editorial neonatal lung disease and respiratory...

Hindawi Publishing CorporationCritical Care Research and PracticeVolume 2013, Article ID 238909, 2 pageshttp://dx.doi.org/10.1155/2013/238909

EditorialNeonatal Lung Disease and Respiratory Failure

Hercília Guimarães,1 Anton van Kaam,2 Gustavo Rocha,3 and Manuel Sánchez Luna4

1 Faculty of Medicine of Porto University, Division of Neonatology of Sao Joao Hospital, Porto, Portugal2 Neonatal Intensive Care (H3-228), Emma Children’s Hospital AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands3 Division of Neonatology, Hospital de Sao Joao, Porto, Portugal4 Paediatrics Complutense University, Neonatology Division, Hospital General Universitario “Gregorio Maranon”, Madrid, Spain

Correspondence should be addressed to Hercılia Guimaraes; [email protected]

Received 7 February 2013; Accepted 7 February 2013

Copyright © 2013 Hercılia Guimaraes et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Neonatal lung disease and respiratory failure are commonin neonates. Causes of lung disease and respiratory failureare divers and are often associated with maternal pathology,prematurity, and congenital anomalies. Better knowledge andunderstanding of the pathophysiology of lung disease haveled to the development of more effective and safe therapiesfor both acute and chronic disease.

This special issue includes research articles as well asreview articles that will stimulate the continuing efforts tounderstand the neonatal lung, the pathophysiology of thelung diseases, the development of strategies to treat theseconditions, and evaluation of outcomes.

Very preterm infants are commonly exposed to a chronic,often asymptomatic, chorioamnionitis that is usually diag-nosed by the histological evaluation of the placenta, only afterdelivery. G. Rocha extensively reviewed and summarized theavailable literature on whether histological chorioamnionitismay be associated to lung injury of the preterm newborn.There is a strong evidence that histologic chorioamnionitisis associated with a reduction of incidence and severity ofrespiratory distress syndrome (RDS). Short-term matura-tional effects on the lungs of extremely premature infantsseem to be, however, accompanied by a greater susceptibilityof the lung, eventually contributing to an increased risk ofbronchopulmonary dysplasia (BPD). Genetic susceptibilityto BPD is an evolving area of research, and several studieshave directly related the risk of BPD to genomic variants.There is a substantial heterogeneity across the studies inthe magnitude of the association between chorioamnionitis

and BPD, and whether or not the association is statisticallysignificant. Recent studies generally seem to confirm theeffect of chorioamnionitis on RDS incidence, while no effecton BPD is seen. Recent data have suggested susceptibility forsubsequent asthma to be increased on long-term followup.

S. Gupta and S. M. Donn describe novel approaches tosurfactant administration. Surfactant replacement therapyhas been the mainstay of treatment for preterm infantswith RDS for more than twenty years. Although trachealinstillation is still reputed as the classicalmethod of surfactantdelivery, alternative techniques have been investigated. Inrecent years, the growing interest in noninvasive ventilationhas led to novel approaches of administration. These poten-tial strategies include intra-amniotic instillation, pharyn-geal instillation, administration via laryngeal mask airway,administration using a thin intratracheal catheter withoutIPPV, or aerosolized/nebulized surfactant administration inspontaneously breathing infants. Data from clinical trialsof these novel techniques will need to evaluate long-termrespiratory and neurodevelopmental outcomes and to assessthe true cost effectiveness.

Survival and outcomes for preterm infants with RDS haveimproved over the past 30 years. F. Flor-de-Lima et al. reportthe changes in perinatal care and delivery roommanagementat her center in 2005, when early nasal continuous positiveairway pressure (NCPAP) and intubate surfactant extubate(INSURE) were introduced, and the positive impact onrespiratory outcome and survival of very low birth weightnewborns.

2 Critical Care Research and Practice

M. O’Reilly et al. focus the short- and intermediate-term outcomes of preterm infants receiving positive pressureventilation in the delivery room. Although recent advancesin neonatal care have improved survival rates, rates of BPDremain unchanged. Although neonatologists are increasinglyapplying gentle ventilation strategies in the neonatal intensivecare unit, the same emphasis has not been applied immedi-ately after birth. A lung-protective strategy should start withthe first breath to help establish functional residual capacity,facilitate gas exchange, and reduce volutrauma and atelec-totrauma. Ideally, a lung-protective strategy should startimmediately after birth because the lungs of very preterminfants are uniquely susceptible to injury because they arestructurally immature, surfactant deficient, fluid filled, andnot supported by a stiff wall.

Flow-synchronized nasal intermittent positive pressureventilation (SNIPPV) could be used to reduce endotrachealventilation, increase successful extubation, decrease the rateof apnea of prematurity, and have better outcome indicatedby fewer death and/or BPD in preterm and term newborninfants. C. Gizzi et al. also demonstrate that the introductionof the routine use of SNIPPV after INSURE technique intheir NICU reduced the need for MV and favorably affectedother short-term morbidities of premature infants <32-weekgestation with RDS.

Vascular endothelial growth factor (VEGF), an angio-genic factor secreted by type II pneumocytes, could play arole in congenital diaphragmatic hernia (CDH) pathogenesis.Studies in rodents suggest that VEGF accelerates lung growthin hypoplastic lungs. E. Sanz-Lopez et al. show the changesin the expression of VEGF after fetal tracheal occlusion(TO) in an experimental model of CDH. VEGF proteinwas significantly lower in fetuses with CDH. TO induced asignificant increase in VEGF compared to the fetuses that didnot undergo TO.

Patent ductus arteriosus (PDA) is a significant cause ofmorbidity and mortality in preterm infants. Many factorsare associated with closure of ductus arteriosus in preterminfants. K. W. Olsson et al. show that a high ductal flowvelocity is associatedwith successful pharmacological closureof PDA in 22–27-week gestational age infants during pharma-cological treatment with cyclooxygenase inhibitors.

O. Carvalho and C. Goncalves evaluated the lungretinoids content to study the possible difference betweenmale and femalemice during prenatal lung development, andto comprehend if the vitamin Ametabolism is similar in bothgenders. They observed that there is a sexual dimorphism inthe retinoids content during mice lung development, moreevident in the last developmental days, as well as a differencein the retinoids metabolism.

Respiratory syncytial virus (RSV) lower respiratory tractinfection is the most common viral respiratory infectionin both term and preterm infants. Some studies have beendone to determine which risk factors are the best predictorsfor severe RSV disease. A. Goncalves et al. evaluated thechest radiographic pattern in RSV disease of the newbornand identified that newborns with a consolidation patternon admission chest radiograph had a more severe diseasecourse, with greater risk of respiratory support, invasive

mechanical ventilation, supplemental oxygen, and prolongedhospitalization.

All of these chapters illustrate some important aspectsof the contemporary respiratory neonatal medicine to beadopted in clinical practices and to stimulate experimental orclinical research.

Hercılia GuimaraesAnton van KaamGustavo Rocha

Manuel Sanchez Luna

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