Neonatal Lung Remodeling Structural, Inflammatory, and Ventilator-induced Injury.pdfVIP

J Perinat Neonat Nurs Vol. 19, No. 4, pp. 362–376 c? 2005 Lippincott Williams Wilkins, Inc. Neonatal Lung Remodeling Structural, Inflammatory, and Ventilator-induced Injury Barbara S. Turner, DNSc, RN, FAAN; Wanda Bradshaw, MSN, RN, NNP, PNP; Debra Brandon, PhD, RN The developing lung is subject to events, both prenatal and postnatal, that alter the normal devel- opmental process. The degree of insult or injury affects how the lung functions at birth and then responds to the insult throughout childhood. In this article, only 3 of the influences are examined: structural, inflammatory, and mechanical. It is recognized that there is a plethora of other factors that influence lung remodeling. Key words: congenital diaphragmatic hernia, infection, lung, ventilator-induced lung injury (VILI) CE CONTINUING EDUCATION SURVIVAL rates for infants born prema-turely have increased steadily over the past several decades. This success is tempered by the realization that infants born prior to term or at term who have respiratory abnormalities or disorders at birth may have residual effects that last throughout infancy, childhood, ado- lescence, and into young adulthood. The ef- fect of early insults on lung structure and func- tion can be traced in large part to events in the perinatal and neonatal periods. The purpose of this article is to explore se- lected events that influence remodeling of the respiratory system. An overview of the em- bryologic lung development serves as a refer- ence for the discussion of selected structural abnormalities of the lung, prenatal and post- natal inflammatory effects, and the effects of ventilator-induced lung injury on the develop- ing respiratory system. From the School of Nursing, Duke University, Durham, NC. The authors have no conflict of interest. Corresponding author: Barbara Turner, DNSc, RN, FAAN, School of Nursing, Box 3322, Duke University Durham, NC 27710 (e-mail: turne017@mc.duke.edu). Submitted for publication: May 19, 2005 Accept