【體外膜肺ECMO課件】-Neonatal-Diseases

NeonatalDiseasesMODULEENeonatalDiseasesMODULEE1ObjectivesIdentifythekeypathophysiologicchangesthatoccurwitheachdisease.Describethetherapeuticinterventionneededtotreateachofthediseases.ObjectivesIdentifythekeypat2PerinatalDiseasesandOtherProblemswithPrematurityRetinopathyofprematurity(ROP)PatentDuctusArteriosusHypoglycemiaColdStressIntraventricular&IntracerebralhemorrhagingBronchopulmonarydysplasiaWilsonMikitySyndromeApneaofprematurityNecrotizingenterocolitisRDSPerinatalDiseasesandOtherP3RetinopathyofPrematurity(ROP)FormerlyknownasRetrolentalFibroplasia(RLF).Initiallydescribedin1940/1950sfollowingincreasedincidenceofblindnesswithbabiesinincubators.Incidencetoday:25to35%ofpreemiesupto35weeksRetinopathyofPrematurity(RO4PhysiologyoftheDevelopingEyeCapillariesofretinabeginbranchingat16weeks.Endofpseudoglandularperiod.Capillariesbeginatopticnerveandgrowanteriorlytowardtheoraserratawhichistheanteriorendoftheretina.Growthisnotcompleteuntil40weeks.Prematureinfantsdon’thavecompletegrowth.Asthecapillarynetworkexpands,arteriesandveinsforminitspath.ROPisthefailureofthisnetworktodevelop.PhysiologyoftheDevelopingE5OxygenandROPInthepresenceofhighPaO2,theretinalvesselsconstrict.ProlongedexposuretohighPaO2willleadtonecrosisofthevessels(vaso-obliteration).Thebodyattemptstocorrectforthisbyoverperfusingthe“good”arteries,whichleadstohemorrhageinthevitreous.Thishemorrhageleadstoscartissuedevelopmentandblindness.OxygenandROPInthepresence6【體外膜肺ECMO課件】-Neonatal-Diseases7StagesandZonesofROP5stages,with5havingtheretinacompletelydetached.ThreeZonesoftheeye(zone1istheworst)StagesandZonesofROP5stage8【體外膜肺ECMO課件】-Neonatal-Diseases9【體外膜肺ECMO課件】-Neonatal-Diseases10RDS-RespiratoryDistressSyndromeaka:IRDSorHyalineMembraneDiseaseAssociatedwithlungimmaturityandadeficiencyinsurfactantproduction.Immaturityofotherorgansystems.DecreasedCompliance&increasedWOB.Severehypoxemiamayresultinmultipleorganfailure.MaybeassociatedwithPPHN(PFC)orPDA.RDS-RespiratoryDistressSy11RDS-RespiratoryDistressSyndromeSymptomsworsenforfirst48-72hours.StabilizationSlowrecoveryWithprogressionofthedisease,scartissuereplacesthenormalalveolartissue.HyalineMembraneRDS-RespiratoryDistressSy12【體外膜肺ECMO課件】-Neonatal-Diseases13ClinicalSignsHistoryofprematurityfabove60/minGruntingRetractionsFlaringofnostrilsCyanosisSeverehypoxemiaonbloodgasesHypothermia&flaccidmuscletoneClinicalSignsHistoryofprema14X-rayFindingsDiffuse“White-out”(Radiopaque)AtelectasisAirbronchogramsReticulogranularPattern“Fishingnet”GroundGlassAppearanceX-rayFindingsDiffuse“White-o15【體外膜肺ECMO課件】-Neonatal-Diseases16TreatmentAttempttoacceleratelungmaturitybypharmacologicalmeans.SteroidsTocolysis:Delaylaborwithb-AdrenergicAgents(Terbutaline)ThermoregulationTreatmentAttempttoaccelerate17TreatmentArtificialSurfactantCPAPormechanicalventilationHighFrequencyVentilationECMOTreatmentArtificialSurfactant18RecoveryPhaseComplicationsROPBronchopulmonarydysplasiaChroniclungdisease(COPDforNeonates)IntraventricularhemorrhageBraindysfunctionNecrotizingEnterocolitisIntrapulmonaryHemorrhageFullRecoveryRecoveryPhaseComplications19BronchopulmonaryDysplasiaOtherNameNeonatalChronicLungDisease(NCLD)Progressivechroniclungdiseasethatpresentswithpersistentrespiratoryproblemsat28daysorlater,radiographic

