الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Respiratory distress in newborn is a challenging problem, its incidence in neonates admitted to neonatal units had been doubled over the last 30 years. Its incidence in the newborn ranges from 2.9% to 7.6%. It is characterized by one or more of the following: nasal flaring, chest retractions, tachypnea, and grunting. An infant who has an advanced degree of respiratory distress may progress to respiratory failure. RF in neonates commonly defined as retention of carbon dioxide with a resultant decrease in the arterial blood pH and accompanied by hypoxemia.
While conditions like RDS are seen more in premature infants, others like MAS considered a disease of the more mature infant. Infections and structural anomalies like TEF and CDH are common in both term and preterm infants.
The spectrum of mechanical support for neonatal respiratory failure has widened substantially over the past 4 decades. Because of increased survival of more immature infants, VILI in the form of BPD has become a major concern for caregivers. The standard mode of ventilation used in newborn infants before the introduction of synchronized ventilation was IMV. SIMV, A/C and PSV are all forms of PTV.
Advances in pulmonary care have reduced the mortality of infants, but important respiratory morbidities continue to affect preterm and term infants. Complications of mechanical ventilation include VILI with its consequences (BPD, extrapulmonary air leak syndromes), tracheal injury and endotracheal tube complications (endotrauma), VAP, and other pulmonary and extrapulmonary complications.
Gentle ventilation strategies have been suggested as a way to improve pulmonary outcomes for very preterm infants. These strategies include the early use of n-CPAP, permissive hypercapnia, and patient triggered ventilation, volume-targeted or volume-controlled ventilation and lastly HFOV. HFOV appeared to hold great promise for neonatal care in the 21st century. HF ventilators apply continuous distending pressure and deliver small tidal volumes superimposed on an extremely rapid rate. HFOV apply open-lung strategy, defined as recruitment of the collapsed alveoli and subsequently stabilization of these alveoli with the lowest possible CDP, using oxygenation as an indirect parameter for lung volume.