**Author details**

of artificial ventilation and hypocapnia, lessen the incidence of BPD, IVH grade III/IV, PTX and PVL in comparison to the pressure-controlled ventilation in preterm neonates. The mor-

During intubation and invasive ventilation, neonates are prone to cardio- and cerebrovascular instability. The intensive invasive therapy subjects neonates to more infections and the invasive ventilation to volu-, barotrauma and shear stress. Common complications due to intubations and invasive ventilation are hoarseness, aphonia, tracheal stenosis, and feeding

**11. Additional supportive therapies for neonatal respiratory distress**

respiratory failure in extreme premature cannot be solved by other means [57].

For treating pulmonary hypertension in different pulmonary diseases of the neonate the inhaled nitric oxide, pulmonary artery dilator, has been shown to have some beneficial effects [55]. On the other hand it has not been shown to be beneficial in preterm neonates with RD in reducing BPD or mortality [56]; though most NICUs are using it nowadays when hypoxic

The ECMO pumps the blood through an artificial lung back into the bloodstream, providing heart-lung bypass support outside of the neonatal body. ECMO is applied in neonates with severe RD due to congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), pneumonia, air leak problems or PPHN [58]. Veno-venous ECMO is preferred to be used in infants with hypoxic respiratory failure unless an arterio-venous ECMO is needed due to combined cardio-respiratory failure. ECMO support should be used only in neonates

General supportive care of a neonate with RD encompasses optimization of thermal neutral environment, fluid and nutritional management and a stable hemodynamic state ensuring

RD of a neonate has almost identical clinical picture irrespective of many etiologic entities it originates from. The perinatal history, labour course, the gestational age and appropriateness of birth measures for the gestational age should all be taken into account in diagnosing the

The modern management of neonatal RD is minimally invasive. In the delivery room, neonates are being stabilized. The respiratory support is primarily non-invasive ventilation as well as the surfactant is applied with less invasive methods not involving intubation and artificial ventilation. If intubation is required, the time of artificial ventilation should be as short as possible. Hyperoxia and hypocapnia should be avoided. Further studies will show whether such non-invasive treatment is also going to affect the incidence of BPD, neurodevelopmental outcome and other long-term consequences of intensive neonatal therapies.

tality rate was unaffected by the mode of artificial ventilation [54].

and perioral sensation disorders.

56 Selected Topics in Neonatal Care

weighing ≥2 kg of body mass.

**12. Conclusion**

aetiology of the RD.

adequate oxygenation and perfusion of neonatal organs.

Štefan Grosek1,2\* and Petja Fister<sup>3</sup>

\*Address all correspondence to: stefan.grosek@kclj.si

1 Department of Pediatric Surgery and Intensive Therapy, Surgical Service, University Medical Centre Ljubljana, Ljubljana, Slovenia

2 Department of Pediatrics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia

3 Department of Neonatology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