changesandoxygendependencyBronchopulmonaryDysplasiaOthe20BronchopulmonaryDysplasiaCriteriaPreterminfantsProlongedoxygenconcentrations(O2toxicity)Positivepressureventilation(barotrauma)Patentductusarteriosus(PDA)TimeexposuretooxygenandpositivepressureMalnutritionBronchopulmonaryDysplasiaCrit21BronchopulmonaryDysplasiaNotallbabieswithRDSdevelopBPD.Patternbeginstounfoldwithinthefirst3-4daysoflifethatplacesaneonateathighriskofdevelopingBPD.BronchopulmonaryDysplasiaNot22BronchopulmonaryDysplasiaLungPathologyMucosalhyperplasiaofsmallairways.DestructionoftypeIcells.Inflammationanddestructionofalveoliandcapillarybed.Lungsarecysticinsomeareasandatelectaticinothers.BronchopulmonaryDysplasiaLung23ChestX-RayRadiology“Honeycomb”appearanceDiaphragmsareflattenedCysticappear(hyperlucent)Atelectasis(radiopaque)ChestX-RayRadiology24HMDtoBPD–3HourHMDtoBPD–3Hour25HMDtoBPD–Day13HMDtoBPD–Day1326HMDtoBPD–Day19HMDtoBPD–Day1927HMDtoBPD–3MonthsHMDtoBPD–3Months28ClinicalPresentationTachypneaRetractionsMucouspluggingHyperinflationofchest–barrelchestCyanoticspellsPoorABGWheezingInadequategrowthIncreasedWOBIncreasedoxygenconsumptionPulmonaryhypertensionandCorPulmonaleClinicalPresentationTachypnea29GoalsofBronchopulmonaryDysplasiaPreventionofBPD.Provideenoughcaloriestosupportgrowth.Weanslowlyoffoxygen.Limitpeakinspiratorypressuresonventilator.CPAPorHFVKeepFiO2levelsaslowaspossible.MayneedtokeepPaO2levelslower.GoalsofBronchopulmonaryDysp30ComplicationsofBronchopulmonaryDysplasiaGastroesophagealrefluxandfeedingintoleranceleadstoaspiration.DecreasedCaandphosphorus(bonefractures.Losssightorhearing(ROP).Chronicinfections.Pneumothorax.Cerebralpalsy.LimitFluidintake–developpulmonaryedema.ComplicationsofBronchopulmon31BronchopulmonaryDysplasiaDeathisusuallydueto:CorPulmonaleInfectionSuddenDeathBronchopulmonaryDysplasiaDeat32DischargeofpatientswithBPDHomeCareOxygen&CPTMechanicalventilatorsMedicationsDiureticsorcardiacmedsSpecialAttentiontonutritionalneedsFrequentre-admissionsbackintothehospital.DischargeofpatientswithBPD33NecrotizingEnterocolitis(NEC)Injurytotheintestinalmucosaduetohypoperfusion,hypoxiaorhyperosmolarfeedings.Themucosacannotsecretetheprotectivelayerofmucusanditbecomesvulnerabletobacterialinvasion.Intestinalischemiamayresultinnecrosisandgangreneoftheintestine.ComplicationofRDS.Highestincidenceinlowestbirthweightinfants.NecrotizingEnterocolitis(NEC34NecrotizingEnterocolitis(NEC)Intestinaldilation(distendedloopsofintestinewithgas).Gastricileus(obstruction)Abdominaldistention.Rectalbleeding

