برکت عمر در کار نیک است حضرت علی ( ع ) respiratory distress in newborn...
TRANSCRIPT
برکت عمر در کار نیک برکت عمر در کار نیک استاست
حضرت علی )ع(حضرت علی )ع(
Respiratory distress in newborn
DrMahmood Noori-Shadkam
Neonatologist
Neonatal Respiratory Distress Signs and symptoms
bull Tachypnea (RR gt 60min)
bull Nasal flaring
bull Retraction
bull Grunting
bull Delayed or decreased air entry
bull +- Cyanosis
bull +- Desaturation
score 0 1 2
Respiratory Rate (breathsmin)
60 60 ndash 80 gt80 or apnea episode
cyanosis None In room air In40oxygen
retraction
Retraction None Mild Moderate to severe
Grunting None Audible with a stethoscope
Audible without a stethoscope
Crying clear decreased Barely audible
Neonatal Respiratory Distress Etiologies
Pulmonarycauses
- RDS- Pneumonia- TTN- MAS- Other aspiration
syndrome- Air leak syndrome- Lung hemorrhage- Lung hypoplasia- Congenital
malformations
Systemiccauses
- Infections- Metabolic causes- Temperature- Anemia
Polycythemia- Congenital heart
disease- Pulmonary
hypertension- Neuromuscular
disorder
Anatomic causes
- Upper airway obstruction
- Airway malformation
- Space occupying lesion
- Rib cage anomalies
- Phrenic nerve injury
diagnosis Hx Phx and LF
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Respiratory distress in newborn
DrMahmood Noori-Shadkam
Neonatologist
Neonatal Respiratory Distress Signs and symptoms
bull Tachypnea (RR gt 60min)
bull Nasal flaring
bull Retraction
bull Grunting
bull Delayed or decreased air entry
bull +- Cyanosis
bull +- Desaturation
score 0 1 2
Respiratory Rate (breathsmin)
60 60 ndash 80 gt80 or apnea episode
cyanosis None In room air In40oxygen
retraction
Retraction None Mild Moderate to severe
Grunting None Audible with a stethoscope
Audible without a stethoscope
Crying clear decreased Barely audible
Neonatal Respiratory Distress Etiologies
Pulmonarycauses
- RDS- Pneumonia- TTN- MAS- Other aspiration
syndrome- Air leak syndrome- Lung hemorrhage- Lung hypoplasia- Congenital
malformations
Systemiccauses
- Infections- Metabolic causes- Temperature- Anemia
Polycythemia- Congenital heart
disease- Pulmonary
hypertension- Neuromuscular
disorder
Anatomic causes
- Upper airway obstruction
- Airway malformation
- Space occupying lesion
- Rib cage anomalies
- Phrenic nerve injury
diagnosis Hx Phx and LF
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Neonatal Respiratory Distress Signs and symptoms
bull Tachypnea (RR gt 60min)
bull Nasal flaring
bull Retraction
bull Grunting
bull Delayed or decreased air entry
bull +- Cyanosis
bull +- Desaturation
score 0 1 2
Respiratory Rate (breathsmin)
60 60 ndash 80 gt80 or apnea episode
cyanosis None In room air In40oxygen
retraction
Retraction None Mild Moderate to severe
Grunting None Audible with a stethoscope
Audible without a stethoscope
Crying clear decreased Barely audible
Neonatal Respiratory Distress Etiologies
Pulmonarycauses
- RDS- Pneumonia- TTN- MAS- Other aspiration
syndrome- Air leak syndrome- Lung hemorrhage- Lung hypoplasia- Congenital
malformations
Systemiccauses
- Infections- Metabolic causes- Temperature- Anemia
Polycythemia- Congenital heart
disease- Pulmonary
hypertension- Neuromuscular
disorder
Anatomic causes
- Upper airway obstruction
- Airway malformation
- Space occupying lesion
- Rib cage anomalies
- Phrenic nerve injury
diagnosis Hx Phx and LF
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
score 0 1 2
Respiratory Rate (breathsmin)
60 60 ndash 80 gt80 or apnea episode
cyanosis None In room air In40oxygen
retraction
Retraction None Mild Moderate to severe
Grunting None Audible with a stethoscope
Audible without a stethoscope
Crying clear decreased Barely audible
Neonatal Respiratory Distress Etiologies
Pulmonarycauses
- RDS- Pneumonia- TTN- MAS- Other aspiration
syndrome- Air leak syndrome- Lung hemorrhage- Lung hypoplasia- Congenital
malformations
Systemiccauses
- Infections- Metabolic causes- Temperature- Anemia
Polycythemia- Congenital heart
disease- Pulmonary
hypertension- Neuromuscular
disorder
Anatomic causes
- Upper airway obstruction
- Airway malformation
- Space occupying lesion
- Rib cage anomalies
- Phrenic nerve injury
diagnosis Hx Phx and LF
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Neonatal Respiratory Distress Etiologies
Pulmonarycauses
- RDS- Pneumonia- TTN- MAS- Other aspiration
syndrome- Air leak syndrome- Lung hemorrhage- Lung hypoplasia- Congenital
malformations
Systemiccauses
- Infections- Metabolic causes- Temperature- Anemia
Polycythemia- Congenital heart
disease- Pulmonary
hypertension- Neuromuscular
disorder
Anatomic causes
- Upper airway obstruction
- Airway malformation
- Space occupying lesion
- Rib cage anomalies
