25 YEARS OF RESPIRATORY SUPPORT OF NEWBORN-INFANTS

Respiratory support of newborn infants has changed in the last 25 year s, because of new knowledge of pathophysiology, controlled studies of respiratory therapy and the realisation of perinatal centers. Respirat ory support has changed from the ''blow in-suck out'' approach, inevit ably leading to severe atelectasis, high morbidity and mortality to a now very sophisticated therapy with reduced mortality and morbidity al so in very-low-birth-weight infants, who were hopeless patients 25 yea rs ago. Major milestones of this development were the introduction of continous distending pressure to surfactant deficient lungs, the high- frequency positive pressure ventilation with fine tuning of inspirator y and expiratory times, adjusted to individual time constants and the substitution of artificial surfactant. Techniques for the future, like HFO, NO-inhalation, proportional assist ventilation and liquid ventil ation are presentely investigated.