BloodystoolFeedingisdifficult.NecrotizingEnterocolitis(NEC35TreatmentStopfeedings.NasogastricSuctioningHyperalimentationIV.Antibiotics.20%requiresurgery.TreatmentStopfeedings.36IntraventricularHemorrhage(IVH)Prematureinfantsandlowbirthweightinfantsarethegreatestrisk.DiagnosedbyultrasoundorCTscan.Seenwithincreasedincidenceinchildrenofalcoholicmothers.4gradesofIVH.Grade1-Bleedingoccursjustinasmallareaoftheventricles.Grade2-Bleedingalsooccursinsidetheventricles.Grade3-Ventriclesareenlargedbytheblood.Grade4-Bleedingintothebraintissuesaroundtheventricles.IntraventricularHemorrhage(I37【體外膜肺ECMO課件】-Neonatal-Diseases38【體外膜肺ECMO課件】-Neonatal-Diseases39EtiologyAndHistoryofIVHEtiologyAndHistoryofIVH40GradesofIVHGradesofIVH41【體外膜肺ECMO課件】-Neonatal-Diseases42IVHTreatmentPreventOccurrenceSupportiveIVHTreatmentPreventOccurrenc43Wilson-MikitySyndromeSeeninprematureandLBWinfants.Lessthan1500gramsatbirth.“Emphysema”oflittlebabies.Lungimmaturitywithruptureofthealveolarsepta.SimilartoBPDexceptbabieshavenotbeenventilated.Treatmentissupportive.Oxygenandmechanicalventilation.Somequestionastowhetheritisaseparatesyndromeornot.Wilson-MikitySyndromeSeenin44MeconiumAspirationDiseaseoftermorposttermneonates.Asphyxiaoccursbefore,duringoraftertheonsetoflabor.Relaxationoftheanalsphincterwithreleaseofthemeconium(firststool).Treatmentisimmediatesuctioning&antibiotics.Intubatewithendotrachealtubeandwithameconium

aspirator.MeconiumAspirationDiseaseof45【體外膜肺ECMO課件】-Neonatal-Diseases46MeconiumAspirationUsuallyassociatedwithPFCandinfection.Pneumothoraxmayresultfromthehyperinflation.Anemergencytensionpneumothoraxistreatedwithaneedleaspirationfollowedbychesttubeinsertion.MeconiumAspirationUsuallyass47Ball-ValveEffectBall-ValveEffect48TransientTachypneaoftheNewborn(TTN)RDStypeII.Occursintermornearterminfantsbornbycesareansection.Causedbytheretentionoflungfluidfollowingbirth.Babyisbornwithrespiratorydistressandrapidf(80–100/minorhigher).Evaporationoflungfluid.TransientTachypneaoftheNew49TransientTachypneaoftheNewbornX-rayfindingsaresimilarforRDS,TTN,andpneumonia.Pleuraleffusionsmaybepresent.Maybestartedonbroadspectrumantibiotics.Lungmaturityisfound.UsuallygoodAPGARscores.Frequentturningishelpfultoeliminatelungfluid.TransientTachypneaoftheNew50TransientTachypneaoftheNewbornABGshowoxygenationproblem.Ventilationisusuallynormal.Ifventilationisstarted,thebabywillweanquickly.Processofelimination.TransientTachypneaoftheNew51TracheoesophagealFistulaorAtresiaFistulaisanabnormalcommunicationbetweentwopassagesorcavities.Atresiaistheabsenceorclosureofanormalbodyorificeortubularpassage.TEFisacongenitalabnormalityresultinginrespiratorydistress.Mostcommontypeisanupperesophagealatresiaandalowertracheal-esophagealfistula.TracheoesophagealFistulaorA52【體外膜肺ECMO課件】-Neonatal-Diseases53DiagnosisThenurse/physicianwilltrytopassacatheterintothestomach.Bronchoscopyorultrasoundisusedtodiagnose.Maybeseenonchest