Intiation of lung ventilation at birth

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Abstract
The newborn baby draws its first postnatal breath either during or within seconds of delivery. Within minutes, a regular breathing rhythm is established and this remains virtually continuous for the remainder of postnatal life. The mechanisms responsible for these sudden, dramatic and vital changes in the respiratory system at birth are only partially understood. Since fetuses make intermittent breathing movements long before birth, understanding the control of the fetal respiratory system may be essential to understanding the rapid onset of respiratory efforts at delivery. In this review the stimuli present at birth will be considered and, based on our current understanding of the fetal and neonatal respiratory control systems, those factors which are likely to play an important role in the initiation of lung ventilation at this time will be examined. Normal respiratory events in the early postnatal period will be concentrated on, but it is important to recognize that in some cases problems occur: a neonate may fail to initiate breathing efforts rapidly, or an apparently healthy premature neonate may suddenly stop breathing a few days after birth. In both cases, clinical intervention may be required to maintain adequate gas exchange and to prevent brain damage or death. Clearly, greater knowledge of respiratory control during this critical time of life would assist in the development of more appropriate and successful treatments for these life-threatening disorders.