ABSTRACT
Although the vast majority of ventilator days are occupied by infants suffering from RDS and its complications, perhaps 5-10 percent of the workload of a neonatal intensive care unit involves ventilating babies with normal lungs who have neurological disease. These infants are important not only because accurate diagnosis is vital in order to avoid iatrogenic lung injury from barotrauma, but also because, quite often, their neurological disease is incurable and their continued survival depends on longterm artificial ventilation. This creates ethical problems, which can be almost insurmountable. As well as this difficult group there are a small number of infants whose stridor or apnea is a manifestation of a CNS disorder. The respiratory manifestations of CNS disorders include apnea, stridor, respiratory failure and failure to wean from artificial ventilation. Neurological disease at any level within the CNS can cause respiratory problems, and it can be helpful to consider the cortex, brainstem, spinal cord, peripheral nervous system and muscle in a hierarchical system (Table 36.1).