-x-ray.DiagnosisThenurse/physicianw54ClinicalManifestationsConstantpoolingoforal,nasalandpharyngealsecretions/drooling.Continuousorsporadicrespiratorydistress.Chokingonfeedings.Repeatedvomitingwithorafterfeedings.Persistentupperlobepneumoniaoratelectasisduetoaspiration.Gastricdistention.ClinicalManifestationsConstan55TreatmentofTEFSurgicalcorrectionisneeded.Supportivecareuntilsurgery.Aspirationisamajorconcern.Agastricfeedingtubeisusuallyplacedintheesophagealpouchtoremovesecretions.Keepin30degreeuprightposition.Infantisfedwithagastrostomytubeuntilsurgery.TreatmentofTEFSurgicalcorre56ChoanalAtresiaAcongenitalmalformationofboneoramembranecausingpartialorcompleteobstructionofoneorbothofthechoana.Theobstructionresultsinasphyxiasinceinfantsarenosebreathersearlyinlife.RespiratoryDistresssubsideswhenthebabycries.ChoanalAtresiaAcongenitalma57DiagnosisAcatheterorprobefailstopassthroughtheinfant’snose.Oftenthenosehasalargeaccumulationofthicksecretions.Iftheobstructionisamembrane,itmaybepuncturedtoprovidereliefoftherespiratorydistress.DiagnosisAcatheterorprobef58ClinicalManifestationsClinicalSignsRespiratorydistressCyanosisRetractionsPoolingofnasalsecretionsClinicalManifestationsClinica59TreatmentTreatmentInsertionofanoralairwaytofacilitatemouthbreathing.Ifdistresscontinues,thenintubateandventilate.TreatmentTreatment60DiaphragmaticHerniaCDHisacongenitalconditioninwhichtheabdominalorgansherniateintothechestcavitythroughthediaphragm.Lifethreateningcondition.Lungtissueiscompressed.DiaphragmaticHerniaCDHisac61DiaphragmaticHerniaMostcommondefectisintheposterolateralregionofthediaphragminanareacalledtheforamenofBochdalek.Leftsideherniationismorefrequent(85-90%).Stomach,spleen&intestinescanenterthechest.Scaphoid(boatshaped)Abdomenispresent.DiaphragmaticHerniaMostcommo62【體外膜肺ECMO課件】-Neonatal-Diseases63【體外膜肺ECMO課件】-Neonatal-Diseases64DiaphragmaticHerniaThebabywillbeinrespiratorydistressatbirth.PMImaybeshifted.Breathsoundsdiminished.Bowelsoundscanbeheardoverlungfields.Confirmedwithchestx-ray.Lungsare

hypoplasitc(underdeveloped).DiaphragmaticHerniaThebabyw65TreatmentofDiaphragmaticHerniasOrogastrictubeisinsertedtoremoveair.Donotmanuallyventilatetheseinfants.Overdistensionofstomachwillworsenproblem.Intubatetopreventairinthestomachandintestines.HighFrequencyVentilation,ECMOHighmortalityrate.Pneumothoraxiscommon.TreatmentofDiaphragmaticHer66TreatmentofDiaphragmaticHerniasPrenatalultrasoundcanaccuratelydiagnoseaCDHinutero(inuterorepairhasbeensuccessfullyaccomplished)!!TreatmentofDiaphragmaticHer67PersistentPulmonaryHypertensionoftheNewborn(PPHN)FormerlyPersistentFetalCirculation(PFC)Pulmonaryhypertensionafterbirthcausedbyasphyxiaandwhichpreventsthetransitionoffetaltonewborncirculation.Itmaybeaprimarydisorderorasecondarydisorder:RDSTTNPneumoniaColdStressMeconiumaspirationDiaphragmaticherniaPersistentPulmonaryHypertens68PersistentPulmonaryHypertensionoftheNewborn(PPHN)BloodisshuntedRighttoLeftacrosstheductusarteriosus.TheApgarisusually5orlessat1and5minutes.PersistentPulmonaryHypertens69SignsandSymptomsTachypneaRetractionsCyanosisBreathsoundsareclearifnopulmonarydiseaseispresent.Refractorytooxygentherapy(trueshunt).Differenceinpre&postductalbloodgases.SignsandSymptomsTachypnea70DiagnosticTestingHyperoxiaTest

