to extra-uterine life with emphasis on breathing mechanics.
Identify infants at
risk for and who have respiratory distressReview of common neonatal disease states.
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CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
Содержание
- 1. CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
- 2. OBJECTIVESReview of Cardio-Pulmonary Development. Define changes that
- 3. STAGES OF NORMAL LUNG GROWTHEmbryonic
- 4. Pseudoglandular 6-16 weeks
- 5. Canalicular Phase 16-24 weeks
- 6. Saccular Phase 24-34 weeks
- 7. PHYSIOLOGIC MATURATION (Surfactant Production)Type 2 pneumocytes appear
- 8. Слайд 8
- 9. Слайд 9
- 10. Maturational FactorsStimulationGlucorticoids, ACTHThyroid Hormones, TRFEGFHeroinAminophyline,cAMPInterferonEstrogensInhibitionDiabetes (insulin, hyperglycemia, butyric acid)TestosteroneTGF-BBarbituratesProlactin
- 11. FETAL CIRCULATION
- 12. TRANSITION TO EXTRA-UTERINE LIFEFetal BreathingInstantaneous; liquid filled
- 13. MECHANICS OF BREATHINGRespiratory Control Center...CNSMetabolic NeedsNegative pressure breathingCompliance and ResistanceInspiratory MusclesRib Cage “Compliability becomes a liability”
- 14. Signs of Respiratory DistressTachypneaIntercostal retractionsNasal FlaringGrunting Cyanosis
- 15. When is it abnormal to show signs
- 16. Causes of Neonatal Respiratory DistressObstructive/restrictive - mucous,
- 17. Infants at Risk for Developing Respiratory DistressPreterm
- 18. Evaluation of Respiratory DistressAdminister Oxygen and other
- 19. Principles of TherapyImprove oxygen delivery to lungs--
- 20. DISEASE STATESRespiratory Distress SyndromeTransient Tachypnea of the
- 21. RESPIRATORY DISTRESS SYNDROMESurfactant DeficiencyTidal Volume VentilationPulmonary Injury Sequence
- 22. CLINICAL FEATURES OF RDSTachypnea/ApneaDyspneaGrunting/FlaringHypoxemiaRadiographic FeaturesPulmonary Function Abnormalities
- 23. Early RDS
- 24. Progressive RDS
- 25. Late RDS
- 26. Hyaline Membrane Disease
- 27. THERAPY FOR RDSOxygen - maintain PaO2 > 50 torrNasal CPAPIntermittent Mandatory VentilationSurfactant ReplacementHigh Frequency VentilationIntercurrent Therapies
- 28. PIE
- 29. PIE Pathology
- 30. PIE Histology
- 31. Pneumothorax/PIE
- 32. Pneumothorax
- 33. Pneumopericardium
- 34. TRANSIENT TACHYPNEA OF THE NEWBORNDelayed Fluid ResorptionHard
- 35. Wet Lung
- 36. MECONIUM ASPIRATION SYNDROMEChemical PneumonitisSurfactant InactivationPotential for InfectionPotential for Pulmonary HypertensionManagement varies on severity
- 37. Meconium Aspiration
- 38. PERSISTENT PULMONARY HYPERTENSIONUsually secondary to primary pulmonary
- 39. PPHN
- 40. CONGENITAL PNEUMONIAInfectious; primarily GBSAmniotic Fluid aspirationViral etiologySurfactant inactivation
- 41. GBS Pneumonia
- 42. CONGENITAL MALFORMATIONSChoanal AtresiaTracheal Atresia/stenosisChest MassDiaphragmatic herniaCCAMSequestrationLobar emphysema
- 43. CCAM
- 44. Lobar Emphysema
- 45. Diaphragmatic Hernia
- 46. Chylothorax
- 47. Phrenic Nerve Paralysis
- 48. ACQUIRED DISEASESInfectionsBronchopulmonary DysplasiaSub-glottic stenosisApnea of Prematurity
- 49. Early BPD
- 50. Progressive BPD
- 51. Late BPD
- 52. APNEADefinition: cessation of breathing for longer than
- 53. Babies at Risk for ApneaPretermRespiratory DistressMetabolic DisordersInfectionsCold-stressed
- 54. Anticipation and DetectionPlace at-risk infants on cardio-respiratory monitorLow heart rate limit (80-100)Respiratory alarm (15-20 seconds)
- 55. Treatment Determine cause:x-rayblood sugarbody and environmental temperaturehematocritsepsis work upelectrolytescardiac work upr/o seizure
- 56. TreatmentCPAPTheophylline/Caffeine therapyMechanical ventilationApnea monitor
- 57. Слайд 57
- 58. Скачать презентанцию
OBJECTIVESReview of Cardio-Pulmonary Development. Define changes that occur during transition to extra-uterine life with emphasis on breathing mechanics.Identify infants at risk for and who have respiratory distressReview of common neonatal disease
Слайды и текст этой презентации
Слайд 2OBJECTIVES
Review of Cardio-Pulmonary Development.
Define changes that occur during transition
to extra-uterine life with emphasis on breathing mechanics.
risk for and who have respiratory distressReview of common neonatal disease states.
Слайд 3STAGES
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 aciniSaccular - 24 - 36 weeks; development of gas-exchange units
Alveolar - 36 weeks and up; expansion of surface area
Слайд 7PHYSIOLOGIC MATURATION
(Surfactant Production)
Type 2 pneumocytes appear at 24-26 weeks
Responsible for
reduction of alveolar surface tension.
