Journal of perinatology : official journal of the California Perinatal Association
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Despite a shift to noninvasive respiratory support, mechanical ventilation remains an essential tool in the care of critically ill neonates. The availability of a variety of technologically advanced devices with a host of available modes and confusing terminology presents a daunting challenge to the practicing neonatologist. Many of the available modes have not been adequately evaluated in newborn infants and there is paucity of information on the relative merits of those modes that have been studied. ⋯ It remains to be seen whether the demonstrated short-term benefits translate into significant reduction in chronic lung disease. Avoidance of mechanical ventilation by means of early continuous positive airway pressure with or without surfactant administration may still be the most effective way to reduce the risk of lung injury. For babies who do require mechanical ventilation, the combination of volume-targeted ventilation, combined with the open-lung strategy appears to offer the best chance of reducing the risk of bronchopulmonary dysplasia.
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To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. ⋯ Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.