Medical Archive

C122.1 Transition to Pulmonary Respiration

C122.2 Apnea

C122.3 Respiratory Distress Syndrome

Pathophysiology

Surfactant

28??? ?? ??, 34?? ??? ?? ??. Phosphatidylcholine(lecithine)? ? ??.

Risk factors

• Male
• Prematurity
• Cesarean delivery
  • d/t lack of stress-induced steroids
• Maternal diabetes
  • Insulin antagonize cortisol & block the maturation of sphingomyelin ? decreases surfactant production
• Perinatal asphyxia

Protective factors

Intrauterine growth restriction
Maternal hypertension
Chronic intrauterine stress from prolonged rupture of membranes

Diagnosis

• L/S ratio <2
  • ????? 36? ????? L/S ratio >2.0)
• Foam stability test (=Shake test)
  • ??? ??? ??? 95% ???? ??? 15? ?? ?? ? 15? ? band? ??? ?? ??.
• Stable microbubble rating test

Differential diagnosis
GBS pneumonia

Treatment

• Umbilical artery catheterization: ??? ABGA ??? ??
• Respiration
  1. O2 supply
     • target PaO2 55~70mmHg (??? O2? ?? ROP, BPD ?? ??)
  2. CPAP
     • Indication: FiO2 0.6?? PaO2 50mmHg? ?? ? ? ? ??.
  3. Intubation, MV
     • Indication: ??? pH <7.2, PaO2 <50, PaCO2 >60, ??? ???
• Artificial surfactant (transtracheal? ??)
  • ??? ??, ?????? MAP ??, ? compliance ??, ?? ??? ?? ??, air leak ??
  • ???? ??? ??
• Fluid
  • D10W – ? 48hr or ?? ????

Complication

• ?? ???
  • Barotrauma? ?? air leak – ??, ????
  • PDA; hypoxemia increases the risk
  • ??? ???
• Retinopathy of prematurity (ROP)
  • ????? ??. Supplemental oxygen increases the risk for free radical injury.
  • ?? 4-8?? ?? ? laser photocoagulation
• Bronchopulmonary dysplasia (BPD)
  • ????? ?? ??? ??? ?? ???? ? ??? ??? ??. X-ray? ????? ????? ??.
  • ??: ??? ?? ??, ?? ??, ?? ?? & ???, Dexamethasone
  • ?? ? ?? ??? ? ??? ???? ???? ?? ??.

C122.4 Bronchopulmonary Dysplasia

• ??<32?: GA36? or ?? ???? O2 ??? ??
• ??>32?: ?? 8? or ?? ???? O2 ??? ??

RDS? ?????? ?? ?, ?? ??? ???? ???? ???.

Treatment

• ???? & furosemide
  • ???? ???? ????? ???? ??? ????? ???? ????.
• ??? ?? ??
• Dexamthasone
  • ?? ?? ??? ???? BPD ??? ???? ? ??? ?? ??? ??? ??.
  • ??? ?? ??? risk ???? (e.g. ???, ???, ??? ??/??, ??? ????, ???, ??? ?? ?? ??)

Prognosis

• 1-2? ? ???? ?? RHF, ??? ???????? ??.

C122.5 Patent Ductus Arteriosus

C122.6 Transient Tachypnea of the Newborn

Pathophysiology

?? ??? ?? ??

Risk factors

Cesarean delivery, prematurity, maternal diabetes

Clinical findings

• Tachypnea, increased work of breathing
• “?? 1-2??? ???? ???? ??? ?? ?? ?? ?? 80? ???”
• Clear breath sounds
• Chest X-ray
  • Hyperinflation
  • Increased pulmonary vascular markings or fluid in the fissures
  • Parallel rib, flat diaphragm

Managment

• Supportive care (eg, oxygen, nutrition)
• Self-resolution in 1-3 days

C122.7 Aspiration of Foreign Material (Fetal Aspiration Syndrome, Aspiration Pneumonia)

C122.8 Meconium Aspiration

• Pathophysiology
  • Fetal hypoxia -> intestinal ischemia -> increased bowel movement -> meconium
• Common cause of persistent pulmonary hypertension of the newborn because it can lead to pulmonary vasoconstriction, which can lead to decreased pulmonary blood flow that leads to a vicious cycle leading to increased right to left shunting and increased PVR
• To help combat this pulmonary vasoconstriction, the infant should be treated with supplemental oxygen (increased/improved oxygenation leads to dilation of lung capillaries and decreased pulmonary vascular resistance)

Clinical manifestations

• ??? ??? ?? ? ??? ??
• ?? ??? ????? ???, ????, ???
• ?? ??? ?? ???? ??? ??
• ?? ??? ?? check valve type? ?? ?? ?? -> ???? ???
• Chest X-ray: ??? ???? ??, ???, ???? ???

Treatment

• ? ?? ?? ????, ???? ???? ?? ??
• ?? ??? ?? ??(-)
  • ??? ???? ?? ??. ?? ?? ????.
• ?? ??? ?? ??(+) (eg, ???? ??, ??, ?? ?? ??)
  • ???? (PPV)
  • ??? ? ?? ?? (??? ? ????? ??? ???? ??)
  • ?? ??? ?? ?? ?? – PPV ? ???? ? ??? ???? ??.
• Mechanical ventilation
  • ??? ?? – ?? ??? ?? ?? ?? ??? ??
  • ??? ?? ?? ?? – ?????? ??? ?? ??? ?? ??? ??? ??.
• Surfactant ?? – ??? ?? 2???? ??????.
• ??? ?????: iNO ?? ??
• ECMO

C122.9 Persistent Pulmonary Hypertension

Treatment

• Oxygen
• Acidosis, Hypercapnia ??
• Mechanical ventilation
• Nitric oxide(iNO) ?? ?? – ??? ???
• ??? ?? (HFV) ??, ECMO

C122.10 Diaphragmatic Hernia

Pulmonary hypoplasia & hypertension
Respiratory distress within hours of birth
Absent breath sounds ipsilateral to defect
Concave abdomen; baarrel-shaped chest

Management

• Endotracheal intubation
• Gastric decompensation (eg, nasogastric tube)
• Bag-and-mask ventilation is contraindicated b/c it pumps air into the GI tract, leading to further lung compression.
• Surgical correction

C122.11 Foramen of Morgagni Hernia

C122.12 Paraesophageal Hernia

C122.13 Eventration

C122.14 Extrapulmonary air leak: Pneumothorax, Pneumomediastinum, Pulmonary Interstitial Emphysema, Pneumopericardium

Etiology and pathophysiology

Risk factors: asthma exacerbation, respiratory infection, tall/thin/adolescent boy

Clinical manifestations

Pneumomediastinum

Acute chest pain, shortness of breath, cough
Subcutaneous emphysema
Hamman sign (crungching sound over heart)

Tension pneumothorax

Diagnosis

• Transillumination
  • Increased brightness on the affected side.

Treatment

Spontaneous pneumothorax

Rest, pain control, and avoidance of maneuvers that increase pulmonary pressure (eg, Valsalva).
Symptoms typically resolve within days to weeks.

Tension pneumothorax

• Emergency needle thoracostomy to evacuate the intrapleural air.
• nCPAP
  • Reduce mean airway pressure
  • Discontinuing will worsen atelectasis and ditress

C122.15 Pulmonary Hemorrhage