(精编)【体外膜肺ECMO精品课件】 Meconium-stained amniotic fluid (MSAF) Pediatrics point of view教学课件.pptVIP

(精编)【体外膜肺ECMO精品课件】 Meconium-stained amniotic fluid (MSAF) Pediatrics point of view教学课件.ppt

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Close up of left lung demonstrating the streaky lucencies of the air in the interstitium (red arrows) complicated by a pneumothorax (yellow arrow). Diagnosis In infants with severe disease who require high concentrations of supplemental oxygen and mechanical ventilation, the lungs may develop an appearance of homogeneous density similar to respiratory distress syndrome (RDS). Radiographic changes resolve over the course of 7 to 10 days but sometimes persist for several weeks. Air leak occurs in 10 to 30 percent of infants with MAS. Homogeneous density similar to respiratory distress syndrome (RDS). Diagnosis Arterial blood gas measurements typically show hypoxemia and hypercarbia. Infants with pulmonary hypertension and right-to-left shunting may have a gradient in oxygenation between preductal and postductal samples. 2D Echocardiogram for evaluation of PPH. Management Management Sept 2007 the ACOG revised recommendations and recommended that “all infants with MSAF should not longer receive intrapartum suctioning. If meconium present and the newborn depressed, the clinician should intubate the trachea and suction meconium from beneath the glottis”. Intrapartum suctioning not effective in removing meconium aspirated by the fetus into the lungs prior delivery. Management Skilled resuscitation team should be present at all deliveries that involve MSAF. Pediatric intervention depends on whether the infant is vigorous. Vigorous infant is if has: Strong resp. efforts Good muscle tone Heart rate 100b/m When this is a case-no need for tracheal suctioning, only routine management. Meconium-stained amniotic fluid (MSAF) Pediatrics point of view MM Presentation Darinka Shaw MD Pediatrics Resident February 2009 Objectives Definition Epidemiology Etiology Pathophysiology Clinical features Management MorbidityMortality Definition Meconium aspiration syndrome (MAS) is a respiratory disorder in an infant born through Meconium stained amniotic fluid whose s

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