EDiaphragmatic hernia 1An abnormal opening in the diaphragm aCauses the

Ediaphragmatic hernia 1an abnormal opening in the

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E.Diaphragmatic hernia 1.An abnormal opening in the diaphragm a.Causes the abdominal contents to herniate into the chest cavity b.Causes the heart and mediastinum to shift to the contralateral side of the hernia c.Postnatal signs and symptoms: i.Respiratory distress ii.Heart sounds shifted to the right iii.Decreased breath sounds on the left iv.Bowel sounds heard in the chest v.Scaphoid abdomen d.Mortality may be as high as 50%. 2.Assessment and management a.A newborn may demonstrate: i.Few or no symptoms ii.Severe hypoxia and increased work of breathing b.Resuscitate on 100% oxygen. i.Bag-mask ventilation will distend intestines and compromise ventilations further. ii.If PPV is necessary, place an ET tube, and deliver a peak ventilatory pressure of 25 mm Hg or less. iii.Place an orogastric tube, and provide intermittent suctioning to minimize distention. c.Monitor heart rate continuously during transport. d.Ultimately requires surgical correction, so transport to a facility with a neonatal intensive care and pediatric surgery. F.Respiratory distress and cyanosis 1.Single most common cause in the neonate is prematurity. a.Respiratory causes include: i.Airway obstruction ii.Aspiration iii.Pneumonia iv.Pneumothorax v.Tracheoesophageal fistula vi.Congenital diaphragmatic hernia vii.Immature lungs b.Other causes:
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i.Any process resulting in a delay in drop of pulmonary vascular resistance after birth leading to shunting of blood across the patent ductus arteriosus and patent foramen ovale ii.Central nervous system depression iii.Septic shock and severe metabolic acidosis iv.Cardiac anomalies 2.Assessment and management a.Ensure patent airway. b.Check that the breathing is adequate. c.Check to see that pulse is present. d.Assess respiratory rate, respiratory effort, and breath sounds. e.Ask parents about increased symptoms with feeding attempt. f.Treatment includes: i.Establishing patent airway ii.Ensuring adequate oxygen delivery iii.Establishing effective ventilation iv.Ensuring adequate circulation g.If resuscitative efforts do not result in improvement, needle thoracentesis may be a necessary. G.Premature and low birth weight infants 1.Premature—newborns delivered before 37 weeks of gestation. a.Often idiopathic, but maternal conditions associated with preterm labor and delivery include: i.Maternal infection (including urinary tract infection) ii.Chorioamnionitis iii.Maternal illness leading to dehydration iv.Placental insufficiency v.Polyhydramnios vi.Preeclampsia/eclampsia vii.Pregnancy-induced hypertension b.In addition to increased mortality, a number of morbidities are associated with prematurity: i.Respiratory distress syndrome ii.Respiratory suppression and apnea iii.Hypothermia iv.Sepsis v.Central nervous system compromise (a)Intraventricular hemorrhage (b)Periventricular leucomalacia c.Low birth weight—newborns weighing less than 5½ lb (2,500 g) i.The most common etiology is prematurity ii.Factors that can predispose a woman to deliver prematurely include: (a)Genetic factors (b)Infection (c)Cervical incompetence (d)Abruption
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