Lung Disease and Ventilator Strategies in Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) continues to be a serious illness in very preterm infants and is usually accompanied by respiratory morbidity such as bronchopulmonary dysplasia. This review emphasizes respiratory management that reduces the risk of NEC, such as by optimizing SpO₂ to the target range of 91% to 95%, and near-infrared spectroscopy (NIRS) measurement of abdominal tissue oxygenation (rsSO₂) of >40%, as well as respiratory management of proven medical or surgical NEC. Infants with proven NEC often require higher pressures, both a higher PEEP (to maintain lung inflation in the presence of abdominal distension) and a higher PIP (due to chest wall edema) to maintain arterial pH in the 7.25 to 7.35 range, with PaCO₂ 35 to 55 mm Hg and HCO₃ 16 to 22. Tissue perfusion may be monitored indirectly by evaluating lactate levels. Efforts to use minimal tidal volumes and reduce ventilator-induced lung injury should be emphasized.