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11- Acute Resp Failure in newborns - diff. diag. (DDx (Persisent pulmonary…
11- Acute Resp Failure in newborns - diff. diag.
most common problem in preterm and term infants in NICare unit.
In preterm most comon etiology is ARDS caused by surfactant deficiency.(IRDS/hyaline membrane disease.)
In term infants most comon etiology is meconium aspiration, sepsis, pulm hypoplasia, primary HT of newborn.
SIGNS
60/min tachypnea
sternal and subcostal indrawings, nasal flaring
expiratory grunting
cynanosis if severe.
MANAGEMENT
admission and monitoring vitals
xray
oxygenation
mechanical ventilation?
DDx
Transient tachypnea of the newborn
Most common casue of resp. distress in term infants.
Caused by delayed resorption of lung liquid.
More common after C-section.
Xray shows fluid in horizontal fissure
Adm. oxygen? Over within some days.
Meconium aspiration
Passed before birth in <20% in terms.
INcrease chance in increased age.
May be sign of fetal hypoxia
Mechanical obstruction and chemical irritant
chemical pneumonitis and later pneumonia(infectious agent).
xray: pathces of consolidation and atelectasis and overinflation.
Pneumothorax and pneumomediastinum
Severe mec. aspir. has high mortality and morbidity
Related to persistent pulm. hypertension
Pneumonia
Predispositions:
prolonged rupture of membranes
chorioamnionitis
low birthweight
Broad spectrum ATB until cultura results
IRDS: See q.35
Pneumothorax
#
Spontanous in 2% of delivieries.
Usually asympt, but may cause distress
Also secondary to mec. asp, ARDS or compl of ventilation
Milk aspiration
more frequently in preterms and terms with resp. distress or neurological damage.
GER predispose to aspiration --> bronchopulmonary dysplasia
Cleft palate are prone to aspirate
Persisent pulmonary HT of newborn
life threatening
Cause:
meconium asp
septicemia
ARDS
May be primary disorder
Right to left shunting in lungs and ductals.
Cynaosis develop soon after birth
Xray: normal size heart, maybe pulmonary oligemia.
echocardiogram is required to exclude congenital heart disease.
No murmurs.
MANAGEMENT
oxygenation
NO or sildenafil adm. to vasodilate pulm. vessels.
High frequenzy ventilation
Extracorporeal membrane oxygenation in severe, reversible cases.
Diaphragmatic hernia
occur 1/4000 births - usually diagnosed by ultrasound before birth
Posterolateral foramen of diaphragm
abdominal contents in thorax, usually left side.
Not responding to rescusitation
Diagnosis: xray or US before birth
gastric suction is done to prevent distention of bowel
Surgical intervention is done
Associated with hypoplasia of affected lung.
Heart failure
Heart murmurs on auscultation
enlarged liver from venous congestion
femoral artery must be palpated to exclude coarc. aortae or interrupted aorta.