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Unformatted text preview: CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS OBJECTIVES Review of Cardio-Pulmonary Development. Review s Define changes that occur during transition Define to extra-uterine life with emphasis on breathing mechanics. breathing s Identify infants at risk for and who have Identify respiratory distress respiratory s Review of common neonatal disease states. s STAGES OF NORMAL LUNG GROWTH Embryonic - first 5 weeks; formation of proximal Embryonic airways airways Pseudoglandular - 5-16 weeks; formation of Pseudoglandular conducting airways conducting Canalicular - 16-24 weeks; formation of acini Saccular - 24 - 36 weeks; development of gasexchange units Alveolar - 36 weeks and up; expansion of surface Alveolar area area Pseudoglandular 6-16 weeks Canalicular Phase 16-24 weeks Saccular Phase 24-34 weeks PHYSIOLOGIC MATURATION (Surfactant Production) s Type 2 pneumocytes appear at 24-26 weeks s Responsible for reduction of alveolar surface tension. x s Lipid profile as indicator of lung maturity x x s LaPlace’s Law L/S Ratio Flourescence Polarization - FLM Many other factors influence lung maturation Maturational Factors s Stimulation x x x x x x x Glucorticoids, ACTH Thyroid Hormones, Thyroid TRF TRF EGF Heroin Aminophyline,cAMP Interferon Estrogens s Inhibition x x x x x Diabetes (insulin, Diabetes hyperglycemia, butyric acid) acid) Testosterone TGF-B Barbiturates Prolactin FETAL CIRCULATION TRANSITION TO EXTRA-UTERINE LIFE s s s s s s Fetal Breathing Instantaneous; liquid filled to air filled lungs Maintenance of FRC Placental blood flow termination Decreased PVR Closure of fetal shunts MECHANICS OF BREATHING s Respiratory Control Center...CNS x Metabolic Needs Negative pressure breathing s Compliance and Resistance s x Inspiratory Muscles x Rib Cage Rib 3 “Compliability becomes a liability” Signs of Respiratory Distress Tachypnea s Intercostal retractions s Nasal Flaring s Grunting Grunting s Cyanosis s When is it abnormal to show signs of respiratory distress? When tachypnea, retractions, flaring, or When grunting persist beyond one hour after birth. birth. s When there is worsening tachypnea, When retractions, flaring or grunting at any time. time. s Any time there is cyanosis s Causes of Neonatal Respiratory Distress s Obstructive/restrictive - mucous, choanal Obstructive/restrictive atresia, pneumothorax, diaphragmatic hernia. atresia, Primary lung problem - Respiratory Distress Primary Syndrome (RDS), meconium aspiration, bacterial pneumonia, transient (TTN). bacterial s Non-pulmonary -pulmonary s -hypovolemia/hypotension, congenital heart disease, hypoxia, acidosis, cold stress, anemia, polycythemia stress, Infants at Risk for Developing Respiratory Distress s Preterm Infants Infants with birth asphyxia Infants of Diabetic Mothers Infants born by Cesarean Section s Infants born to mothers with fever, Prolonged s s s ROM, foul-smelling amniotic fluid. ROM, s Meconium in amniotic fluid. s Other problems Evaluation of Respiratory Distress Administer Oxygen and other necessary Administer emergency treatment emergency s Vital sign assessment s Determine cause-- physical exam, Chest Determine x-ray, ABG, Screening tests: Hematocrit, blood glucose, CBC blood s Sepsis work-up s Principles of Therapy s Improve oxygen delivery to lungs-- supplemental -oxygen, CPAP, assisted ventilation, surfactant oxygen, s Improve blood flow to lungs-- volume expanders, blood -transfusion, partial exchange transfusion for high hematocrit, correct acidosis (metabolic/respiratory) hematocrit, s Minimize oxygen consumption-- neutral thermal -environment, warming/humidifying oxygen, withhold oral feedings, minimal handling oral DISEASE STATES Respiratory Distress Syndrome s Transient Tachypnea of the Newborn s Meconium Aspiration Syndrome s Persistent Hypertension of the Newborn s Congenital Pneumonia s Congenital Malformations s Acquired Processes s RESPIRATORY DISTRESS SYNDROME Surfactant Deficiency Tidal Volume Ventilation Pulmonary Injury Sequence CLINICAL FEATURES OF RDS Tachypnea/Apnea s Dyspnea s Grunting/Flaring s Hypoxemia s Radiographic Features s Pulmonary Function Abnormalities s Early RDS Progressive RDS Late RDS Hyaline Membrane Disease THERAPY FOR RDS Oxygen - maintain PaO2 > 50 torr s Nasal CPAP s Intermittent Mandatory Ventilation s Surfactant Replacement s High Frequency Ventilation s Intercurrent Therapies s PIE PIE Pathology PIE Histology Pneumothorax/PIE Pneumothorax Pneumopericardium TRANSIENT TACHYPNEA OF THE NEWBORN Delayed Fluid Resorption s Hard to differentiate early on from RDS Hard both clinicaly and radiographicaly especially in the premature infant especially s Initial therapy similar to RDS, but hospital Initial course is quite different course s Wet Lung MECONIUM ASPIRATION SYNDROME Chemical Pneumonitis s Surfactant Inactivation s Potential for Infection s Potential for Pulmonary Hypertension s Management varies on severity s Meconium Aspiration PERSISTENT PULMONARY HYPERTENSION Usually secondary to primary pulmonary Usually disease state disease s Pulmonary Vascular Lability s Treat the underlying problem s Maintain normo-oxygenation s Selective Pulmonary Vasodilators s Pray for good luck s PPHN CONGENITAL PNEUMONIA Infectious; primarily GBS s Amniotic Fluid aspiration s Viral etiology s Surfactant inactivation s GBS Pneumonia CONGENITAL MALFORMATIONS Choanal Atresia s Tracheal Atresia/stenosis s Chest Mass s x Diaphragmatic hernia x CCAM x Sequestration x Lobar emphysema CCAM Lobar Emphysema Diaphragmatic Hernia Chylothorax Phrenic Nerve Paralysis ACQUIRED DISEASES Infections s Bronchopulmonary Dysplasia s Sub-glottic stenosis s Apnea of Prematurity s Early BPD Progressive BPD Late BPD APNEA Definition: cessation of breathing Definition: for longer than a 15 second period or for a shorter time if there is bradycardia or cyanosis bradycardia Babies at Risk for Apnea s s s s s s s s s Preterm Respiratory Distress Metabolic Disorders Infections Cold-stressed babies who are being warmed CNS disorders Low Blood volume or low Hematocrit Perinatal Compromise Maternal drugs in labor Anticipation and Detection Place at-risk infants on cardiorespiratory monitor s Low heart rate limit (80-100) s Respiratory alarm (15-20 seconds) s Treatment s Determine cause: s x-ray blood sugar body and environmental temperature hematocrit sepsis work up electrolytes cardiac work up r/o seizure s s s s s s s Treatment CPAP s Theophylline/Caffeine therapy s Mechanical ventilation s Apnea monitor s ...
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