{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:13:52Z","timestamp":1771931632879,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>General anesthesia frequently causes atelectasis, a condition that significantly endangers patient safety during and after surgery, especially in neonates. Evidence suggests that lung protective ventilation (LPV) strategies may reduce the incidence of postoperative atelectasis in patients receiving general anaesthesia; however, the efficacy for neonatal patients remains controversial. This study aims to explore how LPV affects the incidence of atelectasis in neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomized controlled trial involved neonatal patients under general anesthesia with mechanical ventilation for over two hours, randomly assigned to receive LPV (including a Vt of 6\u2005mL\/kg, 5\u2005cmH\n                      <jats:sub>2<\/jats:sub>\n                      O PEEP, and lung RMs once per hour) or conventional ventilation (including a Vt of 8\u201310\u2005mL\/kg without PEEP or RMs). Each infant underwent two lung ultrasound (LUS) scans at specified time points: 5\u2005min post-intubation and at the conclusion of surgery. Additionally, three arterial blood gas analyses were conducted for each infant at T1 (5\u2005min post-intubation), T2 (one hour after mechanical ventilation), and T3 (two hours after mechanical ventilation). HR and MAP were recorded at four time points: T1, T2, T3, and T4 (at the conclusion of surgery). The primary outcomes were the incidence of significant atelectasis (defined as any area with a consolidation score of \u22652) and LUS scores at the conclusion of surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study enrolled 100 neonatal patients, divided into 50 in the LPV group and 50 in the control group. At the conclusion of surgery, the LPV group had a significantly lower incidence of significant atelectasis (18% vs. 58%) and lower median LUS scores [7 [6, 9] vs. 12 [8, 18]] than the control group did (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In addition, there were differences in the partial pressure of arterial oxygen (PaO\u2082) and partial pressure of arterial carbon dioxide (PaCO\u2082) between the two groups at T2 and T3, although both were within the normal range. No significant differences were observed in HR, MAP or the rate of respiratory events after surgery between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with conventional ventilation, LPV results in a significantly lower incidence of significant postoperative atelectasis and lower LUS scores in neonates receiving general anaesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      , ChiCTR2100051721\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1730470","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:46:19Z","timestamp":1770878779000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of lung protective ventilation and conventional ventilation on postoperative atelectasis in neonates under general anesthesia"],"prefix":"10.3389","volume":"14","author":[{"given":"Jingru","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingying","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/ALN.0000000000003943","article-title":"Perioperative pulmonary atelectasis: part I. Biology and mechanisms","volume":"136","author":"Zeng","year":"2022","journal-title":"Anesthesiology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/anae.13713","article-title":"Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial","volume":"72","author":"Song","year":"2017","journal-title":"Anaesthesia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/PCC.0000000000001865","article-title":"Modified lung ultrasound examinations in assessment and monitoring of positive end-expiratory pressure-induced lung reaeration in young children with congenital heart disease under general anesthesia","volume":"20","author":"Wu","year":"2019","journal-title":"Pediatr Crit Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1213\/ANE.0b013e31829332b5","article-title":"Incidence of intraoperative hypoxemia in children in relation to age","volume":"117","author":"De Graaff","year":"2013","journal-title":"Anesth Analg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/pan.14362","article-title":"Developmental respiratory physiology","volume":"32","author":"Trachsel","year":"2022","journal-title":"Paediatr Anaesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1093\/bja\/aew173","article-title":"Effects of anaesthesia on paediatric lung function","volume":"117","author":"Trachsel","year":"2016","journal-title":"Br J Anaesth"},{"key":"B7","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br J Anaesth"},{"key":"B8","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/ALN.0000000000004009","article-title":"Perioperative pulmonary atelectasis: part II. Clinical implications","volume":"136","author":"Lagier","year":"2022","journal-title":"Anesthesiology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1111\/pan.14345","article-title":"Is there a role for lung-protective ventilation in healthy children?","volume":"32","author":"Heath","year":"2022","journal-title":"Pediatr Anesth"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.21037\/tp-21-265","article-title":"Anesthetic management of thoracoscopic procedures in neonates: a retrospective analysis of 45 cases","volume":"10","author":"Liu","year":"2021","journal-title":"Transl Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1111\/pan.13894","article-title":"Lung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: a prospective randomized controlled trial","volume":"30","author":"Sun","year":"2020","journal-title":"Pediatr Anesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1097\/EJA.0000000000001451","article-title":"Effects of positive end-expiratory pressure\/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children: a randomised clinical trial","volume":"38","author":"Zhu","year":"2021","journal-title":"Eur J Anaesthesiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1097\/ALN.0000000000004366","article-title":"Intraoperative protective mechanical ventilation: fact or fiction?","volume":"137","author":"Musch","year":"2022","journal-title":"Anesthesiology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1097\/ALN.0000000000000231","article-title":"Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children","volume":"120","author":"Acosta","year":"2014","journal-title":"Anesthesiology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1097\/EJA.0000000000000761","article-title":"Lung recruitment prevents collapse during laparoscopy in children: a randomised controlled trial","volume":"35","author":"Acosta","year":"2018","journal-title":"Eur J Anaesthesiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/ALN.0000000000002870","article-title":"Assessment of common criteria for awake extubation in infants and young