10Complications Pulmonary Hemorrhage Pneumothorax IVH + PDA + NEC InfectionROPCLD or BPD
11Wet Lung (TTN) Predisposing factors Cesarean section without labor Perinatal distressinfants of diabetic mothersBreechDelayed cord clampingMaternal sedation And IV large volumes
12Signs and symptoms Term or near term male infant Tachypnea ( breaths per minute)Mild retractionMild CyanosisHyperaerationOccasional grunting and nasal flaring
13Chest x-ray Increased markings centrally Fluid in fissures and costophrenic anglesHyperaeration may be present
14Cont. Wet Lung Blood gases, SaO2 Hypoxemia Acidosis or alkalosis may be presentResolution one to five days; most improve during the first 24 hoursManagement: oxygen, occasionally CPAP/PEEP
15PneumoniaTerm infant 2.85kg boy, Borne to 34 yeas old mother G6 P4 +1 unbookedPresented with SROM > 36 hsImmediately after birth he started to hasSever respiratory distress , associated with very soft ejection systolic murmurWhat is (are) the diagnosis?How do you manage this infant ?
16Air leak syndrome31 wks ,1200gm , admited to NICU with milde RDS, Connected to CMV with good blod gases and oxygen saturation.2nd day developed sudden deterioration became hypoxic, skin mottling and low BPWhat is your diagnosis ?How do you manage this inbfant?
18Meconium AspirationTerm boy infant IDM born to 30 ys old mother with prolong second stage, Thick MSAFHow do you resuscitate this infant?On admission to NICU he showed sever respiratory distress sever hypoxia What is the diagnosis and D/D ?How do you manage such infant?What are the complications ?
19Congenital Diaphragmatic hernia Term baby presented with cyanosis at birthPhysical exam refealed respiratory distress, a scaphoid abdomen, decrease breath sound on the left side.What is the diagnosis ?What is the immediate treatment ?What is the long term management ?
22EtiologyAcute pulmonary vasoconstriction (e.g., acidosis, hypoxia, RDS, pneumonia; hyperviscosity)Increased pulmonary vascular smooth muscle with its extension (e.g., perinatal distress, aspiration ?) to arterioles surrounding alveoliDecreased number of pulmonary blood vessels with excessive muscle (e.g., diaphragmatic hernia, other thoracic space-occupying lesions)
23Esophageal Atresia withTEF Term female newborn 3kg, presented with vomiting and abdominal distensionO/E Mild respiratory distress no dismorphic featurs had exseisve salivationWhat is (are) the D/D ?What is the line of management ?
25. Signs and symptoms Maternal polyhydramnios in 30-70% of patients Excessive secretions and drooling after birthChoking, coughing and cyanosis with feedingsInability to pass an orogastric tube to the stomachRespiratory distressCongenital anomalies (50%) -VACTERL or VATER
26X-ray Dilated proximal pouch in the mediastinum Right upper lobe pneumonia or atelectasis (overflow of secretions)Gastric dilatation and excessive air in the bowel loops if a fistula is presentNo air in abdomen if a fistula is absent
27Initial managementIntermittent suction or aspiration of the upper pouch, nasopharynxHead and chest elevated 45 degrees from the horizontalPrevent excessive cryingAntibioticsSurgery when stable - gastrostomy should be done early
28Congenital lobar emphysema Location is usually left upper lobe, right middle lobe or right upper lobe, unless due to an aberrant vessel related to congenital heart diseasePartial obstruction of the airway on expiration leads to overdistention of the lobe; there is often abnormal bronchial cartilageIntraluminal obstructionExtraluminal compression, often associated with congenital heart disease (lower lobes)
29Signs and symptoms Progressive respiratory distress Wheezing Cyanosis Asymptomatic
30. Chest x-ray Overdistention of the lobe Compression of surrounding lobesMediastinal shiftRadiolucent lobe
31Differential diagnosis Lung cystTension pneumothoraxCompensatory emphysema due to contralateral atelectasisPneumatocele
32Initial management Ventilatory support with 100% oxygen Alkalosis Good lung uppermostSurgery
33Pleural effusion (bilateral or unilateral) EtiologyChylothoraxHydrops fetalis (immunologic or nonimmunologic)PneumoniaTurner syndromeWet lungCongestive heart failureHemothoraxParenteral nutrition or fluid extravasation