IfPaO2doesnotincreasewith100%oxygen,suspectacardiacshuntNotspecificforPFCComparepreductalandpostductalPaO2IfshuntispresentPreductal>Postductal.15to20mmHgand-with-FiO2Hyperoxia-HyperventilationTest

Mostdefinitive.HyperventilateuntilPaCO2is20–25mmHgAlkalosiswillreducepulmonaryhypertensionandPaO2willimprove.Echocardiography–ultrasoundoftheheartCardiacCatheterizationDiagnosticTestingHyperoxiaTe71TreatmentforPPHNOxygentherapytomaintainPaO2greaterthan50–60mmHg.Mechanicalventilation.NitricOxideECMO,HFVKeepglucoseandelectrolytesnormal.TreatmentforPPHNOxygenthera72PneumothoraxCyanosisTachypneaGruntingNasalflaringPMIisshiftedDiminishedorabsentbreathsoundsPneumothoraxCyanosis73ConfirmationofaPneumothoraxTransilluminationBedSideChestx-rayConfirmationofaPneumothorax74TreatmentofPneumothoraxEmergencytreatment.NeedleAspiration2ndintercostalspaceChestTube.Giventhebaby100%oxygenuntilchesttubeisinserted.TreatmentofPneumothoraxEmerg75InfectionsPneumonia–infectioninthelungs.Septicemia–infectioninthebloodstream.Meningitis–infection/inflammationofthecoveringofthebrainandspinalcord.UrinaryTractInfectionsConjunctivitis–infectionorinflammationoftheeye.Omphalitis–infection/inflammationoftheumbilicalstump.InfectionsPneumonia–infectio76PneumoniaTransplacentalAcquiredatbirthAmnioticfluid.Prematureruptureofmembranesgreaterthan12-24hours(PROM).PostnatalInvasivelines.Respiratoryequipment.HospitalPersonnel.PneumoniaTransplacental77PneumoniaPrematureinfantsareatgreaterrisk.GroupBBetaHemolyticStreptococci&EscherichiaColiarethemostcommonorganisms.PFCisusuallyaconsequenceofpneumonia.PneumoniaPrematureinfantsare78DiagnosisofPneumoniaChestx-rayVerydifficulttodistinguishbetweenPneumonia,RDS&TTN.CultureandSensitivity.DiagnosisofPneumoniaChestx-79PostnatallyAcquiredPneumoniaKlebsiellaPseudomonasMethicillin-ResistantStaphylococcus(MRSA)Resistanttopenicillintypedrugs.CandidaAlbicans(fungal).PostnatallyAcquiredPneumonia80VirusesthataffecttheNewbornsHerpesVirusRespiratorySyncytialVirus(RSV)RubellaAdenovirusCytomegalovirusChlamydiaVirusesthataffecttheNewbor81NeonatalDiseasesMODULEENeonatalDiseasesMODULEE82ObjectivesIdentifythekeypathophysiologicchangesthatoccurwitheachdisease.Describethetherapeuticinterventionneededtotreateachofthediseases.ObjectivesIdentifythekeypat83PerinatalDiseasesandOtherProblemswithPrematurityRetinopathyofprematurity(ROP)PatentDuctusArteriosusHypoglycemiaColdStressIntraventricular&IntracerebralhemorrhagingBronchopulmonarydysplasiaWilsonMikitySyndromeApneaofprematurityNecrotizingenterocolitisRDSPerinatalDiseasesandOtherP84RetinopathyofPrematurity(ROP)FormerlyknownasRetrolentalFibroplasia(RLF).Initiallydescribedin1940/1950sfollowingincreasedincidenceofblindnesswithbabiesinincubators.Incidencetoday:25to35%ofpreemiesupto35weeksRetinopathyofPrematurity(RO85PhysiologyoftheDevelopingEyeCapillariesofretinabeginbranchingat16weeks.Endofpseudoglandularperiod.Capillariesbeginatopticnerveandgrowanteriorlytowardtheoraserratawhichistheanteriorendoftheretina.Growthisnotcompleteuntil40weeks.Prematureinfantsdon’thavecompletegrowth.Asthecapillarynetworkexpands,arteriesandveinsforminitspath.ROPisthefailureofthisnetworktodevelop.PhysiologyoftheDevelopingE86OxygenandROPInthepresenceofhighPaO2,theretinalvesselsconstrict.ProlongedexposuretohighPaO2willleadtonecrosisofthevessels(vaso-obliteration).Thebodyattemptstocorrectforthisbyoverperfusingthe“good”arteries,whichleadstohemorrhageinthevitreous.Thishemorrhageleadstoscartissuedevelopmentandblindness.OxygenandROPInthepresence87【體外膜肺ECMO課件】-Neonatal-Diseases88StagesandZonesofROP5stages,with5havingtheretinacompletelydetached.ThreeZonesoftheeye(zone1istheworst)StagesandZonesofROP5stage89【體外膜肺ECMO課件】-Neonatal-Diseases90【體外膜肺ECMO課件】-Neonatal-Diseases91RDS-RespiratoryDistressSyndromeaka:IRDSorHyalineMembraneDiseaseAssociatedwithlungimmaturityandadeficiencyinsurfactantproduction.Immaturityofotherorgansystems.DecreasedCompliance&increasedWOB.Severehypoxemiamayresultinmultipleorganfailure.MaybeassociatedwithPPHN(PFC)orPDA.RDS-RespiratoryDistressSy92RDS-RespiratoryDistressSyndromeSymptomsworsenforfirst48-72hours.StabilizationSlowrecoveryWithprogressionofthedisease,scartissuereplacesthenormalalveolartissue.HyalineMembraneRDS-RespiratoryDistressSy93【體外膜肺ECMO課件】-Neonatal-Diseases94ClinicalSignsHistoryofprematurityfabove60/minGruntingRetractionsFlaringofnostrilsCyanosisSeverehypoxemiaonbloodgasesHypothermia&flaccidmuscletoneClinicalSignsHistoryofprema95X-rayFindingsDiffuse“White-out”(Radiopaque)AtelectasisAirbronchogramsReticulogranularPattern“Fishingnet”GroundGlassAppearanceX-rayFindingsDiffuse“White-o96【體外膜肺ECMO課件】-Neonatal-Diseases97TreatmentAttempttoacceleratelungmaturitybypharmacologicalmeans.SteroidsTocolysis:Delaylaborwithb-AdrenergicAgents(Terbutaline)ThermoregulationTreatmentAttempttoaccelerate98TreatmentArtificialSurfactantCPAPormechanicalventilationHighFrequencyVentilationECMOTreatmentArtificialSurfactant99RecoveryPhaseComplicationsROPBronchopulmonarydysplasiaChroniclungdisease(COPDforNeonates)IntraventricularhemorrhageBraindysfunctionNecrotizingEnterocolitisIntrapulmonaryHemorrhageFullRecoveryRecoveryPhaseComplications100BronchopulmonaryDysplasiaOtherNameNeonatalChronicLungDisease(NCLD)Progressivechroniclungdiseasethatpresentswithpersistentrespiratoryproblemsat28daysorlater,radiographic