children","volume":"131","author":"Templeton","year":"2019","journal-title":"Anesthesiology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1486236","DOI":"10.3389\/fmed.2024.1486236","article-title":"A comparison of the effects of lung protective ventilation and conventional ventilation on the occurrence of atelectasis during laparoscopic surgery in young infants: a randomized controlled trial","volume":"11","author":"Yue","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1002\/ppul.24720","article-title":"Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery","volume":"55","author":"Sun","year":"2020","journal-title":"Pediatr Pulmonol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1213\/ANE.0000000000001603","article-title":"Lung ultrasonography for the assessment of perioperative atelectasis: a pilot feasibility study","volume":"124","author":"Monastesse","year":"2017","journal-title":"Anesth Analg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.jpeds.2010.05.043","article-title":"Ventilation practices in the neonatal intensive care unit: a cross-sectional study","volume":"157","author":"van Kaam","year":"2010","journal-title":"J Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1002\/ppul.25315","article-title":"Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass","volume":"56","author":"He","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.redar.2017.12.006","article-title":"Maniobras de reclutamiento en anestesia: \u00bfqu\u00e9 m\u00e1s excusas para no usarlas?","volume":"65","author":"Garc\u00eda-Fern\u00e1ndez","year":"2018","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"B23","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1111\/pan.14335","article-title":"Atelectasis and lung recruitment in pediatric anesthesia: an educational review","volume":"32","author":"Bruins","year":"2022","journal-title":"Pediatr Anesth"},{"key":"B24","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1097\/EJA.0000000000001175","article-title":"Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children: a randomised controlled trial","volume":"37","author":"Lee","year":"2020","journal-title":"Eur J Anaesthesiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1038\/s41390-019-0704-1","article-title":"Modes and strategies for providing conventional mechanical ventilation in neonates","volume":"90","author":"van Kaam","year":"2021","journal-title":"Pediatr Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.bja.2021.09.024","article-title":"Determining optimal positive end-expiratory pressure and tidal volume in children by intratidal compliance: a prospective observational study","volume":"128","author":"Lee","year":"2022","journal-title":"Br J Anaesth"},{"key":"B27","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1097\/ALN.0000000000004856","article-title":"Effect of an individualized lung protective ventilation on lung strain and stress in children undergoing laparoscopy: an observational cohort study","volume":"140","author":"Acosta","year":"2024","journal-title":"Anesthesiology"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1001\/jama.2017.2570","article-title":"Optimizing the settings on the ventilator: high PEEP for all?","volume":"317","author":"Serpa Neto","year":"2017","journal-title":"JAMA"},{"key":"B29","doi-asserted-by":"publisher","first-page":"111075","DOI":"10.1016\/j.jclinane.2023.111075","article-title":"Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young infants: a randomised controlled trial","volume":"86","author":"Gao","year":"2023","journal-title":"J Clin Anesth"},{"key":"B30","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1038\/s41390-023-02730-y","article-title":"Lung ultrasound-guided best positive end-expiratory pressure in neonatal anesthesia: a proposed randomized, controlled study","volume":"95","author":"Camporesi","year":"2024","journal-title":"Pediatr Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/j.1460-9592.2006.02045.x","article-title":"Atelectasis in children undergoing either propofol infusion or positive pressure ventilation anesthesia for magnetic resonance imaging","volume":"17","author":"Lutterbey","year":"2007","journal-title":"Pediatr Anesth"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1111\/pan.13718","article-title":"Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children: a randomized controlled trial","volume":"29","author":"Song","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"B33","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.bja.2020.01.022","article-title":"Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial","volume":"124","author":"Jang","year":"2020","journal-title":"Br J Anaesth"},{"key":"B34","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12871-021-01318-5","article-title":"Lung-protective mechanical ventilation for patients undergoing abdominal laparoscopic surgeries: a randomized controlled trial","volume":"21","author":"Nguyen","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1001\/jama.2020.12866","article-title":"Effect of intraoperative low tidal volume vs conventional tidal volume on postoperative pulmonary complications in patients undergoing major surgery: a randomized clinical trial","volume":"324","author":"Karalapillai","year":"2020","journal-title":"JAMA"},{"key":"B36","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.bja.2019.02.013","article-title":"Lung protective ventilation during pulmonary resection in children: a prospective, single-centre, randomised controlled trial","volume":"122","author":"Lee","year":"2019","journal-title":"Br J Anaesth"},{"key":"B37","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1097\/EJA.0000000000001351","article-title":"Prevention of atelectasis by continuous positive airway pressure in anaesthetised children: a randomised controlled study","volume":"38","author":"Acosta","year":"2021","journal-title":"Eur J Anaesthesiol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.21037\/tp-24-453","article-title":"Optimizing perioperative lung protection strategies for reducing postoperative respiratory complications in pediatric patients: a narrative review","volume":"13","author":"Wang","year":"2024","journal-title":"Transl Pediatr"},{"key":"B39","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/j.2040-4603.2012.tb00393.x","article-title":"Respiratory function during anesthesia: effects on gas exchange","volume":"2","author":"Hedenstierna","year":"2012","journal-title":"Compr Physiol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1730470\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:26:44Z","timestamp":1771928804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1730470\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":39,"alternative-id":["10.3389\/fped.2026.1730470"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1730470","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"article-number":"1730470"}}