatrics , Women and Infants’ Hospital of Rhode Island, Brown University , Providence , RI , USA

John P. Kinsella , MD Children’s Hospital of Colorado , Aurora , CO , USA

Haresh Kirpalani , BM, MRCP, FRCP, MSc The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine , Philadelphia , PA , USA

Joanne Lagatta , MD, MS Department of Pediatrics , Medical Collegeof Wisconsin , Milwaukee , WI , USA

Mithilesh Lal , FRCPCH Department of Neonatal Medicine , The James Cook University Hospital , Middlesbrough , UK

xxii List of Contributors

Kimberly LaMar , ND, NPD-BC Chamberlain College of Nursing, Phoenix Campus , Phoenix , AZ , USA

Andrea L. Lampland , MD Department of Newborn Medicine , Children’s Hospitals and Clinics of Minnesota , St. Paul , MN , USA

Naomi Laventhal , MD, MA Department of Pediatrics , University of Michigan C.S. Mott Children’s Hospital , Ann Arbor , MI , USA

Brigitte Lemyre , MD, FRCP University of Ottawa, Division of Neonatology, Department of Pediatrics , Children’s Hospital of Eastern Ontario , Ottawa , ON , Canada

Mark C. Mammel , MD Department of Newborn Medicine , Children’s Hospitals and Clinics of Minnesota , University of Minnesota , St. Paul , MN , USA

Richard J. Martin , MBBS, FRACP Case Western Reserve University , Cleveland , OH , USA

Division of Neonatology , Rainbow Babies & Children’s Hospital , Cleveland , OH , USA

Neil McIntosh , DSc(Med), FRCP, FRCPE, FRCPCH University of Edinburgh, Child Life and Health , Edinburgh , UK

William Meadow , MD, PhD Department of Pediatrics , The University of Chicago , Chicago , IL , USA

Cyndy Miller , RRT, AS/AA Department of Clinical Education , Newport Medical Instruments , Costa Mesa , CA , USA

Anthony D. Milner , MD Division of Asthma, Allergy and Lung Biology , King’s College London , London , UK

Colin J. Morley , MB Bchir, DCH, MD, FRCPCH, FRACP Neonatal Research, The Royal Women’s Hospital , Melbourne , VIC, Australia

The Rosie Maternity Hospital, Cambridge, UK

Fernando Moya , MD Department of Neonatology , New Hanover Regional Medical Center, Coastal Carolina Neonatology, PLLC , Wilmington , NC , USA

Prashanth Murthy , MBBS, MD, MRCPCH Department of Pediatrics , McMaster Children’s Hospital , Hamilton , ON , Canada

Joanne Nicks , RRT, AAS Pediatric Respiratory Care, C.S. Mott Children’s Hospital , Ann Arbor , MI , USA

Donald M. Null , Jr., MD Primary Children’s Medical Center, Newborn Intensive Care Unit , Salt Lake City , UT , USA

Elvira Parravicini , MD Division of Neonatology, Department of Pediatrics , NY Presbyterian Morgan Stanley Children’s Hospital , New York , NY , USA

xxiiiList of Contributors

Jeffrey M. Perlman , MB, ChB Division of Newborn Medicine, Weill Cornell Medical Center, New York-Presbyterian Hospital , New York , NY , USA

Barbara Pilgrim SLE Ltd, Twin Bridges Offi ce Park , Croydon , Surrey , UK

Christian F. Poets , MD Department of Neonatology , Tuebingen University Hospital , Tuebingen , Germany

Richard A. Polin , MD Division of Neonatology, Department of Pediatrics , NY Presbyterian Morgan Stanley Children’s Hospital , New York , NY , USA

Tonse N. K. Raju , MD, DCH Eunice Kennedy Shriver National Institute of Child Health and Human Development , Bethesda , MD , USA

Janet M. Rennie , MA, MD, FRCP, FRCPCH, FRCOG Institute of Women’s Health, University College London Hospitals , London , UK

Ramon Sanchez , MD Section of Pediatric Radiology, University of Michigan , C.S. Mott Children Hospital , Ann Arbor , MI , USA

Subrata Sarkar , MD Division of Neonatal-Perinatal Medicine, Department of Pediatrics , C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Saroj Saigal , MD, FRCPC Department of Pediatrics , McMaster Children’s Hospital , Hamilton , ON , Canada

