(See also Overview of Perinatal Respiratory Disorders.) Extensive physiologic changes accompany. If the infant fails to respond to resuscitation or suddenly deteriorates after an initial response, pneumothorax Pneumothorax Pulmonary air-leak syndromes involve dissection of air out of the normal pulmonary airspaces. If intubation is necessary, a cardiac monitor is recommended as the most accurate way to assess the infant's heart rate. PPV with a bag and mask should be avoided in this circumstance so as not to inflate the bowel and further compromise the lungs. Lung compression may cause persistent pulmonary hypertension. Immediate endotracheal intubation is indicated if PPV is required for an infant with a prenatally diagnosed or clinically suspected diaphragmatic hernia Diaphragmatic Hernia Diaphragmatic hernia is protrusion of abdominal contents into the thorax through a defect in the diaphragm. If the infant fails to respond to positive pressure ventilation delivered by mask or the heart rate is < 60 beats/minute, the infant should undergo endotracheal intubation Mechanical Ventilation Initial stabilization maneuvers include mild tactile stimulation, head positioning, and suctioning of the mouth and nose followed as needed by Supplemental oxygen Continuous positive airway. Devices that measure and control tidal volume during resuscitation have been described and may be helpful, but their role currently is not established. Because even brief periods of excessive tidal volume can easily damage neonatal lungs, particularly in preterm infants, it is important to frequently assess and adjust PIP during resuscitation. Most of the time, preterm infants need lower pressures to obtain adequate ventilation. Although the peak inspiratory pressure (PIP) should be set at the minimum level to which the infant responds, an initial PIP of 25 to 30 cm H2O may be required to produce adequate ventilation in a term infant. Increase the airway pressure to ensure the chest wall rises adequately. If the heart rate does not increase within 15 seconds, adjust the mask to ensure a good seal, check the position of the head, mouth, and chin to ensure the airway is open, suction the mouth and airway using a bulb syringe and/or a size 10 to 12 F catheter, and assess chest wall rise. The effectiveness of ventilation is judged mainly by rapid improvement in the heart rate.
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