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Treatment of hypoxemic respiratory failure in neonates: past, present and future

Journal of Perinatology volume 36, pages S1–S2 (2016)Cite this article

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Despite advances in the field of neonatology, hypoxemic respiratory failure (HRF) and persistent pulmonary hypertension of the newborn (PPHN) continue to impact neonatal mortality and morbidity. A limited evidence base for treatments and the difficulty in designing and conducting research to optimize long-term outcomes in neonates highlight the need for collaboration to share best practices, as well as to identify promising developments. With this in mind, a group of experienced neonatologists with a wide array of research and clinical interests convened at a roundtable meeting to discuss the past, present and future of treating neonatal HRF. What began as presentations of individual research expertise and experience evolved into lively discussions about current clinical care and the challenges of and potential for research leading to continued improvements in diagnosis, monitoring and therapies. The articles in this supplement review the presentations and discussions from this meeting. They provide a snapshot of where we are, how we got there and an educated glimpse into the future.

A common theme running through the discussions was the need to better understand pathophysiology in the individual neonate in order to customize treatment. The first article entitled ‘The fetal circulation, pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy,’ by S Lakshminrusimha and OD Saugstad, provides an overview of the physiologic processes associated with HRF and PPHN. The article explores the fetal circulation and the structural, cellular signaling and other events that may impact pulmonary–vascular transition and the necessary decrease in pulmonary–vascular resistance at birth. Furthermore, it discusses the history and evolving understanding of how best to individualize oxygen management in a variety of settings, which is important to maximize outcomes while minimizing the risks associated with oxygen toxicity.

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Acknowledgements

This publication is based on discussions at a roundtable meeting supported by a grant from Mallinckrodt Pharmaceuticals, formerly Ikaria. Presentations and discussions were developed solely by the participants, without grantor input.

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  1. Department of Pediatrics, Children's National Medical Center, Washington, DC, USA

    R H Steinhorn

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  1. R H Steinhorn
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Correspondence to R H Steinhorn.

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Competing interests

RHS received honoraria for her participation in a roundtable meeting supported by a grant from Mallinckrodt Pharmaceuticals, formerly Ikaria. The author has also received research grant support from Pfizer and the NIH (5R01HL054705-13).

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Steinhorn, R. Treatment of hypoxemic respiratory failure in neonates: past, present and future. J Perinatol 36 (Suppl 2), S1–S2 (2016). https://doi.org/10.1038/jp.2016.41

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  • DOI: https://doi.org/10.1038/jp.2016.41

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