Lng Injury Induced during Resuscitation of the Preterm Newborns in the Delivery Room

Lee, Hyeon Soo

Abstract

Neonatologists are deeply concerned with the concept of ventilator-induced lung injury (VILI) and they are greatly careful in the neonatal intensive care unit to apply positive-pressure ventilation (PPV) strategies that are gentle to the lungs. To achieve adequate gas exchange after delivery, lung fluid should be cleared and replaced with air, and functional residual capacity (FRC) should be established. However preterm newborns have difficulties establishing FRC and maintaining upper airway patency at birth. Hence majority of preterm newborns need some assistance to initiate breathing after birth and some require extensive resuscitation. PPV is therefore commonly used in the delivery room, however most clinicians including neonatologists or obstetricians appear less aware that the gentle approach as in NICU should be applied to prevent lung injury during the first few minutes of life. PPV may cause lung injury through various mechanisms such as high Vt (tidal volume) and overdistension (volutrauma), repeated alveolar collapse and re-expansion (atelect-trauma), and infection and inflammation (biotrauma), through which leads to epithelial cell injury, leakage of proteinaceous fluid into the lungs, inhibiting surfactant function and interfering lung mechanics, and consequently generating lung injury. In this review, I describe briefly what causes preterm lung injury during PPV based on animal and human researches, and I suggest some strategies to help minimize lung injury during resuscitation of preterm newborns in the delivery room.