- Phrenic nerve injury
diagnosis Hx Phx and LF
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Neonatal Respiratory Distress
AlgorithmRespiratory
Distress(tachypnoea retractions grunt)
Preterm Term
lt 6hrs old gt 6hrs old lt 6hrs old gt 6hrs old
HMD (RDS)PneumoniaLung anomaly
PneumoniaCHDPul Hemorrhage
TTNMASPPHNAsphyxiaLung anomalyAir leak
PneumoniaCHD
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Respiratory Distress Syndrome
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Introduction
bull The most frequent cause of respiratory distress in premature infants
bull 60-80 of lt28wk GA 15-30 of 32-36wk GA 5 of 37wk-term
bull Classic presentation of grunting retractions increasing O2 requirement reticulogranular pattern and air bronchograms on CXR and onset lt 6hrs age
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
PathogenesisPrematurity Prenatal asphyxia
Reduced surfactant synthesis storage release
Increased alveolar surface tension
Progressive atelectasis Diffusion
Uneven VQ Hypoventilation gradient
Hypoxemia CO2 retention
Acidosis
Pulmonary vasoconstriction Hypoperfusion
Capillary endothelial damage
Plasma leak Fibrin
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Pathology
bull Gross Lung firm red liverlikebull Microscopic Diffuse atelectasis pink
membrane lining alveoli amp alveolar ducts Pulmonary arterioles with thick muscular coat small lumen Distended lymphatics
bull Electron microscopic Damage loss of alveolar epithelial cells disappearance of lamellar inclusion bodies swelling of capillary endothelial cells
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Pathology (contd)bull Biophysical
ndash Deficient absent surfactantndash Abnormal pressure volume curve
Normal
Vol
RDS
Pressurendash Severely reduced arterial bed with blockage near
pulmonary arterioles
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Pathology (contd)
bull Biochemical ndash Diminished surface-active phospholipid
(phosphatidylcholine)ndash Diminished apoprotein content ( SP-A B C
D)
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Pathophysiology
bull Reduced lung compliance (15th -110th)
bull Poor lung perfusion ( 50-60 not perfused) decreased capillary blood flow
bull R--gt L shunting ( 30-60 )
bull Alveolar ventilation decreased
bull Lung volume reduced
bull Increased work of breathing
bull Hypoxemia hypercapnia acidosis
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Physiologic abnormalities
bull Lung compliance 10-20 of norm
bull Atelectasishellipareas not ventilated
bull Areas not perfused
bull Decrease alveolar ventilation
bull Reduce lung volume
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Risk factor
PrematurityAcidosisHypoxiaHypercapniaHypothermiaCSAsphyxia and stressMaleFamilialDM mother
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
signs
bull tachypnea
bull retraction
bull grunting
bull Nasal flaring
bull apneic episode
bull cyanosis
bull extremities puffy or swollen
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Chest X-ray
bull Ground glass appearance
bull Reticulogranular
bull With air bronchograms
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Treatment
bull Surfactant ndash Preventionndash rescue
bull Supportivendash Thermalndash Fluid and nutritionndash oxygen
bull Mechanical ventilation
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
complications
bull Pneumothorax
bull PDA
bull Infection
bull Line problems
bull ROP
bull Chronic lung disease
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Meconium aspiration
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
M A S
مكونيوم به آغشته آمنيوتيك مايع آسپيريشنمنجر است آسپيريشن ممكن سندرم به
قابل مورتاليتي و مربيديتي كه گردد مكونيومبا زايمان مديريت بنابراين دارد اي مالحظه
پيشگيري براي مكونيوم به آغشته آمنيوتيك مايعدارد زيادي اهميت آسپيراسيون از
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
مكونيوم تركيب
bull Cellular particle
bull Bile pigment
bull Lango
bull Mocus
bull Vernix
bull Pancreatic secretion
bull One gr meconium = one mg Billirubin
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Incidence
مكونيوم متوسط ( 20تا 8دفع زايمانها كل درصد12(
در آسپيريشن ها 4مكونيوم مكونيومي درصدشود می دیده
دارد عمدتاPost maturity و SGA وجود
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
فيزيوپاتولوژي
دفع علت و آن كامل فيزيوپاتولوژي چه اگرپديده اين اما نشده شناخته كامال مكونيوم
هفته از قبل شود 34بندرت مي ديده
بر دال عالمتي ها كرده دفع مكونيوم از بسياريعده و اند نداشته دپرسيون يا تنفسي مشكل
اند كرده دفع مكونيوم آسفيكسي بعلت هم اي
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
مكونيوم دفع علت
عصبي (1 تكامل فيزيولوژيك پديدهاي روده پريستالتيسم برقراري و پاراسمپاتيك
