**2. Methods**

during foetal life and needed to accomplish readiness for extra-uterine exchange of gases. During labour, different obstetric and non-obstetric factors may affect lung inflation in transi-

Even mature neonates have smaller diameter of the airways in comparison to infants, children and also adults; their chest wall is more compliant and the lung volume at the end of expiration is the same as the closing volume. Therefore, their lungs are prone to collapse. Besides, the neonates have fewer alveoli with ventilation perfusion mismatch, but a two–three–fold increase in oxygen demand in comparison to adults [1]. They have relatively inefficient respiratory muscles due to lack of red respiratory muscles and more white ones, which get tired faster. Their pulmonary vascular wall contains more muscle fibres and is therefore more prone to vasoconstriction. The sudden falls in partial oxygen pressure result quickly after short hyperpnoea in hypopnoea or apnoea. The foetal haemoglobin binds oxygen with greater affinity than adult haemoglobin. Neonates also have immature immune system with lack of the acquired immunity against microorganisms and are thus more prone to infection. In a premature infant, all these differences in lung development are more prominent in comparison to the term neonate and further influence the transitional

Because of all the above-mentioned developmental immaturity of the lungs, heart, blood vessels, circulation and immune system, neonates are more prone to develop idiopathic respiratory distress (RD) at the beginning of the life but also in later days and weeks and these differences are even more pronounced in premature and very premature neonates. The aetiology and pathophysiology of the RD differ between mature and premature infants [2]. In the most extreme prematurity, several forms of RD syndrome or hyaline membrane disease

(HMD) may develop because of lack of surfactant and underdevelopment of the lung.

RD is very common in neonates, affecting about 10% of them [3]. Some of them have disorders of transition from foetal to extra-uterine life; others have RD caused by congenital or acquired infection or congenital malformations of different organs (thoracic and extra-thoracic). Regarding perinatal and labour history, gestational age and appropriateness of birth measures, the aetiology of the neonatal RD could be suspected. Clinical picture of neonatal RD is rather nonspecific in regard to the aetiology of it and also the management is quite universal. RD may develop immediately and acutely after birth or more slowly in the next few hours depending

According to the situation in the delivery room, we have to decide how to approach the neonate with breathing difficulties. A well-equipped and trained neonatology team should be available during all difficult or premature deliveries which have to follow recommended resuscitation care of the neonate. The first golden minutes are the most important not only to properly recognize a neonate who needs our support but also to apply appropriate, sufficient and not too aggressive support if not needed. Appropriate inspiratory pressure and oxygen therapy during artificial ventilation in the delivery room may prevent immediate and later complications especially in the most vulnerable extreme premature infants. Prevention of hypothermia, in premature neonates with plastic bag, is also one of the important preventable methods because it may prevent severe metabolic derangements due to hypothermia,

tional period to extra-uterine life.

46 Selected Topics in Neonatal Care

period of extra-uterine life.

harmful for all organs [5].

on the cause of neonatal breathing difficulties [4].

We conducted electronic searches of articles on respiratory management and care of neonates with RD, using key terms: neonate, respiration, ventilation, oxygenation, oxygen, evidence based therapy, caffeine, surfactant, respiratory distress in the PubMed data base from the years 2000 to 2017 and reported the most relevant ones. Also, consensus guidelines on neonates with RD were reviewed [6]. The article describes transition from intra- to extra-uterine life, lists the methods for assessment of neonates with RD, describes the respiratory support in the delivery room, treatment with methylxantines, oxygen and surfactant, and the noninvasive and invasive tools for artificial ventilation.

This chapter includes the impact of optimal ventilation, tissue oxygenation and perfusion on the non-invasive and invasive respiratory management of neonates with RD. Also, the shortand long-term outcome in respect of respiratory management of neonates in the neonatal intensive care unit (NICU) is addressed.