LaPlace’s Law
Lipid profile as indicator of
lung maturityL/S Ratio
Flourescence Polarization - FLM
Many other factors influence lung maturation
Слайд 10Maturational Factors
Stimulation
Glucorticoids, ACTH
Thyroid Hormones, TRF
EGF
Heroin
Aminophyline,cAMP
Interferon
Estrogens
Inhibition
Diabetes (insulin, hyperglycemia, butyric acid)
Testosterone
TGF-B
Barbiturates
Prolactin
Слайд 12TRANSITION
TO
EXTRA-UTERINE LIFE
Fetal Breathing
Instantaneous; liquid filled to air filled lungs
Maintenance of
FRC
Placental blood flow termination
Decreased PVR
Closure of fetal shunts
Слайд 13MECHANICS OF BREATHING
Respiratory Control Center...CNS
Metabolic Needs
Negative pressure breathing
Compliance and Resistance
Inspiratory
Muscles
Rib Cage
“Compliability becomes a liability”
Слайд 15When is it abnormal to show signs of respiratory distress?
When
tachypnea, retractions, flaring, or grunting persist beyond one hour after
birth.When there is worsening tachypnea, retractions, flaring or grunting at any time.
Any time there is cyanosis
Слайд 16Causes of Neonatal Respiratory Distress
Obstructive/restrictive - mucous, choanal atresia, pneumothorax,
diaphragmatic hernia.
Primary lung problem - Respiratory Distress Syndrome (RDS), meconium
aspiration, bacterial pneumonia, transient (TTN).Non-pulmonary -hypovolemia/hypotension, congenital heart disease, hypoxia, acidosis, cold stress, anemia, polycythemia
Слайд 17Infants at Risk for Developing Respiratory Distress
Preterm Infants
Infants with birth
asphyxia
Infants of Diabetic Mothers
Infants born by Cesarean Section
Infants born to
mothers with fever, Prolonged ROM, foul-smelling amniotic fluid.Meconium in amniotic fluid.
Other problems
Слайд 18Evaluation of Respiratory Distress
Administer Oxygen and other necessary emergency treatment
Vital
sign assessment
Determine cause-- physical exam, Chest x-ray, ABG, Screening tests:
Hematocrit, blood glucose, CBCSepsis work-up
Слайд 19Principles of Therapy
Improve oxygen delivery to lungs-- supplemental oxygen, CPAP,
assisted ventilation, surfactant
Improve blood flow to lungs-- volume expanders, blood
transfusion, partial exchange transfusion for high hematocrit, correct acidosis (metabolic/respiratory)Minimize oxygen consumption-- neutral thermal environment, warming/humidifying oxygen, withhold oral feedings, minimal handling
Слайд 20DISEASE STATES
Respiratory Distress Syndrome
Transient Tachypnea of the Newborn
Meconium Aspiration Syndrome
Persistent
Hypertension of the Newborn
Congenital Pneumonia
Congenital Malformations
Acquired Processes
Слайд 21RESPIRATORY DISTRESS SYNDROME
Surfactant Deficiency
Tidal Volume Ventilation
Pulmonary Injury Sequence
Слайд 22CLINICAL FEATURES OF RDS
Tachypnea/Apnea
Dyspnea
Grunting/Flaring
Hypoxemia
Radiographic Features
Pulmonary Function Abnormalities
Слайд 27THERAPY FOR RDS
Oxygen - maintain PaO2 > 50 torr
Nasal CPAP
Intermittent
Mandatory Ventilation
Surfactant Replacement
High Frequency Ventilation
Intercurrent Therapies
Слайд 34TRANSIENT TACHYPNEA OF THE NEWBORN
Delayed Fluid Resorption
Hard to differentiate early
on from RDS both clinicaly and radiographicaly especially in the
premature infantInitial therapy similar to RDS, but hospital course is quite different
Слайд 36MECONIUM ASPIRATION SYNDROME
Chemical Pneumonitis
Surfactant Inactivation
Potential for Infection
Potential for Pulmonary Hypertension
Management
varies on severity
Слайд 38PERSISTENT PULMONARY HYPERTENSION
Usually secondary to primary pulmonary disease state
Pulmonary Vascular
Lability
Treat the underlying problem
Maintain normo-oxygenation
Selective Pulmonary Vasodilators
Pray for good luck
Слайд 40CONGENITAL PNEUMONIA
Infectious; primarily GBS
Amniotic Fluid aspiration
Viral etiology
Surfactant inactivation
Слайд 42CONGENITAL MALFORMATIONS
Choanal Atresia
Tracheal Atresia/stenosis
Chest Mass
Diaphragmatic hernia
CCAM
Sequestration
Lobar emphysema
Слайд 48ACQUIRED DISEASES
Infections
Bronchopulmonary Dysplasia
Sub-glottic stenosis
Apnea of Prematurity
Слайд 52APNEA
Definition: cessation of breathing for longer than a 15 second
period or for a shorter time if there is bradycardia
or cyanosis
Слайд 53Babies at Risk for Apnea
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
Слайд 54Anticipation and Detection
Place at-risk infants on cardio-respiratory monitor
Low heart rate
limit (80-100)
Respiratory alarm (15-20 seconds)
Слайд 55Treatment
Determine cause:
x-ray
blood sugar
body and environmental temperature
hematocrit
sepsis work up
electrolytes
cardiac work
up
r/o seizure
