Recent advances in respiratory care of the term neonate.

Persistent pulmonary hypertension is a major cause of morbidity and mortality in the term and near-term infant. Management of this condition, which is characterized by respiratory distress and cyanosis, has been greatly enhanced by inhaled nitric oxide (NO) therapy. The following treatment regime is suggested: Conventional ventilation should be used initially, and hyperventilation should be avoided. Surfactant should be administered early, preferably within 6 hours of diagnosis. If conventional ventilation fails, the next step is high-frequency ventilation or inhaled NO. Some infants who do not respond to inhaled NO when administered by conventional ventilation will respond to NO delivery via a high-frequency ventilator. If all of these therapies fail, extracorporeal membrane oxygenation (ECMO) should be considered. By the use of this approach, the mortality from PPH has been considerably reduced, and concerns today relate primarily to morbidity, particularly long-term neurologic outcome and chronic lung disease resulting from ventilation and barotrauma.