newbornRespDis - Physiologic Basis for the Management of...

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Unformatted text preview: Physiologic Basis for the Management of Acute Respiratory Disorders in the Newborn Marc Collin, MD 18 November 2003 Developmental Anatomy • Alveoli-developed by 25th week -increase in # until 8 yr. -from 20 to 300 million -surface area: 2.8 m2 @ birth 32 m2 @ 8 yr. 75 m2 @ adulthood-diameter: 150- 300 um(NB-Adult) Developmental Anatomy • Airways- cartilaginous - relatively weak in infancy - dynamic compression - bronchiolitis (RSV) - RAD - crying! Developmental Anatomy – airways enlarge in diameter/length – distal airways lag in first 5 yr. – high peripheral resistance in infancy – Resistance = 1/R4 Pulmonary Physiology • Compliance = Change in Volume Change in Pressure Static Lung Volumes Mechanics of Infant v. Adult Lung Pulmonary Physiology • Alveoli at birth • fluid-filled v. air-filled v. air-liquid interface • pressures up to 80 cm H2O @ birth • alveolar rupture Pressure-Volume Curves after Air v. Liquid Lung Expansion Pulmonary Physiology LaPlace relationship: P = 2T/R P= distending pressure T= wall tension R= radius (alveolar) Pressure-Volume Curves of First 3 Breaths Developmental Biochemistry of Alveoli • History: Avery & Mead-1959 - RDS secondary to surfactant deficiency - Treatment: CPAP Surfactant • Phospholipids - phosphatidylcholine- phosphatidylglycerol • Surfactant proteins - A, B, C Surfactant Components Surfactant • Type II alveolar epithelial cells-responsible for synthesis, storage, secretion, and reuptake • Lamellar bodies -intracellular storage form of surfactant -secreted via exocytosis -forms tubular myelin in extracellular space Surfactant and Type II Cells Surfactant...
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newbornRespDis - Physiologic Basis for the Management of...

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