Exploratory Research

researchers stated that SIDS babies probably have a defect in the brain neurochemicals that usually operate the protective responses to changes in oxygen and carbon dioxide levels.(IntelliHealth 3)

The new versus classic BPD features have changed over the years. The approaches to care, including surfactant administration, permissive hypercapnia, and noninvasive ventilation have changed. All these has increased the survival of low birth weight infants as before with classic BPD. The classic BPD was before surfactant and more management techniques, and inflammation and alveolar septal fibrosis. All these changes were associated with oxygen toxicity, infection, and barotrauma.

The list of proposed chronic abnormalities is lengthy. To this date, research has confirmed the following: 1) SIDS is due to a dysfunction of the cardiac and/or respiratory systems, and 2) the death of the infant is due to hypo-ventilation of the lungs and periods of complete cessation of breathing or apnea. Hypo-ventilation and apnea cause hypo-perfusion of the tissues with necessary oxygen. Ischemia of tissues results and eventually causes death. Research now centers around discovering the cause of infant hypo-ventilation and apnea.

Inability for the baby's body to detect a build-up of carbon dioxide in the blood

Another group of patients which require challenging ventilation strategies are the preterm infants. The lungs of preterm infants have undeveloped distal airway structures, with a thick air/blood barrier and a small surface area for gas-exchange (Wallace et al., 2009). They are most likely to be surfactant deficient due to under-developed epithelial cells which lack the type II alveolar cells (Wallace et al., 2009). As a result, preterm infants often require respiratory support in the minutes following birth (Roupie et al., 1995).

There have been many changes throughout the years in healthcare. One of the many changes that affect us every day is oxygen toxicity in premature babies and the effects on their eyes. There is a fine line to walk when protecting the function of the brain and preserving vision. The risks have been a concern for healthcare providers for decades. Some people were born at 26 weeks in the early 60’s and suffers from severe retinopathy from over oxygenation. Between 1950 and the mid-1960’s many babies were blinded due to over oxygenation (Millenson, 2015).

Postnatal respiratory complications among newborns are common. The most commonly reported cause of neonatal respiratory distress is transient tachypnea of the newborn (TTN), with an estimated incidence of 1% to 2% of in all newborns.1

In this article, DiBlasi argues that the conventional method used to provide ventilatory support to preterm neonates with respiratory distress syndrome; nasal continuous positive airway pressure (CPAP) is ineffective. The author bases the claim on the fact that almost half of the infants supported by this technique often develop respiratory failure that warrants invasive ventilatory support and endotracheal intubation that is injurious in nature. According to the author, invasive ventilatory procedures should be avoided to minimize the excessive complications that are usually associated with them.

Nitric oxide is a molecule that our body produces that helps cells communicate with each other. Nitric oxide has previously been used for respiratory failure in term and preterm babies. Nitric oxide is commonly known as an environmental pollutant because it is a component of the smog we breath during bad air days. Nitric oxide is naturally produced in the body in the upper and lower airway but can also be present in cigarette smoke. This paper will be looking at the effects and use of inhaled nitric oxide in acute respiratory distress syndrome (ARDS). ARDS can be triggered by other things such as pneumonia, a serious injury to the chest, inhaling vomit, and many other things. Having ARDS means there is inflammation throughout the lungs

The medical field is very fast-paced and new technological discoveries are constantly being made. When one thinks of new medical findings, cancer cures and surgery are common thoughts. However, a very interesting and slightly controversial discovery has been made in the neonatal world. The Neurally Adjusted Ventilatory Assist (NAVA) is “a form of partial ventilator assistance in which the machine delivers assistance in proportion to the electrical activity of the diaphragm (EAdi), as assessed by means of transesophageal electromyography” (Gianmaria Cammarota et al., 2011). It is meant to lower inspiratory pressure and respiratory muscle load in preterm infants (Gianmaria Cammarota et al., 2011). In other words, it helps the patient- whether they be an infant or an adult- breathe when their lungs aren’t able to aid in that process. M. Ferrer and P. Pelosi, authors of “European Respiratory Monograph 55: New Developments in Mechanical Ventilation” say that the signal from the EAdi is used to regulate NAVA, which then causes the airways to receive pressure. “With NAVA, both timing and the magnitude ventilator delivered assistance are controlled by the EAdi” (M. Ferrer & P. Pelosi., 2012, p 116). My research proves that NAVA can work better than pressure support ventilation (PSV) and can be used not only for neonates, but patients in the ICU that are affected by lung-related injury or illness that causes them to have difficulty breathing on their own; though there are

Keywords: brain natriuretic peptide (BNP); bronchopulmonary dysplasia (BPD); patent ductus arteriosus (PDA); persistent pulmonary hypertension of the newborn (PPHN)

Step one of the five steps approach to interpret the above values is to look at the PaO2 level which is currently 70. Since the normal level is between 80 to 100 mm hg, the current PaO2 of 70 means Mary is experiencing hypoxemia. However, the patient’s current oxygen delivery is at 100% thus the nurse needs to continue to monitor the patient closely. A strategy to correct the PaO2 level is correcting the PaCO2 level first because as CO2 rises, PaO2 falls. The nurse can adjust the PEEP level and can be increased to 6 or 7cm H20 since that will help keep the alveoli open to better the oxygenation for the patient so we are able to eventually decrease the delivered O2 to protect the patient from any possible oxygen toxicity. The second step is

blockage of the air passages, the lungs can hyperinflate or collapse (Ward et al., 2016, p. 737). The pulmonary surfactant that allows for alveolar re- expansion is also affected by the inhalation of meconium, leading to respiratory failure. El Shahed, Dargaville, Ohlsson, & Soll (2014) pointed out that “Meconium inhibits the surface tension-lowering properties of surfactant.” MAS is the most common cause of persistent pulmonary hypertension of the newborn (PPHN). It occurs when fetal circulation remains after birth due to vascular resistance in the pulmonary system, causing failure of transition to normal adult- type circulation (Ward et al., 2016, p. 738). Systematic reviews have been conducted to test the effectiveness of the interventions of MAS, leading to better clinical outcomes.

The physiological effects of nitric oxide were first recognized in 1876, but was not acknowledged for its physiological and medical usage until the late 20th century. Since then, inhaled nitric oxide has been used by medical clinicians for the treatment of neonates who suffer from hypoxic respiratory failure linked with persistent pulmonary hypertension and for the treatment of adults with pulmonary hypertension associated with respiratory distress syndrome. Although inhaled nitric oxide has been known to offer great benefits for patients with respiratory diseases, it may also have a detrimental effect on patients if the accurate amount of dosage is not administered properly. To ensure the proper dosage is being administered to the patient, there are several newly designed nitric oxide systems being developed to use in conjunction with mechanical ventilation or for single use. Nitric oxide therapy has improved drastically over the last twenty years, but it is still being developed and researched in pursuit of the most effective treatment for patients with respiratory diseases.

Preterm infants are born during the late cannalicular to early saccular stages of lung development, which corresponds to the period when respiratory bronchioles capable for gas exchange and type II alveolar