Pediatric pulmonology: Pulmonology of the newborn.

The lung provides alveolar capillary exchange surface of oxygen and carbon dioxide in order to meet the needs of aerobic cellular respiration. The embryonic lung buds originating from the foregut generate a tree like structure that develops into bronchi, bronchioles and alveoli. Cystic lung diseases including cystic adenomatoid malformation, bronchogenic cyst, pulmonary sequestration, and congenital lobar emphysema are treated surgically. Lung hypoplasia might be primary or result from pulmonary cavity disorders comprising congenital diaphragmatic hernia and pleural effusion. Intra-uterine interventions by tracheal occlusion aimed at increasing tracheal airway pressure in congenital diaphragmmatic hernia and thoracoamniotic shunt for pleural effusion might enable pulmonary proliferation. Before the onset of labor, the fetal lung fluid in the airspaces starts to decrease, with a further decrease during labor. Delayed clearance of lung fluids results in transient tachypnea of the newborn. Respiratory distress syndrome is the clinical morbidity resulting from lung immaturity associated with surfactant deficiency. Respiratory failure might be associated with meconium aspiration, pulmonary hemorrhage, and pulmonary hypertension. Invasive and non-invasive ventilation, oxygen, and surfactant supplementation are the principle treatments. Synchronized ventilatory strategies reduce the extent of air leak syndrome and chronic lung disease. Antenatal steroids to enhance lung maturation and methylxanthines to reduce apnea of prematurity also improve neurodevelopmental outcome. Bronchopulmonary dysplasia results from injury by mechanical ventilation and oxygen exposure. Infants born before thirty-two weeks also suffer from developmental arrest of the alveoli and vasculature. Treatment consists of gentle ventilation, fluids homeostasis, nutritional support and sepsis prevention. [ABSTRACT FROM AUTHOR]