Neonatal and Pediatric Lung Disease

Etiology and Pathophysiology

The American Thoracic Society recommends that neonatal respiratory distress syndrome (RDS) be caused by surfactant deficiency in preterm infants, especially those <30 weeks of gestation and <1,000 g, being the most common respiratory disorder in this group 1
The American Journal of Respiratory and Critical Care Medicine states that bronchopulmonary dysplasia (BPD) evolves as a common endpoint after RDS, characterized by alveolar simplification due to intrauterine inflammation and premature extraterine lung development 2
The American Journal of Respiratory and Critical Care Medicine notes that neonatal pneumonia/sepsis causes acute lung injury requiring mechanical ventilation and supplemental oxygen 2
The American Journal of Respiratory and Critical Care Medicine indicates that meconium aspiration causes direct lung injury in term newborns 2
Exposure to environmental factors, such as inhalation or chronic aspiration, can lead to lung disease in children, according to the American Journal of Respiratory and Critical Care Medicine 3

The American College of Chest Physicians recommends that signs of respiratory distress in neonates, including grunting, nasal flaring, retractions, and tachypnea, be evaluated promptly 4
Tachypnea, defined as ≥70 breaths/minute in infants 2-11 months or ≥60 breaths/minute in children 12-59 months, indicates severe respiratory distress, according to the American Academy of Pediatrics 4
The American Thoracic Society states that children with interstitial lung disease (chILD) may present with chronic or persistent symptoms, including cough, tachypnea, and exercise intolerance, and require a comprehensive evaluation to exclude common causes of lung disease 3, 6

The American Journal of Respiratory and Critical Care Medicine recommends that high-resolution computed tomography (HRCT) be used to demonstrate the distribution and extent of lung disease in children with suspected chILD, although it may not correlate with functional severity or prognosis 3, 6
The American College of Radiology states that HRCT with controlled ventilation is the preferred method for minimizing respiratory artifacts in infants and young children 3, 6
The American Heart Association recommends that echocardiography be performed to exclude structural heart disease and pulmonary vascular disease, which can mimic interstitial lung disease, and to evaluate for pulmonary hypertension 3, 6

The American Academy of Pediatrics recommends that continuous positive airway pressure (CPAP) be initiated immediately after birth for all preterm infants with respiratory distress, instead of routine intubation, to prevent atelectasis and reduce the risk of BPD or death 1
The American Thoracic Society states that surfactant replacement therapy reduces mortality, severity of RDS, and the combined outcome of BPD or death in preterm infants <30 weeks of gestation 1
The American Journal of Respiratory and Critical Care Medicine recommends that oxygen supplementation be maintained to prevent hypoxemia and promote growth in children with chronic lung disease, and that bronchodilators be used for persistent airway hyperreactivity 2
The American College of Chest Physicians notes that corticosteroids may reduce airway inflammation in children with chronic lung disease, although evidence is limited 2

The American Heart Association recommends that pulmonary hypertension be monitored in children with chronic lung disease, as it is associated with a poorer prognosis, and that echocardiography be performed serially to evaluate for pulmonary hypertension 3, 6
The American Academy of Pediatrics states that nutrition should be optimized to promote growth and development in children with chronic lung disease, and that neurocognitive development should be monitored and supported in preterm infants with chronic lung disease 2