Ola Didrik Saugstad , MD, PhD Department of Pediatric Research , Oslo University Hospital, Rikshospitalet , Oslo , Norway

Andreas Schulze , MD, PhD Division of Neonatology , Dr. von Hauner Children’s Hospital , Munich , Germany

Department of Pediatrics, Klinikum Grosshadern, Ludwig Maximilian University , Munich , Germany

Robert E. Schumacher , MD Department of Pediatrics , C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Sunil K. Sinha , MD, PhD, FRCP, FRCPCH Department of Neonatal Medicine , The James Cook University Hospital, University of Durham , Marton-in-Cleveland, Middlesbrough , UK

Emidio M. Sivieri , MS Neonatal Pulmonary Function Laboratory , Pennsylvania Hospital , Philadelphia , PA , USA

Alan R. Spitzer , MD Department of Research, Education, and Quality , MEDNAX, Inc. , Sunrise , FL , USA

Peter J. Strouse , MD Section of Pediatric Radiology, University of Michigan , C.S. Mott Children Hospital , Ann Arbor , MI , USA

xxiv List of Contributors

Sumesh Thomas , MBBS, DCH, FRCP, FRCPCH, FRCPC Department of Pediatrics , McMaster Children’s Hospital , Hamilton , ON , Canada

Win Tin , FRCPCH Department of Neonatal Medicine , The James Cook University Hospital , Middlesbrough , UK

Wan Chong Tsai , MD, MS Department of Pediatric Pulmonology , Promedica Toledo Children’s Hospital and University of Toledo , Toledo , OH , USA

Deepak Kalbigiri Vasudev , MBBS, DCH, MRCPCH Leicester Royal Infi rmary, Neonatal Unit, Infi rmary Square , Leicester , UK

Brooke D. Vergales , MD Department of Pediatrics , University of Virginia , Charlottesville , VA , USA

Teresa A. Volsko , MHHS, RRT, FAARC Respiratory Care and Polysomnography Programs, Youngstown State University , Youngstown , OH , USA

Karen Wiseman , MD Division of Neonatal–Perinatal Medicine , C.S. Mott Children’s Hospital, University of Michigan Health System , Ann Arbor , MI , USA

Thomas E. Wiswell , MD Department of Pediatrics , Florida Children’s Hospital , Orlando , FL , USA

Lorelei Woody , MLIS Alfred A. Taubman Health Sciences Library, University of Michigan , Ann Arbor , MI , USA

Jonathan Wyllie , BSc(Hons), MB ChB, FRCPCH, FRCP, FERC Department of Neonatalogy , The James Cook University Hospital , Middlesbrough , Cleveland , UK

xxv

List of Abbreviations

m m Micrometer °C Degrees Celsius (Centigrade) °K Degrees, Kelvin

A Alveolar a Arterial a/A Arterial/alveolar ratio A/C Assist/control AAC Automatic airway compensation A-aDO

2 Alveolar–arterial oxygen gradient

ABG Arterial blood gas ACT Activated clotting time ADP Adenosine diphosphate AH Absolute humidity ALTE Apparent life-threatening event AM Morning AMP Adenosine monophosphate Ao Aortic AOI Apnea of infancy AOP Apnea of prematurity AP Anteroposterior ARDS Adult (or acute) respiratory distress syndrome ASD Atrial septal defect ATP Adenosine triphosphate ATPS Ambient temperature and pressure, saturated with water vapor

BAER Brainstem audiometric-evoked responses BP Blood pressure BPD Bronchopulmonary dysplasia BPM (bpm) Beats or breaths per minute BR Breath rate BTPS Body temperature and pressure, saturated with water vapor

xxvi List of Abbreviations

C Compliance C20 Compliance over last 20% of infl ationCCAM congenital cystic adenomatoid malformation cAMP Cyclic adenosine monophosphate CBF Cerebral blood fl ow CBG Capillary blood gas cc Cubic centimeter C

D or C

DYN Dynamic compliance

CDH Congenital diaphragmatic hernia CDP Constant distending pressure CF Cystic fi brosis cGMP Cyclic guanosine monophosphate CHAOS Congenital high airway obstruction syndrome CHD Congenital heart disease C

L Compliance

CLD Chronic lung disease CLE Congenital lobar emphysema cm Centimeter CMV Conventional mechanical ventilation CMV Cytomegalovirus CNS Central nervous system CO Cardiac output CO

