Module 3C10: Physiologic Basis for Neonatal Respiratory Disorders
Objectives
1. Contrast the maternal, fetal and neonatal outcomes between vaginal and cesarean births including the impact of both cesarean section timing and the issues surrounding a trial of labor prior to birth
2. Relate the potential impact of elective cesarean birth on key aspects of developmental pulmonary physiology including associated neonatal respiratory morbidities
3. List potential approaches to reduce mortality and morbidity associated with elective cesarean births
4. Describe the pathophysiology of lung injury in the extremely low birth weight infant including the impact of various therapies and interventions used in treating this population
5. Explain the development of bronchopulmonary dysplasia (BPD) and outline the consensus definition for the three forms of the disorder
6. Understand the underlying biology of nitric oxide and the role it plays in lung development as well as the physiologic basis for its therapeutic uses
7. Discuss the effects of nitric oxide as they relate to clinical issues of the preterm infant
Content Outline
1. Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome
1.1 Overview of elective cesarean sections (ECS)
1.1.1 Risks and benefits of ECS
1.1.2 Factors involved in the rise of ECS
1.2 Evidence-based comparison of planned vaginal and cesarean births
1.3 Impact of timing of ECS relative to fetal and neonatal outcomes
1.4 Neonatal respiratory morbidities linked to ECS
1.5 Physiologic basis of morbidities related to retained fetal lung fluid: role of sodium and chloride channels
1.6 Approaches to reduce neonatal morbidities associated with ECS
1.7 Antenatal versus rescue strategies
2. Understanding the Sequence of Pulmonary Injury in the Extremely Low Birth Weight, Surfactant-Deficient Infant
2.1 Overview of human lung development and the role of pulmonary surfactant
2.2 Sequence of pulmonary injury associated with preterm births and role of oxygen toxicity and free radicals
2.3 Definition and description of bronchopulmonary dysplasia (BPD)
2.4 Strategies to prevent lung injury
3. Inhaled Nitric Oxide for Preterm Neonates
3.1 Biologic characteristics of nitric oxide
3.2 Nitric oxide’s role in lung development
3.3 Physiologic basis of inhaled nitric oxide use in the preterm infant
3.4 Physiologic effects of inhaled nitric oxide therapy in the clinical
setting including results of related clinical trials
3.4.1 Hypoxic respiratory failure
3.4.2 Disorders of lung growth, function & injury
3.4.3 Neuroprotection
Resources
Module 3C10: Physiologic Basis for Neonatal Respiratory Disorders is based on the resources listed below. A copy of each article is included in the Self Assessment Program Package.
“Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome”, Ramachandrappa, MD, Ashwin, et al., Clinics In Perinatology, Volume 35, 2008, pp. 373-393
“Understanding the Sequence of Pulmonary Injury in the Extremely Low Birth Weight, Surfactant-Deficient Infant”, Peterson, Steven, Neonatal Network, Volume 28, No. 4, July/August 2009, pp. 221-229
“Inhaled Nitric Oxide for Preterm Neonates”, Arul, MD, Nandini, et al., Clinical Perinatology, No. 36, 2009, pp. 43-61