Pulmonary diseases in the newborn period.ppt

pulmonarydiseasesinthenewbornperiod,oladidriksaugstaddepartmentofpediatricsthenationalhospital,universityofoslo,studentlectureat9thsemestermedicalfaculty,universityofoslo,pulmonarydiseasesinthenewbornperiod,1/13havebreathingproblemsatbirth(7.5%)1/6withbreathingproblemshaveinfectionsga0,40infectionwork-up(r-lshuntcalculation),pulmonarydiseasesinthenewbornperiod,respiratorydistresssyndrome(rds)surfactantdeficiencyandimmaturesurfactantlungecompliancereducedto10-20%reducedlungperfusion(50-60%)increasedr-lshunting(30-60%)reducedlungvolumincreasedworkofbreathing,propertiesofsurfactant,rapidadsorptionefficientspreadinglowersurfacetension,alveoliasbubbles,surfacetension,air,liquid,surface,polarh2omoleculesattract,laplaceslaw,where:p=pressuret=surfacetensionr=radiusofthebubble,p=2t,r,p=2x1=0.2,10,p=2x1=0.4,5,10,5,connectedbubbles,phospholipidspolarheadsinsolubletailsnegativetails,monolayerhypophase,surfactantaction,alveolargas,composition,1,2,3,4,5,6,7,dppc-dipalmitoylphosphatidylcholine50%*reducesalveolarsurfacetension,pg-phosphatidylglycerol7%*promotesthespreadingofsurfactantthroughoutthelungs,apoproteinsorsurfactantspecificproteins2%*,1.serumproteins8%*2.otherlipids5%*3.otherphospholipids3%*4.phosphatidylinositol2%*5.sphingomyelin2%*6.phosphatidylethanolamine4%*7.unsaturatedphosphatidylcholine17%*bymolecularweight,dppc,dipalmitoylphosphatidylcholine,watersoluble,insolublefattyacidchains,surfactantproteins,spahostdefence,tubularmyelinspdimmuneactivityspb&spcspreadingandadsorption,stimulusforrelease,gasenteringlungsalveolarstretch(inspiration)adrenergicinnervationprostaglandins,productionandrelease,typellcell,alveolarairspacehypophasetypeicellbasallaminacapillaryendothelium,monolayerhypophase,alveolargas,lmvb,golgi,rer,dmvb,typeicell,tubularmyelin,lamellarbodies,surfactantcycle,typeiicell,lossfromlungs,cholinefattyacids,lysosomes,mvb,degradation,endoplasmicreticulum,golgi,synthesisandsecretion,lamellarbodies,recycling,precursors,reuptake,catabolicanabolic,alveolartransformations,alveolus,otherlosses-macrophages-airways-otherlungcells,surfactanttherapy,instillationofsurfactantintothelungssyntheticsurfactant(almostnotinuseanymore)naturalsurfactant(porcine,bovine)prophylacticvsrescue,beforesurfactant1hraftersurfactant,survivalwithout,withone,andmultipledosesofsurfactant,survival,without1dosemultipledosesofsurfactant,medianduration40%oxygen,withoutonedosemultipledosessurfactant,days,pulmonarydiseasesinthenewbornperiod,respiratorydistresssyndrome0.5(-1.0)%ofallbirthsincreaseswithdecreasinggestationalage(ga60breathsperminexpiratorygruntingretractions(sternal,inter-andsubcostal)cyanosisinroomairduration24hrs,pulmonarydiseasesinthenewbornperiod,thenaturalcourseofrespiratorydistresssyndrome:maximumafter24-36hrsspontaneousbreathinginroomairinuncomplicatedcasesdeteriorationat3-5daysduetoanopenductusarteriosus,pulmonarydiseasesinthenewbornperiod,respiratorydistresssyndromedifferentialspneumonia/sepsistransitorictachypnoecongenitalcardiacmalformationpneumothorax/airleakprimarypulmonaryhypertension,pulmonarydiseasesinthenewbornperiod,respiratorydistresssyndrome-therapyreduceprematurityrateantenatalsteroids24-168hrsbeforebirthgivesa50%reductionintheincidensand40%reductioninmortalitysurfactanttherapyreducesmortality/chroniclungdisease30-40%generaltherapy:oxygen,respirator,fluid-electrolytes,nutrition,antibiotics,pulmonarydiseasesinthenewbornperiod,classificationofneonatalpneumoniaecongenitalearlyonset(48hrs),pulmonarydiseasesinthenewbornperiod,pneumonianeonatalpneumoniamaybeanisolatedfocalinfectionbutusuallyisapartofageneralinfection-sepsis.incidenceofbacterialpneumonia:3,7per1000liveborn(oxford),neonatalpneumonia,acquiredbythefetus(ascending,transplacentalpassage,pprom,throughintactmembranes?grbstreptococci(sepsisdevelopsin1%ofcolonizedfrommaternalgenitaltract(1-4/1000(usa).intrapartumantibioticsasprophylaxisofgroupbposmothersrecommendedaap1992-1997.incidencemorethanhalvedfrom93-98,pulmonarydiseasesinthenewbornperiod,pneumonia-symptomsrespiratorydistress(tachypnoe,apnoe,cyanosis,retractions)vomiting,hypotensionpoorweigthgain,icterus,hypo/hyperthermiapulmonaryhypertensjonandhypoxemiar-lshuntingreducedlungfunction(respiratorpatients)increasedtrachealaspirate,pulmonarydiseasesinthenewbornperiod,congenitalpneumoniarare-highmortalitysecondarytoascendinginfections(afterprom)throughintactmembranes?chorioamnionitisintrauterineasfyxia,pulmonarydiseasesinthenewbornperiod,earlyonsetpneumonia1,8per1000livenewborngrbstreptococci(70%inuk)h.influenzas.pneumoniaelisteriamonocytogenesgramnegativeenterobakterier(fungi)virus(rs,adeno,cmv,coxsacki),pulmonarydiseasesinthenewbornperiod,lateonsetpneumoniausualinpretermonartificialventilation10-35%ofallonventilatorgrampositivegramnegativestaphareusenterobakterenterocokkere.coligrbstreptokokkerklebsiellafungicandida,pulmonarydiseasesinthenewbornperiod,pneumonia-otheragentsureaplasmaurealyticum(invagina,-pneumoniaandlungfibrosis)rsvirus(epidemics),moreseriousifchroniclungdiseasechlamydia(earlyonset-maycrossintactmembranes).interminfantstypicaldebut3-4weeksofage.slowonset.treatedwitherythromycin,pulmonarydiseasesinthenewbornperiod,pneumonia-therapyantibioticsgeneralsupportivetherapy,pulmonarydiseasesinthenewbornperiod,transitorictachypn(wetlung)amildrespiratorydisturbancyinnewborninfantsoccasionallyseenafterbirthunknownetiologyincreasedlungwaterdurationmax5-6days,pulmonarydiseasesinthenewbornperiod,transitorictachypnoeboysgirlsga32-42weeks(average38weeks)bw(average)3200grresprateat6hrsage:80perminoxygenin60%ofcasesincidens0.37%atlemoenstudentthesisoslo1990,pulmonarydiseasesinthenewbornperiod,transitorictachypnoeclinicdifferentialdiagnosistachypnoerdscyanosisinroomairpneumoniagruntingmekoniumaspirationretractionscongheartmalformationduration3hrsoxygenneednotincreasing,pulmonarydiseasesinthenewbornperiod,transitorytachypnoea-xrayfindingsxray:perihilarstreaking,patchyinfiltratesreducedairand/orreticularpatterntherapyobservationinincubatoroxygenifneededantibioticsuntilinfectionisexcluded,pulmonarydiseasesinthenewbornperiod,airleakspneumothorax/mediastinum1%ofallnewbornbutonly1/10aresymptomaticincreasedriskinpositivepressureventilation,pulmonarydiseasesinthenewbornperiod,primarypulmonaryhypertensionseverehypoxemiar-lshuntingnormalheartartificialventilationnoinhalation,pulmonarydiseasesinthenewbornperiod,meconiumaspirationsyndrome(mas)1:10-1:5meconiumstainedamnioticfluid1:1000-1:5000birthdevelopmasterm-posttermchildreninhalationbeforeandduringbirthpluggingtheairways(acuteeffects)inflammation(latereffects)inactivatessurfactant,pulmonarydiseasesinthenewbornperiod,symptomsinmeconiumaspirationsyndrom(mas)respiratorydistressinfectionpulmonaryhypertensionpulmonaryfailureandhypoxia/hie,pulmona