Strategies to prevent chronic neonatal lung disease.

The pathogenesis of chronic neonatal lung disease involves the combined iatrogenic insults of oxygen toxicity and barotrauma in addition to lung inflammation. Newer ventilator strategies using smaller tidal volumes (3-7 mL/kg) in order to avoid overdistension, higher positive end-respiratory pressure and lower peak inspiratory pressures decrease barotrauma. Earlier reduction of FiO2 through the use of surfactant, high frequency ventilation and nitric oxide reduce oxygen toxicity. Other measures include careful fluid balance, avoidance of prolonged paralysis and early steroids to decrease inflammation.