2 Carbon dioxide

CO-Hb Carboxyhemoglobin COPD Chronic obstructive pulmonary disease CPAP Continuous positive airway pressure CPL Congenital pulmonary lymphangiectasia CPR Cardiopulmonary resuscitation CPT Chest physiotherapy CRP C-reactive protein CSF Cerebrospinal fl uid C

ST Static compliance

CT Computed tomography CVP Central venous pressure CXR Chest X-ray (radiograph)

D End-diastole D5W Dextrose 5% in water DCO

2 Gas transport coeffi cient for carbon dioxide

DIC Disseminated intravascular coagulation dL Deciliter DNA Deoxyribonucleic acid DPG Diphosphoglycerate DPPC Dipalmitoyl phosphatidyl choline DR Delivery room

xxviiList of Abbreviations

E Elastance ECG Electrocardiogram ECMO Extracorporeal membrane oxygenation EDRF Endothelial-derived relaxing factor EEG Electroencephalogram EF Ejection fraction ELBW Extremely low birth weight EMG Electromyogram EMLA Eutectic mixture of Lidocaine and Prilocaine ERV Expiratory reserve volume ET Endotracheal ETCO

2 End-tidal carbon dioxide

ETCPAP Endotracheal continuous positive airway pressure ETT Endotracheal tube

F or f Frequency F or Fr French FCV Flow control valve, fl ow-cycled ventilation FDA Food and Drug Administration (US) FDP Fibrin degradation products FGF Fibroblast growth factor FIO

2 Fraction of inspired oxygen

FiO 2 Fraction of inspired oxygen

FOE Fractional oxygen extraction FRC Functional residual capacity FSP Fibrin split products FTA Fluorescent treponemal antibody

g Gauge g Gram G Gravida GA Gestational age GBS Group B streptococcus GER Gastro-esophageal refl ux GERD Gastro-esophageal refl ux disease GIR Glucose infusion rate gm Gram GNP Gross national product GTP Guanosine triphosphate GUI Graphics user interface

h or hr Hour H

2 O Water

Hb Hemoglobin HCH Hygroscopic condenser humidifi er HCO

3 − Bicarbonate

xxviii List of Abbreviations

HFJV High-frequency jet ventilation HFNC High fl ow nasal cannula HFO High-frequency oscillation HFOV High-frequency oscillatory ventilation HFV High-frequency ventilation Hg Mercury Hgb Hemoglobin HME Heat and moisture exchanger HR Heart rate HSV Herpes simplex virus Hz Hertz

I Inertance I:E Inspiratory:expiratory ratio IC Inspiratory capacity Ig Immunoglobulin IL Interleukin IMV Intermittent mandatory ventilation INO Inhaled nitric oxide IO Intraosseous IP Inspiratory pressure IPPV Intermittent positive pressure ventilation IRV Inspiratory reserve volume IUGR Intrauterine growth restriction IV Intravenous IVC Inferior vena cava(l) IVH Intraventricular hemorrhage IVS Interventricular septum

K Constant kDa Kilodalton kg Kilogram kPa Kilopascal

L Liter LA Left atrium LBW Low birth weight LCD Liquid crystalline display LED Light emitting diode LHR Ratio of lung diameter to head circumference LOS Length of stay LPM (lpm) Liters per minute LVEDD Left ventricular end-diastolic dimension LVID Left ventricular internal diameter LVIDD Left ventricular internal diameter at diastole LVIDS Left ventricular internal diameter at systole LVO Left ventricular output

xxixList of Abbreviations

m Meter MAP Mean arterial pressure MAS Meconium aspiration syndrome mcg Microgram MD Minute distance mEq Milliequivalent MetHb Methemoglobin mg Milligram MIC Mean inhibitory concentration min Minute mL (ml) Milliliter mm Millimeter MMV Mandatory minute ventilation mOsm Milliosmoles MRI Magnetic resonance imaging MSAF Meconium-stained amniotic fl uid MV Minute ventilation

NAVA Neurally adjusted ventilatory assist NEC Necrotizing enterocolitis NICU Neonatal intensive care unit NIPPV Noninvasive positive pressure ventilation NIRS Near-infrared spectroscopy NO Nitric oxide NO