و ( ها ترم در شيوع جنين تكامل به پاسخ درنارس ) نوزادان در بودن نادر
افزايش (2 باعث تواند مي هيپوكسين تو كاهش و ها روده پريستالتيسم
مايع ( با نوزادان اكثر البته شود اسفنكترآنالندارند ) اسيدوز و پايين آپگار مكونيال آمنيوتيك
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Alarm of MAS
1- Thick meconium
2-Fetal tachycardia
3- lack of increase heart rate during intra partum monitoring
4-Low cord PH
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
پاتوژنز
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
MAS complicationbull Partial obstruction
o
bull complete obstruction
bull Surfactant destruction
bull Chemical pneumonitis ampBacterial pneumonia
bull Asphyxia
bull PPHN
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Clinical sign
bull Classic sign Post maturity nail skin umblical cord are heavily stained with a yellowish pigment
bull Early sign (resp Distress) grunting amp cyanosis amp nasal flaring amp retraction amp marked tachypnea
bull Characteristic sign chest overinflation and Rale
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Radiography of MAS
bull Coarse nodular irregular pulmonary densities with areas of diminished aeration or consolidation
bull Hyperinflation of the chest bull Atelectasis bull Flattening of diaphragmbull Cardiomegally(manifestation of the underlying prenatal
hypoxia)
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
ChestXRay
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Meconium Aspiration Syndrome
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
ABG in MAS
1 تنفسي آلكالوز يك از شواهدي
2 هيپوكسي3 اسيدوز و تنفسي اسيدوز شديد مواقع در
متابوليك
4 چپ به راست شنت از شواهدي
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Management of MAS
بردیسترس دليل آمنيوتيك مايع در مكونيوم حضور- پی و جنین قلب ضربان وچنانچه نيست جنینی
است خوب آگهي پيش باشد طبيعي ناف بند اچ
باضافه آمنيوتيك مايع با مكونيوم شدن آميختهيك دهنده نويد مناسب نا قلب ضربان
باشد مي آسفيكسي
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Intra partum
روي در آمد بيرون سر وقتي مواقع گونه اين دربا فارنكس و وبيني دهان ساكشن بايد پرينه
نمره اينكه ( 14يا 12كاتتر از قبل شود انجامكند ) تنفس بخواهد نوزاد و بيايد بيرون توراكس
شده متولد نوزاد ارزيابي اولين vigorous or depress
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Criteria of vigorous
1) Heart rate greater than 100 beat min
2) Good muscle tone
3) regular breathing
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Guidelines of the baby exposed to meconium
Vigorous
Immediate tracheal suction
Meconium No meconium
reintubate and suction
PPV and suction again later
Clear secretions and meconiuminitial resuscitation steps
HRgt100 HRlt100
No Yes
The American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee management guidelines of the baby exposed to meconium
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Meconium
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
ET suction indication
bull Only in non vigorous baby- depressed respirations
- decreased muscle tone - heart rate lt 100 beats per minute
bull Pharyngeal suctioning of an infant before delivery of the shouldersbull Removal of meconium from hypopharynx and larynx by large-bore catheterbull Meconium aspirator attached to wall suction bull Endotracheal intubation for removal of meconium in the lower airway
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Management1 Prevention
bull Monitor fetal status bull Amnioinfusionbull Suctioning +- intubation and immediate
suctioning bull Avoid harmful techniques
2 Interventionbull Optimal thermal environment amp minimal handlingbull Respiratory care Oxygen therapy amp ECMObull Keep stable VSbull Surfactant therapy
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Steroid therapy for meconium aspiration syndrome in newborn infants
bull The Cochrane Database of Systematic Reviews 2007 Issue 3 The Cochrane Library (ISSN 1464-780X
bull Conclusions
At present there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome
(no significant reduction in mortality duration of hospital stay Duration of mechanical ventilation incidence of air leakincrease in duration of oxygen therapy was seen with the use of steroids)
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Role of antibiotics in meconium aspiration syndromebull Ann Trop Paediatr 2007 Jun27(2)107-13 bull Basu S Kumar A Bhatia BDbull Division of Neonatology Department of Paediatrics Institute of
Medical Sciences Banaras Hindu University Varanasi India drsriparnabasurediffmailcom
bull CONCLUSION
Routine antibiotic therapy is not necessary for managing MAS No significant difference
ndash period of oxygen dependency (58 vs 59 days)
