AUTHOR=Barton Samantha K. , Tolcos Mary , Miller Suzie L. , Roehr Charles C. , Schmölzer Georg M. , Davis Peter G. , Moss Timothy J. M. , LaRosa Domenic A. , Hooper Stuart B. , Polglase Graeme R. 

TITLE=Unraveling the Links Between the Initiation of Ventilation and Brain Injury in Preterm Infants

JOURNAL=Frontiers in Pediatrics

VOLUME=3

YEAR=2015

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2015.00097

DOI=10.3389/fped.2015.00097

ISSN=2296-2360

ABSTRACT=<p>The initiation of ventilation in the delivery room is one of the most important but least controlled interventions a preterm infant will face. Tidal volumes (<italic>V</italic><sub>T</sub>) used in the neonatal intensive care unit are carefully measured and adjusted. However, the <italic>V</italic><sub>T</sub>s that an infant receives during resuscitation are usually unmonitored and highly variable. Inappropriate <italic>V</italic><sub>T</sub>s delivered to preterm infants during respiratory support substantially increase the risk of injury and inflammation to the lungs and brain. These may cause cerebral blood flow instability and initiate a cerebral inflammatory cascade. The two pathways increase the risk of brain injury and potential life-long adverse neurodevelopmental outcomes. The employment of new technologies, including respiratory function monitors, can improve and guide the optimal delivery of <italic>V</italic><sub>T</sub>s and reduce confounders, such as leak. Better respiratory support in the delivery room has the potential to improve both respiratory and neurological outcomes in this vulnerable population.</p>