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Presentation on theme: "CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS."— Presentation transcript:


2 OBJECTIVES n Review of Cardio-Pulmonary Development. n Define changes that occur during transition to extra-uterine life with emphasis on breathing mechanics. n Identify infants at risk for and who have respiratory distress n Review of common neonatal disease states.

3 STAGES OF NORMAL LUNG GROWTH Embryonic - first 5 weeks; formation of proximal airways Pseudoglandular - 5-16 weeks; formation of conducting airways Canalicular - 16-24 weeks; formation of acini Saccular - 24 - 36 weeks; development of gas- exchange units Alveolar - 36 weeks and up; expansion of surface area

4 Pseudoglandular 6-16 weeks

5 Canalicular Phase 16-24 weeks

6 Saccular Phase 24-34 weeks

7 PHYSIOLOGIC MATURATION (Surfactant Production) n Type 2 pneumocytes appear at 24-26 weeks n Responsible for reduction of alveolar surface tension. u LaPlace’s Law n Lipid profile as indicator of lung maturity u L/S Ratio u Flourescence Polarization - FLM n Many other factors influence lung maturation



10 Maturational Factors n Stimulation u Glucorticoids, ACTH u Thyroid Hormones, TRF u EGF u Heroin u Aminophyline,cAMP u Interferon u Estrogens n Inhibition u Diabetes (insulin, hyperglycemia, butyric acid) u Testosterone u TGF-B u Barbiturates u Prolactin


12 TRANSITION TO EXTRA-UTERINE LIFE n Fetal Breathing n Instantaneous; liquid filled to air filled lungs n Maintenance of FRC n Placental blood flow termination n Decreased PVR n Closure of fetal shunts

13 MECHANICS OF BREATHING n Respiratory Control Center...CNS u Metabolic Needs n Negative pressure breathing n Compliance and Resistance u Inspiratory Muscles u Rib Cage F “Compliability becomes a liability”

14 Signs of Respiratory Distress n Tachypnea n Intercostal retractions n Nasal Flaring n Grunting n Cyanosis

15 When is it abnormal to show signs of respiratory distress? n When tachypnea, retractions, flaring, or grunting persist beyond one hour after birth. n When there is worsening tachypnea, retractions, flaring or grunting at any time. n Any time there is cyanosis

16 Causes of Neonatal Respiratory Distress n Obstructive/restrictive - mucous, choanal atresia, pneumothorax, diaphragmatic hernia. n Primary lung problem - Respiratory Distress Syndrome (RDS), meconium aspiration, bacterial pneumonia, transient (TTN). n Non -pulmonary - hypovolemia/hypotension, congenital heart disease, hypoxia, acidosis, cold stress, anemia, polycythemia

17 Infants at Risk for Developing Respiratory Distress n Preterm Infants n Infants with birth asphyxia n Infants of Diabetic Mothers n Infants born by Cesarean Section n Infants born to mothers with fever, Prolonged ROM, foul-smelling amniotic fluid. n Meconium in amniotic fluid. n Other problems

18 Evaluation of Respiratory Distress n Administer Oxygen and other necessary emergency treatment n Vital sign assessment n Determine cause-- physical exam, Chest x-ray, ABG, Screening tests: Hematocrit, blood glucose, CBC n Sepsis work-up

19 Principles of Therapy n Improve oxygen delivery to lungs-- supplemental oxygen, CPAP, assisted ventilation, surfactant n Improve blood flow to lungs-- volume expanders, blood transfusion, partial exchange transfusion for high hematocrit, correct acidosis (metabolic/respiratory) n Minimize oxygen consumption-- neutral thermal environment, warming/humidifying oxygen, withhold oral feedings, minimal handling

20 DISEASE STATES n Respiratory Distress Syndrome n Transient Tachypnea of the Newborn n Meconium Aspiration Syndrome n Persistent Hypertension of the Newborn n Congenital Pneumonia n Congenital Malformations n Acquired Processes

21 RESPIRATORY DISTRESS SYNDROME Surfactant Deficiency Tidal Volume Ventilation Pulmonary Injury Sequence

22 CLINICAL FEATURES OF RDS n Tachypnea/Apnea n Dyspnea n Grunting/Flaring n Hypoxemia n Radiographic Features n Pulmonary Function Abnormalities

23 Early RDS

24 Progressive RDS

25 Late RDS

26 Hyaline Membrane Disease

27 THERAPY FOR RDS n Oxygen - maintain PaO2 > 50 torr n Nasal CPAP n Intermittent Mandatory Ventilation n Surfactant Replacement n High Frequency Ventilation n Intercurrent Therapies

28 PIE

29 PIE Pathology

30 PIE Histology

31 Pneumothorax/PIE

32 Pneumothorax

33 Pneumopericardium

34 TRANSIENT TACHYPNEA OF THE NEWBORN n Delayed Fluid Resorption n Hard to differentiate early on from RDS both clinicaly and radiographicaly especially in the premature infant n Initial therapy similar to RDS, but hospital course is quite different

35 Wet Lung

36 MECONIUM ASPIRATION SYNDROME n Chemical Pneumonitis n Surfactant Inactivation n Potential for Infection n Potential for Pulmonary Hypertension n Management varies on severity

37 Meconium Aspiration

38 PERSISTENT PULMONARY HYPERTENSION n Usually secondary to primary pulmonary disease state n Pulmonary Vascular Lability n Treat the underlying problem n Maintain normo-oxygenation n Selective Pulmonary Vasodilators n Pray for good luck


40 CONGENITAL PNEUMONIA n Infectious; primarily GBS n Amniotic Fluid aspiration n Viral etiology n Surfactant inactivation

41 GBS Pneumonia

42 CONGENITAL MALFORMATIONS n Choanal Atresia n Tracheal Atresia/stenosis n Chest Mass u Diaphragmatic hernia u CCAM u Sequestration u Lobar emphysema


44 Lobar Emphysema

45 Diaphragmatic Hernia

46 Chylothorax

47 Phrenic Nerve Paralysis

48 ACQUIRED DISEASES n Infections n Bronchopulmonary Dysplasia n Sub-glottic stenosis n Apnea of Prematurity

49 Early BPD

50 Progressive BPD

51 Late BPD

52 APNEA Definition: cessation of breathing for longer than a 15 second period or for a shorter time if there is bradycardia or cyanosis

53 Babies at Risk for Apnea n Preterm n Respiratory Distress n Metabolic Disorders n Infections n Cold-stressed babies who are being warmed n CNS disorders n Low Blood volume or low Hematocrit n Perinatal Compromise n Maternal drugs in labor

54 Anticipation and Detection n Place at-risk infants on cardio- respiratory monitor n Low heart rate limit (80-100) n Respiratory alarm (15-20 seconds)

55 Treatment n Determine cause: n x-ray n blood sugar n body and environmental temperature n hematocrit n sepsis work up n electrolytes n cardiac work up n r/o seizure

56 Treatment n CPAP n Theophylline/Caffeine therapy n Mechanical ventilation n Apnea monitor



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