1. Principles of Neonatal Surgery Respiratory Distress Dr. Abdulrahman Al-Bassam. FRCS professor and Consultant, head section Pediatric Surgery, professor and Consultant, head section Pediatric Surgery, Division of Pediatric Surgery, Department of Surgery, College of Medicine and King Khalid University Hospital, Riyadh

2. Principles of Neonatal Surgery Respiratory Distress l l Definition: – –Neonates presented with l l Tachypnea l l Grunting l l Retraction of chest wall l l If severe, it may leads to cyanosis, shock, bradycardia, apnea

3. Principles of Neonatal Surgery Respiratory Distress l l Management : A logical step by step manner – – Mild respiratory distress l l Needs further investigations l l To find out the cause – –Moderate to severe distress l l Needs full resuscitation l l Care for upper airway l l Bag and mask or IPPV l l Reassess and call for help!!

4. Principles of Neonatal Surgery Respiratory Distress l l Causes – –Medical l l Respiratory distress syndrome l l Meconium aspiration l l Congenital heart disease l l Pneumonia l l Pneumothorax l l Drugs- opiates, diazepam during labour l l Birth asphyxia, cerebral hemorrhage

5. Principles of Neonatal Surgery Respiratory Distress l l Causes – –Surgical l l Upper airway obstruction l l Congenital diaphragmatic hernia l l Eventration of Diaphragm l l Esophageal atresia with TOF l l Congenital lobar emphysema l l Congenital cystic adenomatoid malformation l l Pulmonary Sequestration

6. Principles of Neonatal Surgery Congenital Diaphragmatic Hernia l l Incidence: 1:2000 to 5000, l l female more affected, l l prematurity and low BW, l l Left side is more commom

7. l l Symptoms None to severe Polyhydramnios Presents birth to after many days l l Signs Scaphoid abdomen Audible bowel sound in the chest Principles of Neonatal Surgery Congenital Diaphragmatic Hernia

8. l l Diagnosis: – –Prenatal <25wks, prognosis bad – –Clinical – –CXR – –10% >after neonatal period

9. Principles of Neonatal Surgery Congenital Diaphragmatic Hernia l l Management – –Reussciataion and stabilization – –Laparotomy l l Primary l l Patch by mesh or muscle – –Laparoscopic repair

10. Eventration of Diaphragm l Def: Abnormal elevation of diaphragm that results in paradoxical motion of affected hemidiaphragm during inspiration and expiration l Cause: –Congenital –Acquired l Symptoms: –None –Resp. distress –Wheezing, repeated URI, exercise intolerance

11. Eventration of Diaphragm l Diagnosis: –CXR –Fluoroscopy or –Real time US

12. Eventration of Diaphragm l Managemnet: –Conservative(mild symptoms /Asymptomatic) –plication

13. Principles of Neonatal Surgery Congenital cystic adenomatoid malformation (CCAM) l l It is multicystic mass of pulmonary tissue in which there is overgrowth of bronchial structure at the expanse of alveoli. l l Types: – –I: Cyst >2 cm – –II: Cyst <1 cm – –III: noncytic, mainly solid l l Symptoms – –Asymptomatic, prenatal diagnosis – –Respiratory distress – –Infections

14. Principles of Neonatal Surgery Congenital cystic adenomatoid malformation (CCAM) l l Diagnosis – –CXR – –CT scan l l Treatment: – –Lobectomy

15. Principles of Neonatal Surgery Congenital lobar Over Inflation(CLO) l l It is bronchial abnormality with overdistention of one or two lobes due to air trapping. l l Sites: – –I: left upper lobe 47% – –II: Right middle and upper lobe (28 %, 20%) l l Cause: – –1: Chrondromalacia to one bronchus. – –2: Extrinsic pressure due anomalous artery – –3: Idiopathic

16. Principles of Neonatal Surgery Congenital lobar Over Inflation(CLO) l l Symptoms – –Respiratory distress due compression of normal lobe l l Diagnosis – –CXR – –CT scan/Ventilation perfusion scan

17. Principles of Neonatal Surgery Congenital lobar Over Inflation(CLO) l l Treatment: – –Lobectomy to affected lobe

18. Principles of Neonatal Surgery Respiratory Distress l Upper airway obstruction –Bilateral Choanal atresia –Laryngomalacia/tracheomalacia/ Broncheomalacia –Subglotic stenosis –Vocal card paralysis –Cervical masses ( cystic hygroma, teratoma etc)

19. Principles of Neonatal Surgery Respiratory Distress l l The newborn suspected of having respiratory distress should be studied in a logical step by step manner. l l It is important to establish that the infant has a surgical problem before surgery is performed. l l Resuscitation must be done before operation l Every condition will be dealt accordingly