Use of continuous positive airway pressure breathing in the improved management of neonatal emergencies

Abstract

A ventilatory system consisting of spontaneous breathing with continuous positive airway pressure has dramatically decreased mortality in newborn infants with hyaline membrane disease. 1 In the past 2 yr, we have applied this new technique in the management of noncardiac thoracic and abdominal emergencies in more than 25 small infants, most of whom were newborn. The purpose of this paper is to describe the use of continuous positive airway pressure breathing (CPAPB) in this group of babies with life-threatening conditions, which included intestinal atresia, meconium peritonitis, fecal peritonitis, gastroschisis, omphalocele, tracheoesophageal fistula, and diaphragmatic hernia (Table 1). As an adjunctive measure in the management of respiratory insufficiency associated with these conditions, we believe this new system has contributed importantly to the survival of these infants. A common denominator in this group of varied newborn emergencies was pulmonary dysfunction which was usually manifested by peripheral arterial unsaturation associated with right to left pulmonary shunting. The pulmonary abnormality was often a concomitant complication of severe metabolic acidosis, sometimes in the presence of gram-negative septicemia. Since these congenital anomalies all required urgent operative procedures, the above physiologic derangements were further distorted by anesthesia and the surgical trauma. In the past, pulmonary insufficiency, combined with severe sepsis and metabolic acidosis, was frequently lethal; but the postoperative courses in this group of infants have demonstrated improved respiratory function with the use of CPAPB. Selected cases have been chosen from this series to illistrate this experience.