Adjunctive Therapies for Treatment of Severe Respiratory Failure in Neonates

Severe neonatal pulmonary failure in late preterm or term neonates still represents a major challenge in neonatology. In contrary with a considerable number of controlled clinical trials facing classical neonatal respiratory distress syndrome (RDS), e. g. primary surfactant deficiency syndrome in an immature lung, only a limited number of studies have been published to address this problem in near term or term neonates. Since the beginning 90 s, extracorporeal membrane oxygenation (ECMO) had been getting standard in neonatal intensive care. This trend had been intensified since the publication of a clinical controlled trial and follow-up data from the UK, testing ECMO in term neonates with severe respiratory failure [3].

In parallel with this trend, adjunctive therapies in severe neonatal respiratory failure have been developed facing surfactant administration, e. g. for meconium aspiration syndrome [11], administration of nitric oxide in persistent pulmonary hypertension [4] and high-frequency oscillation ventilation in hypoxic respiratory failure [8]. The data of these studies were convincing with respect to improving gas exchange acutely after introduction of either therapy, however, upon analyses of survival without oxygen requirements or other major clinical outcome variables, only few studies did show efficacy in term neonates suffering from either pathophysiology of respiratory failure.

• References

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