Lung injury in neonates: Causes, strategies for prevention, and long-term consequences

The process of supporting gas exchange in the very low birth weight infant may have lifelong consequences. Our choices begin in the delivery room where we must support a safe transition from fetal to neonatal life. How we support gas exchange and normalize lung inflation from the first breath is important. CPAP, surfactant, and HFV all may be useful in establishing and maintaining normal FRC. The establishment of normal FRC reduces the risk of acute lung injury caused by atelectrauma. As lung volume is recruited and maintained, it is important to avoid high end-inspiratory lung volumes to reduce volutrauma and the development of hypocarbia. Reducing oxygen exposure to that needed to support normal oxygen delivery can also reduce lung injury. If these strategic principles are followed, we can reduce the pulmonary and systemic inflammatory changes associated with ventilator-induced lung injury and hopefully promote better long-term health.