ndash day of starting feeds (40 vs 42)
ndash day of achievement of full feeds (94 vs 93)
ndash clearance of chest radiograph (117 vs 129 days)
ndash duration of hospital stay (137 vs 135 days)
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Surfactant for meconium aspiration syndrome in full termnear term infants
bull Cochrane Database Syst Rev 2007 Jul 18(3)CD002054 bull El Shahed A Dargaville P Ohlsson A Soll R
bull CONCLUSIONS In infants with MAS surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO The relative efficacy of surfactant therapy compared to or in conjunction with other approaches to treatment including inhaled nitric oxide liquid ventilation surfactant lavage and high frequency ventilation remains to be tested
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
PPHN prevention1 Avoid vasoconstriction
bull Acidosisbull Hypoxiabull Metabolic disturbance - Hypocalcemia
- Hypercalcemia- Hyperglycemia- Hypoglycemia
2 Prevent right to left shunt
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Infections
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Infections
bull Pneumonia amp Sepsis have various manifestations including typical signs of distress as well as temperature instability
bull Common pathogen- Group B Streptococcus Staph aureus Streptococcus PneumoniaGm neg rods
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Infections con
bull Risk factors- prolonged rupture of membranes prematurityamp maternal fever
bull CXR- bilateral infiltrates suggesting in utero infection
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Congenital pneumonia
bull Sepsis risk factorsndash PROMndash Prematurityndash Maternal fever discharge abdominal pain
leukocytosisndash Colonization with GBS
bull Same signs of RDS
bull X-ray
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Transient Tachypnea of Newborn
bull Most common cause of respiratory distress
bull Residual fluid in fetal lung tissuesbull Risk factors- maternal asthma c- section
male sex macrosomia maternal diabetes
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
TTN
bull Tachypnea immediately after birth or within two hours with other predictable signs of respiratory distress
bull Symptoms can last few hours to two days
bull Chest radiography shows diffuse parenchymal infiltrates a ldquo wet silhouetterdquo around heart or intralobar fluid accumulation
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
X-ray
Fluid in the fissureFluid in the fissure
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Transient tachypnea of newborn
bull Term
bull Cesarian delivery
bull Usually tachypnea without O2 requirment
bull Resolve in 48-72 houres
bull Lung fluid
bull X-ray
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Other causes-
bull Congenital malformations-Pulmonary hypoplasia congenital emphysema esophageal atresia amp diaphragmatic hernia
bull Neurological causes- hydrocephalus amp intracranial hemorrhage
bull Metabolic derangements-hypoglycemia hypocalcemia polycythemia
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Congenital Heart disease
Cyanotic Heart Disease-
bull Tetralogy of fallot- ( VSD Pulmonary stenosis overriding aorta RVH)
bull Tricuspid atresia
bull Transposition of great vessel
bull Total anomalous pul venous return
bull Truncus arteriosus
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
Hyperoxia Test
bull Obtain ABGndashgt Then place the patient on 100 O2 for 10 minutes then repeat ABG If the cyanosis is pulmonary the PaO2 should be increased by 30 mm of Hg If the cause is cardiac there will be minimal improvement in PaO2
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-
با تشکراز همکاران
گرامی
- Slide 1
- Slide 2
- Respiratory distress in newborn
- Neonatal Respiratory Distress Signs and symptoms
- Slide 5
- Neonatal Respiratory Distress Etiologies
- Neonatal Respiratory Distress Algorithm
- Slide 8
- Introduction
- Pathogenesis
- Pathology
- Pathology (contd)
- Slide 13
- Slide 14
- Pathophysiology
- Physiologic abnormalities
- Risk factor
- signs
- Chest X-ray
- Slide 20
- Slide 21
- Treatment
- complications
- Slide 24
- M A S
- تركيب مكونيوم
- Incidence
- فيزيوپاتولوژي
- علت دفع مكونيوم
- Alarm of MAS
- پاتوژنز
- MAS complication
- Clinical sign
- Radiography of MAS
- Slide 35
- Slide 36
- Meconium Aspiration Syndrome
- Slide 38
- ABG in MAS
- Management of MAS
- Intra partum
- Criteria of vigorous
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Infections
- Infections con
- Congenital pneumonia
- Slide 57
- Transient Tachypnea of Newborn
- TTN
- X-ray
- Transient tachypnea of newborn
- Other causes-
- Congenital Heart disease
- Hyperoxia Test
- Slide 65
-