新生儿呼吸系统疾病(英文).ppt

Congenital diaphragmatic hernia Can complicated with lung hypoplasia, Increased risk of PPHN and pneumothorax Should be intubated immediately after birth Case 5 Preterm infant born at 30 weeks gestation Started frequently desaturation and bradycardia at 2 weeks of age, SpO2 down to 70%, HR down to 80 Recovered by O2 and stimulation Apnea of prematurity Cessation of breathing for 20 seconds Cessation of breathing for 20 seconds if associated with bradycardia, cyanosis or pallor Epidemiology 59 - 78% of all preterm infants ?with increasing gestational age 50% of infants 1500g require intervention for apnea Persists longer with ? GA Most infants reach respiratory maturity by 42 - 44 weeks CGA Apnea of prematurity Central (10-20%) No nasal airflow No observable respiratory effort Obstructive (10-25%) No nasal airflow Observable chest wall motion Obstruction in the upper airway Mixed (50-75%) Apnea of prematurity Causes of apnea: CNS Respiratory CVS GI Metabolic Idiopathic Management of Apnea Stimulation CPAP Medication * * * Complete the Primary Survey. This should prompt students ask questions about items not yet described or discussed. decreased lung inflation lung fields diffusely hazy, total or near total “white out” appearance heart borders and diaphragm 50% obscured air bronchograms in upper and lower lobes * * In RDS the alveoli are collapsed due to lack of surfactant. This impairs gas exchange between lung and pulmonary circulation. * Surfactant administration re-expands the alveoli, improving gas exchange. It also decreases the incidence of pneumothorax decreases the need for more aggressive ventilation and shortens the duration of ventilation decreases development of chronic lung disease improves survival lung inflation improved sinificantly lung fields diffusely hazy, with “ground glass” appearance heart borders and diaphragm approximately 50% obscured. air bronchograms more widely seen in upper and lower lobes * * * normal or increa