changesandoxygendependencyBronchopulmonaryDysplasiaOthe101BronchopulmonaryDysplasiaCriteriaPreterminfantsProlongedoxygenconcentrations(O2toxicity)Positivepressureventilation(barotrauma)Patentductusarteriosus(PDA)TimeexposuretooxygenandpositivepressureMalnutritionBronchopulmonaryDysplasiaCrit102BronchopulmonaryDysplasiaNotallbabieswithRDSdevelopBPD.Patternbeginstounfoldwithinthefirst3-4daysoflifethatplacesaneonateathighriskofdevelopingBPD.BronchopulmonaryDysplasiaNot103BronchopulmonaryDysplasiaLungPathologyMucosalhyperplasiaofsmallairways.DestructionoftypeIcells.Inflammationanddestructionofalveoliandcapillarybed.Lungsarecysticinsomeareasandatelectaticinothers.BronchopulmonaryDysplasiaLung104ChestX-RayRadiology“Honeycomb”appearanceDiaphragmsareflattenedCysticappear(hyperlucent)Atelectasis(radiopaque)ChestX-RayRadiology105HMDtoBPD–3HourHMDtoBPD–3Hour106HMDtoBPD–Day13HMDtoBPD–Day13107HMDtoBPD–Day19HMDtoBPD–Day19108HMDtoBPD–3MonthsHMDtoBPD–3Months109ClinicalPresentationTachypneaRetractionsMucouspluggingHyperinflationofchest–barrelchestCyanoticspellsPoorABGWheezingInadequategrowthIncreasedWOBIncreasedoxygenconsumptionPulmonaryhypertensionandCorPulmonaleClinicalPresentationTachypnea110GoalsofBronchopulmonaryDysplasiaPreventionofBPD.Provideenoughcaloriestosupportgrowth.Weanslowlyoffoxygen.Limitpeakinspiratorypressuresonventilator.CPAPorHFVKeepFiO2levelsaslowaspossible.MayneedtokeepPaO2levelslower.GoalsofBronchopulmonaryDysp111ComplicationsofBronchopulmonaryDysplasiaGastroesophagealrefluxandfeedingintoleranceleadstoaspiration.DecreasedCaandphosphorus(bonefractures.Losssightorhearing(ROP).Chronicinfections.Pneumothorax.Cerebralpalsy.LimitFluidintake–developpulmonaryedema.ComplicationsofBronchopulmon112BronchopulmonaryDysplasiaDeathisusuallydueto:CorPulmonaleInfectionSuddenDeathBronchopulmonaryDysplasiaDeat113DischargeofpatientswithBPDHomeCareOxygen&CPTMechanicalventilatorsMedicationsDiureticsorcardiacmedsSpecialAttentiontonutritionalneedsFrequentre-admissionsbackintothehospital.DischargeofpatientswithBPD114NecrotizingEnterocolitis(NEC)Injurytotheintestinalmucosaduetohypoperfusion,hypoxiaorhyperosmolarfeedings.Themucosacannotsecretetheprotectivelayerofmucusanditbecomesvulnerabletobacterialinvasion.Intestinalischemiamayresultinnecrosisandgangreneoftheintestine.ComplicationofRDS.Highestincidenceinlowestbirthweightinfants.NecrotizingEnterocolitis(NEC115NecrotizingEnterocolitis(NEC)Intestinaldilation(distendedloopsofintestinewithgas).Gastricileus(obstruction)Abdominaldistention.Rectalbleeding

BloodystoolFeedingisdifficult.NecrotizingEnterocolitis(NEC116TreatmentStopfeedings.NasogastricSuctioningHyperalimentationIV.Antibiotics.20%requiresurgery.TreatmentStopfeedings.117IntraventricularHemorrhage(IVH)Prematureinfantsandlowbirthweightinfantsarethegreatestrisk.DiagnosedbyultrasoundorCTscan.Seenwithincreasedincidenceinchildrenofalcoholicmothers.4gradesofIVH.Grade1-Bleedingoccursjustinasmallareaoftheventricles.Grade2-Bleedingalsooccursinsidetheventricles.Grade3-Ventriclesareenlargedbytheblood.Grade4-Bleedingintothebraintissuesaroundtheventricles.IntraventricularHemorrhage(I118【體外膜肺ECMO課件】-Neonatal-Diseases119【體外膜肺ECMO課件】-Neonatal-Diseases120EtiologyAndHistoryofIVHEtiologyAndHistoryofIVH121GradesofIVHGradesofIVH122【體外膜肺ECMO課件】-Neonatal-Diseases123IVHTreatmentPreventOccurrenceSupportiveIVHTreatmentPreventOccurrenc124Wilson-MikitySyndromeSeeninprematureandLBWinfants.Lessthan1500gramsatbirth.