TY  - CHAP
M1  - Book, Section
TI  - Chapter 61. Special Intensive Care
A1  - Parker, Thomas A.
A2  - Rudolph, Colin D.
A2  - Rudolph, Abraham M.
A2  - Lister, George E.
A2  - First, Lewis R.
A2  - Gershon, Anne A.
PY  - 2011
T2  - Rudolph's Pediatrics, 22e
AB  - Respiratory  failure  is  one  of  the  most  common  problems  requiring  admission  to  the  neonatal  intensive  care  unit.  Respiratory  failure  is  often  the  final  result  of  restrictive  lung  disease  with  regional  or  global  alveolar  collapse  or  consolidation.  In  order  to  achieve  optimal  alveolar  gas  exchange,  the  lung  needs  to  be  inflated  at  end  expiration  (at  functional  residual  capacity)  and  have  sufficient  tidal  and  minute  ventilation  to  eliminate  carbon  dioxide.1  Under  optimal  conditions,  several  factors  help  prevent  the  collapse  of  alveoli  at  the  end  of  expiration  and  thereby  maintain  an  adequate  functional  residual  capacity.  Surfactant,  which  is  produced  in  the  type  II  cells  of  the  lung,  dramatically  reduces  surface  tension  and  opposes  the  tendency  of  alveoli  to  collapse  when  lung  volume  is  at  its  lowest.  In  addition,  the  rigidity  of  the  chest  wall  opposes  lung  collapse.  In  comparison  to  the  adult,  several  factors  present  disadvantages  for  the  neonate’s  capacity  to  maintain  optimal  lung  volumes.  The  neonatal  chest  is  highly  compliant,  which  limits  its  ability  to  oppose  elastic  recoil  and  collapse  during  expiration  and  increases  the  potential  for  the  development  of  collapse.  This  problem  is  greatly  exacerbated  in  the  setting  of  surfactant  deficiency  or  inactivation,  in  which  unopposed  surface  tension  dramatically  increases  the  chance  of  alveolar  collapse  during  expiration.  Lastly,  although  the  small  diameter  of  the  neonatal  tracheobronchial  tree  generally  is  sufficient  to  provide  unimpeded  airflow,  further  small  reductions  in  its  diameter  can  dramatically  increase  resistance  and  adversely  affect  gas  entry  and  egress.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=6736591
ER  -