[Physiology and physiopathology of postnatal pulmonary adaptation. 1: Physiology].

Abstract

The aim of the review consists of the help to understand the complex physiological mechanisms of the onset of breathing and the regulation of the respiration during the early newborn period. The lungs of the newborn contain nearly no alveoli. Postnatal formation of alveoli enlarges the gas exchange surface until the 20th year of life, the lung volume increases by a factor of 27. Immediately postnatal the aeration of the lungs is performed by several deep inspirations with breath hold and following crying. The fetal lung liquid is resorbed via both, lymph and blood vessels. Stability of the functional residual capacity is reached very rapidly. The inflation augmenting reflex and sighing support effectively this process. The significant importance of the surfactant for the successful begin of air breathing is described. Onset of respiration is combined with the decrease of the pulmonary arterial resistance and the remarkable increase of the pulmonary blood flow. The hypoxic response in the newborn is biphasic. An initial short hyperventilation is regularly followed by ventilatory depression. Neurophysiological causes are evident. Hyperventilation by inhalation of gas mixtures with higher CO2 concentrations is low, at least in preterm infants. The causes are believed to ly in the limitation of the efficiency of the respiratory muscles. Peripheral chemoreceptors in the glomus caroticum and in the bronchial mucosa, stretch receptors in the bronchial muscles, and muscle spindles in the intercostal muscles are functioning in newborns as well as in preterm infants.