“Emphysema”oflittlebabies.Lungimmaturitywithruptureofthealveolarsepta.SimilartoBPDexceptbabieshavenotbeenventilated.Treatmentissupportive.Oxygenandmechanicalventilation.Somequestionastowhetheritisaseparatesyndromeornot.Wilson-MikitySyndromeSeenin125MeconiumAspirationDiseaseoftermorposttermneonates.Asphyxiaoccursbefore,duringoraftertheonsetoflabor.Relaxationoftheanalsphincterwithreleaseofthemeconium(firststool).Treatmentisimmediatesuctioning&antibiotics.Intubatewithendotrachealtubeandwithameconium

aspirator.MeconiumAspirationDiseaseof126【體外膜肺ECMO課件】-Neonatal-Diseases127MeconiumAspirationUsuallyassociatedwithPFCandinfection.Pneumothoraxmayresultfromthehyperinflation.Anemergencytensionpneumothoraxistreatedwithaneedleaspirationfollowedbychesttubeinsertion.MeconiumAspirationUsuallyass128Ball-ValveEffectBall-ValveEffect129TransientTachypneaoftheNewborn(TTN)RDStypeII.Occursintermornearterminfantsbornbycesareansection.Causedbytheretentionoflungfluidfollowingbirth.Babyisbornwithrespiratorydistressandrapidf(80–100/minorhigher).Evaporationoflungfluid.TransientTachypneaoftheNew130TransientTachypneaoftheNewbornX-rayfindingsaresimilarforRDS,TTN,andpneumonia.Pleuraleffusionsmaybepresent.Maybestartedonbroadspectrumantibiotics.Lungmaturityisfound.UsuallygoodAPGARscores.Frequentturningishelpfultoeliminatelungfluid.TransientTachypneaoftheNew131TransientTachypneaoftheNewbornABGshowoxygenationproblem.Ventilationisusuallynormal.Ifventilationisstarted,thebabywillweanquickly.Processofelimination.TransientTachypneaoftheNew132TracheoesophagealFistulaorAtresiaFistulaisanabnormalcommunicationbetweentwopassagesorcavities.Atresiaistheabsenceorclosureofanormalbodyorificeortubularpassage.TEFisacongenitalabnormalityresultinginrespiratorydistress.Mostcommontypeisanupperesophagealatresiaandalowertracheal-esophagealfistula.TracheoesophagealFistulaorA133【體外膜肺ECMO課件】-Neonatal-Diseases134DiagnosisThenurse/physicianwilltrytopassacatheterintothestomach.Bronchoscopyorultrasoundisusedtodiagnose.Maybeseenonchest-x-ray.DiagnosisThenurse/physicianw135ClinicalManifestationsConstantpoolingoforal,nasalandpharyngealsecretions/drooling.Continuousorsporadicrespiratorydistress.Chokingonfeedings.Repeatedvomitingwithorafterfeedings.Persistentupperlobepneumoniaoratelectasisduetoaspiration.Gastricdistention.ClinicalManifestationsConstan136TreatmentofTEFSurgicalcorrectionisneeded.Supportivecareuntilsurgery.Aspirationisamajorconcern.Agastricfeedingtubeisusuallyplacedintheesophagealpouchto