NONIMMUNE HYDROPS.ppt

ICN management Supportive care as appropriate, especially for the premature infants. Evaluation of the newborn if cause of NIH is not known. Specific therapy based on underlying etiology of NIHF when possible. Asses parental needs and encourage them to participate in the care. Evaluation of NIH infant with unknown cause CVS: Echo and electrocardiogram Pulm: CXR, pleural fluid analysis Hemat: cord blood studies and PBS GI:U/S of abdomen, LFTs, peritoneal fluid analysis. Evaluation of NIH infant with unknown cause Renal: UA, BUN, Cr. Genetic: Chromosomal analysis, skeletal radiographs, genetic consultation. Cong infections: Viral cultures or serology Pathologic: Placental examination, autopsy(in case of neonatal death) NIHF Prognosis Prognosis is very poor with high rate of morbidity and mortality Perinatal mortality: 50 to 90% 50% of cases diagnosed in utero result in fetal death. 50% of all live born infants die. NIHF prognosis Idiopathic variety have the best prognosis. Good prognosis with: Anemia that can be treated in utero or in newborn period; 90% survive. Isolated arrhythmia ; 50% survive. NIHF prognosis Poor prognosis associated with: Prematurity Pleural effusion with pulmonary hypoplasia. Chromosomal disorders Structural malformations. Severe hydrops. Thank you NONIMMUNE HYDROPS Geetha B. Thippeswamy, MD August 16th 2002 Neonatal presentation Transition of hydropic babies to extrauterine life Understanding this is very important in planning the resuscitation of the hydropic newborn Hydropic babies often display signs of intrapartum asphyxia at birth No respiratory effort or have a poor effort. Transition of hydropic babies to extrauterine life Decreased respiratory compliance and increased resistance: Airway edema Chest wall edema Pulmonary edema RDS Pleural effusion, Ascites Pulmonary hypoplasia Transition of hydropic babies to extrauterine life Hypoxia and acidosis sec to gas exchange compromise. Hypoxia decreases cardiac function. PPHN sec to