Презентация на тему: CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS

CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
OBJECTIVES
STAGES OF NORMAL LUNG GROWTH
Pseudoglandular 6-16 weeks
Canalicular Phase 16-24 weeks
Saccular Phase 24-34 weeks
PHYSIOLOGIC MATURATION (Surfactant Production)
CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
Maturational Factors
FETAL CIRCULATION
TRANSITION TO EXTRA-UTERINE LIFE
MECHANICS OF BREATHING
Signs of Respiratory Distress
When is it abnormal to show signs of respiratory distress?
Causes of Neonatal Respiratory Distress
Infants at Risk for Developing Respiratory Distress
Evaluation of Respiratory Distress
Principles of Therapy
DISEASE STATES
RESPIRATORY DISTRESS SYNDROME
CLINICAL FEATURES OF RDS
Early RDS
Progressive RDS
Late RDS
Hyaline Membrane Disease
THERAPY FOR RDS
PIE
PIE Pathology
PIE Histology
Pneumothorax/PIE
Pneumothorax
Pneumopericardium
TRANSIENT TACHYPNEA OF THE NEWBORN
Wet Lung
MECONIUM ASPIRATION SYNDROME
Meconium Aspiration
PERSISTENT PULMONARY HYPERTENSION
PPHN
CONGENITAL PNEUMONIA
GBS Pneumonia
CONGENITAL MALFORMATIONS
CCAM
Lobar Emphysema
Diaphragmatic Hernia
Chylothorax
Phrenic Nerve Paralysis
ACQUIRED DISEASES
Early BPD
Progressive BPD
Late BPD
APNEA
Babies at Risk for Apnea
Anticipation and Detection
Treatment
Treatment
CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS
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Первый слайд презентации: CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS

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Слайд 2: OBJECTIVES

Review 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 distress Review of common neonatal disease states.

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Слайд 3: STAGES 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 acini Saccular - 24 - 36 weeks; development of gas-exchange units Alveolar - 36 weeks and up; expansion of surface area

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Слайд 4: Pseudoglandular 6-16 weeks

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Слайд 5: Canalicular Phase 16-24 weeks

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Слайд 6: Saccular Phase 24-34 weeks

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Слайд 7: PHYSIOLOGIC 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 maturity L/S Ratio Flourescence Polarization - FLM Many other factors influence lung maturation

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Слайд 8

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Слайд 9

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Слайд 10: Maturational Factors

Stimulation Glucorticoids, ACTH Thyroid Hormones, TRF EGF Heroin Aminophyline,cAMP Interferon Estrogens Inhibition Diabetes (insulin, hyperglycemia, butyric acid) Testosterone TGF-B Barbiturates Prolactin

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Слайд 11: FETAL CIRCULATION

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Слайд 12: TRANSITION 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

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Слайд 13: MECHANICS OF BREATHING

Respiratory Control Center...CNS Metabolic Needs Negative pressure breathing Compliance and Resistance Inspiratory Muscles Rib Cage “Compliability becomes a liability”

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Слайд 14: Signs of Respiratory Distress

Tachypnea Intercostal retractions Nasal Flaring Grunting Cyanosis

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Слайд 15: When 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

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Слайд 16: Causes 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

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Слайд 17: Infants 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

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Слайд 18: Evaluation 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, CBC Sepsis work-up

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Слайд 19: Principles 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

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Слайд 20: DISEASE STATES

Respiratory Distress Syndrome Transient Tachypnea of the Newborn Meconium Aspiration Syndrome Persistent Hypertension of the Newborn Congenital Pneumonia Congenital Malformations Acquired Processes

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Слайд 21: RESPIRATORY DISTRESS SYNDROME

Surfactant Deficiency Tidal Volume Ventilation Pulmonary Injury Sequence

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Слайд 22: CLINICAL FEATURES OF RDS

Tachypnea/Apnea Dyspnea Grunting/Flaring Hypoxemia Radiographic Features Pulmonary Function Abnormalities

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Слайд 23: Early RDS

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Слайд 24: Progressive RDS

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Слайд 25: Late RDS

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Слайд 26: Hyaline Membrane Disease

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Слайд 27: THERAPY FOR RDS

Oxygen - maintain PaO2 > 50 torr Nasal CPAP Intermittent Mandatory Ventilation Surfactant Replacement High Frequency Ventilation Intercurrent Therapies

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Слайд 28: PIE

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Слайд 29: PIE Pathology

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Слайд 30: PIE Histology

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Слайд 31: Pneumothorax/PIE

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Слайд 32: Pneumothorax

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Слайд 33: Pneumopericardium

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Слайд 34: TRANSIENT TACHYPNEA OF THE NEWBORN

Delayed Fluid Resorption Hard to differentiate early on from RDS both clinicaly and radiographicaly especially in the premature infant Initial therapy similar to RDS, but hospital course is quite different

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Слайд 35: Wet Lung

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Слайд 36: MECONIUM ASPIRATION SYNDROME

Chemical Pneumonitis Surfactant Inactivation Potential for Infection Potential for Pulmonary Hypertension Management varies on severity

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Слайд 37: Meconium Aspiration

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Слайд 38: PERSISTENT 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

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Слайд 39: PPHN

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Слайд 40: CONGENITAL PNEUMONIA

Infectious; primarily GBS Amniotic Fluid aspiration Viral etiology Surfactant inactivation

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Слайд 41: GBS Pneumonia

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Слайд 42: CONGENITAL MALFORMATIONS

Choanal Atresia Tracheal Atresia/stenosis Chest Mass Diaphragmatic hernia CCAM Sequestration Lobar emphysema

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Слайд 43: CCAM

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Слайд 44: Lobar Emphysema

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Слайд 45: Diaphragmatic Hernia

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Слайд 46: Chylothorax

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Слайд 47: Phrenic Nerve Paralysis

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Слайд 48: ACQUIRED DISEASES

Infections Bronchopulmonary Dysplasia Sub-glottic stenosis Apnea of Prematurity

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Слайд 49: Early BPD

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Слайд 50: Progressive BPD

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Слайд 51: Late BPD

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Слайд 52: APNEA

Definition: cessation of breathing for longer than a 15 second period or for a shorter time if there is bradycardia or cyanosis

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Слайд 53: Babies 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

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Слайд 54: Anticipation and Detection

Place at-risk infants on cardio-respiratory monitor Low heart rate limit (80-100) Respiratory alarm (15-20 seconds)

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Слайд 55: Treatment

Determine cause: x-ray blood sugar body and environmental temperature hematocrit sepsis work up electrolytes cardiac work up r/o seizure

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Слайд 56: Treatment

CPAP Theophylline/Caffeine therapy Mechanical ventilation Apnea monitor

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Последний слайд презентации: CONGENITAL AND ACQUIRED RESPIRATORY DISORDERS IN INFANTS

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