Program Overview:
Chronic lung disease, specificly respiratory distress syndrome (RDS), remains a significant cause of morbidity and mortality in the preterm infant. The use of exogenous pulmonary surfactants has significantly improved the survival of premature infants with RDS. Currently, surfactants are delivered to the alveoli by dispensing boluses of the liquid formulation into the trachea via an endotracheal tube. Existing evidence indicates that more uniform distribution of the surfactant within the lung is achieved by larger volume boluses administered over a shorter period of time. However, larger and faster boluses also increase the amount of time that the airway is transiently occluded during surfactant administration, raising concerns about potential peridosing adverse effects on factors such as mean arterial blood pressure and cerebral perfusion and oxygenation.
Injury to both the fragile lung parenchyma and airways of the preterm can lead to acute and long-term consequences. Evidence suggests that mechanical ventilation and intubation play lead roles in neonatal lung injury. Optimizing the use of non-invasive respiratory therapy and surfactant administration, along with strategies to minimize intubation and re-intubation has the most promise to move the bar on chronic lung disease reduction in this population.
Informed consent is a cornerstone of modern medical ethics, as well as a legal requirement. This program will review the philosophical and historical principles that underlie the informed consent doctrine, and explain how the process relates to neonatal patients, who are clearly unable to consent for themselves.
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