2 Nitrogen dioxide

NOS Nitric oxide synthase

O 2 Oxygen

OI Oxygenation index

P Para P Pressure P50 Point of 50% saturation of hemoglobin with oxygen PACO

2 Partial pressure of carbon dioxide, alveolar

PaCO 2 Partial pressure of carbon dioxide, arterial

PAO 2

Partial pressure of oxygen, alveolar PaO

2 Partial pressure of oxygen, arterial

PAV Proportional assist ventilation Paw Airway pressure Pāw Mean airway pressure PB Periodic breathing PC Pressure control PCA Postconceptional age PCR Polymerase chain reaction PDA Patent ductus arteriosus PE Elastic pressure

xxx List of Abbreviations

PEEP Positive end-expiratory pressure PFC Persistent fetal circulation, perfl uorocarbon PG Prostaglandin PH

2 O Partial pressure of water vapor

PI Inspiratory pressure P

I Pressure, inertital

PICC Percutaneous intravenous central catheter PIE Pulmonary interstitial emphysema PIP Intrapleural pressure PIP Peak inspiratory pressure PL Pressure limit PL Pressure limit PLV Partial liquid ventilation PMA Postmenstrual age PMA Premarket approval (US) PN

2 Partial pressure of nitrogen

PPHN Persistent pulmonary hypertension of the newborn ppm Parts per million PR Resistive pressure prbc Packed red blood cells PRVC Pressure-regulated volume control PSI Pounds per square inch PSIG Pounds force per square inch gauge PST Static pressure PSV Pressure support ventilation PT Prothrombin time PTP Transpulmonary pressure PTT Partial thromboplastin time PTV Patient-triggered ventilation PUFA Polyunsaturated fatty acids PV-IVH Periventricular–intraventricular hemorrhage PVL Periventricular leukomalacia PvO

2 Mixed central venous oxygen tension

PvO 2

Partial pressure of oxygen, venous PVR Pulmonary vascular resistance

q Every Q Perfusion

r Radius R Resistance R

AW Airway resistance

RBC Red blood cell RCT Randomized controlled trial RDS Respiratory distress syndrome RE Expiratory resistance

xxxiList of Abbreviations

REM Rapid eye movement RH Relative humidity RI Inspiratory resistance ROP Retinopathy of prematurity ROS Reactive oxygen species RR Respiratory rate, relative risk RSV Respiratory syncytial virus RV Reserve volume RVO Right ventricular output

S End-systole S1 (2,3,4) First (second, third, fourth) heart sound SaO

2 Arterial oxygen saturation

s Second sGC Soluble guanylate cyclase SIDS Sudden infant death syndrome SIMV Synchronized intermittent mandatory ventilation SNAP Score for neonatal acute physiology SOD Superoxide dismutase SP Surfactant protein SpO

2 Pulse oximetry saturation

sq Square STPD Standard temperature and pressure, dry SV Stroke volume SVC Superior vena cava(l) SvO

2 Venous oxygen saturation

SVR Systemic vascular resistance

T Temperature TBW Total body water TcPCO

2 Transcutaneous carbon dioxide tension

TCPL(V) Time-cycled, pressure-limited (ventilation) TcPO

2 Transcutaneous oxygen tension

TCT Total cycle time T

E or T

e Expiratory time

TEF Tracheo-esophageal fi stula TGF Transforming growth factor TGV Total or thoracic gas volume THAM Tris-hydroxyaminomethane T

I or T

i Inspiratory time

TLC Total lung capacity TLV Total liquid ventilation TPN Total parenteral nutrition TPV Time to peak velocity TRH Thyroid releasing hormone TTN, TTNB Transient tachypnea of the newborn TTV Targeted tidal volume

xxxii List of Abbreviations

U Units UAC Umbilical artery catheter

V Volume, velocity V� Flow V�� Rate of change of fl ow V/Q Ventilation/perfusion V

A Alveolar ventilation

VA Anatomic volume V-A Veno-arterial VAP Ventilator-associated pneumonia VAPS Volume-assured pressure support VC Vital capacity VCF Velocity of circumferential fi ber shortening VCO

2 Carbon dioxide elimination

VCV Volume-controlled ventilation VD Deadspace volume VDRL Venereal disease research laboratory VEGF Vascular endothelial growth factor VILI Ventilator-induced lung injury VLBW Very low birthweight VS Volume support VSD Ventricular septal defect V

T Tidal volume

V TE

Expired tidal volume V

TI Inspired tidal volume

VTI Velocity time interval V-V Venovenous

WBC White blood cell