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Signs of respiratory distress
&
Common respiratory problems
Dr.Osama Arafa Abd EL Hameed
M. B.,B.CH - M.Sc Pediatrics - Ph...
Pulmonary diseases in the newborn
period
1/13have breathing problems at birth
1/6with breathing problems have infections
G...
Infants at Risk for Developing
Respiratory Distress
Preterm Infants
Infants with birth asphyxia
Infants of Diabetic Mother...
Pediatric Respiratory System
Large head, small
mandible, small neck
Large, posteriorly-placed
tongue
High glottic opening
...
Pediatric Respiratory System
Poor accessory muscle development
Less rigid thoracic cage
Horizontal ribs, primarily diaphra...
Pediatric Respiratory System
Decrease respiratory reserve +
Increased O2 demand =
Increased respiratory failure risk
Pulmonary diseases in the newborn
period
Symptoms and signs
Tachypne (frequency > 60 per min(
Cyanosis in room air
Flare o...
Respiratory Distress
When is it abnormal to show
signs of respiratory distress?
When tachypnea, retractions, flaring, or grunting
persist beyon...
Causes of Neonatal Respiratory
Distress
Obstructive/restrictive - mucous, choanal atresia,
pneumothorax, diaphragmatic her...
Pulmonary diseases in the newborn
period
Respiratory Distress Syndrome(RDS(
Transient Tachypnoe of newborn(TTN(.
Pneumonia...
Pulmonary causes
Common Rare
RDS Lung hypoplasia
Trans tachypne Obstr upper airways
Meconium asp Tumours
Pneumonia Pulm he...
Extra-pulmonary causes
Common Rare
Persist Fetal Circulat Cerebral edema
Cong Cord Malfor Drugs
Cerebral Hemorrhage Neurom...
Evaluation of Respiratory
Distress
Administer Oxygen and other necessary
emergency treatment
Vital sign assessment
Determi...
Principles of Therapy
Improve oxygen delivery to lungs-- supplemental
oxygen, CPAP, assisted ventilation, surfactant
Impro...
Respiratory Distress Syndrome
Also called as hyaline membrane disease
Most common cause of respiratory distress in
prematu...
CLINICAL FEATURES OF RDS
Tachypnea/Apnea
Dyspnea
Grunting/Flaring
Hypoxemia
Radiographic Features
Pulmonary Function Abnor...
Early RDS
Progressive RDS
Late RDS
THERAPY FOR RDS
Oxygen - maintain PaO2 > 50 torr
Nasal CPAP
Intermittent Mandatory Ventilation
Surfactant Replacement
High...
PIE
PIE Pathology
Pneumothorax/PIE
Pneumothorax
Pneumopericardium
TRANSIENT TACHYPNEA OF
THE NEWBORN
40%cases
Delayed Fluid Resorption
Hard to differentiate early on from RDS both
clinical...
Wet Lung
Meconium Aspiration Syndrome
Incidence- 1.5- 2 % in term or post term infants.
Meconium is locally irritative, obstructive...
Meconium Aspiration
MAS
PERSISTENT PULMONARY
HYPERTENSION
Usually secondary to primary pulmonary disease state
Pulmonary Vascular Lability
Treat t...
PPHN
CONGENITAL PNEUMONIA
Infectious; primarily GBS
Amniotic Fluid aspiration
Viral etiology
Surfactant inactivation
GBS Pneumonia
Pneumonia
CONGENITAL MALFORMATIONS
Choanal Atresia
Tracheal Atresia/stenosis
Chest Mass
Diaphragmatic hernia
Sequestration
Lobar emp...
Lobar Emphysema
Diaphragmatic Hernia
Chylothorax
Phrenic Nerve Paralysis
ACQUIRED DISEASES
Infections
Bronchopulmonary Dysplasia
Sub-glottic stenosis
Apnea of Prematurity
Early BPD
Progressive BPD
Late BPD
APNEA
Definition:
cessation of breathing for longer than a
15 second period or for a shorter time if
there is bradycardia ...
Babies at Risk for Apnea
Preterm
Respiratory Distress
Metabolic Disorders
Infections
Cold-stressed babies who are being wa...
Anticipation and Detection
Place at-risk infants on cardio-
respiratory monitor
Low heart rate limit (80-100(
Respiratory ...
Treatment
Determine cause:
x-ray
blood sugar
body and environmental temperature
hematocrit
sepsis work up
electrolytes
car...
Treatment
CPAP
Theophylline/Caffeine therapy
Mechanical ventilation
Apnea monitor
Signs of respiratory distress
Signs of respiratory distress
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Signs of respiratory distress

  1. 1. Signs of respiratory distress & Common respiratory problems Dr.Osama Arafa Abd EL Hameed M. B.,B.CH - M.Sc Pediatrics - Ph. D. Consultant Pediatrician & Neonatologist Head of Pediatrics Department - Port-Fouad Hospital By
  2. 2. Pulmonary diseases in the newborn period 1/13have breathing problems at birth 1/6with breathing problems have infections GA< 31 : 1/2 have infections Boys 9.3%, Girls 5.9% Mortality 0.4% (5% < 36 weeks GA(
  3. 3. Infants at Risk for Developing Respiratory Distress Preterm Infants Infants with birth asphyxia Infants of Diabetic Mothers Infants born by Cesarean Section Infants born to mothers with fever, Prolonged ROM, foul-smelling amniotic fluid. Meconium in amniotic fluid. Other problems
  4. 4. Pediatric Respiratory System Large head, small mandible, small neck Large, posteriorly-placed tongue High glottic opening Small airways Presence of tonsils, adenoids
  5. 5. Pediatric Respiratory System Poor accessory muscle development Less rigid thoracic cage Horizontal ribs, primarily diaphragm breathers Increased metabolic rate, increased O2 consumption
  6. 6. Pediatric Respiratory System Decrease respiratory reserve + Increased O2 demand = Increased respiratory failure risk
  7. 7. Pulmonary diseases in the newborn period Symptoms and signs Tachypne (frequency > 60 per min( Cyanosis in room air Flare of the nostrils Chest retractions Grunting
  8. 8. Respiratory Distress
  9. 9. When is it abnormal to show signs of respiratory distress? When tachypnea, retractions, flaring, or grunting persist beyond one hour after birth. When there is worsening tachypnea, retractions, flaring or grunting at any time. Any time there is central cyanosis Acrocynosis: blue color of the hands and feet with pink color of the rest of the body, common in delivery room and is usually NORMAL
  10. 10. Causes of Neonatal Respiratory Distress Obstructive/restrictive - mucous, choanal atresia, pneumothorax, diaphragmatic hernia. Primary lung problem - Respiratory Distress Syndrome (RDS(, meconium aspiration, bacterial pneumonia, transient (TTN(. Non-pulmonary -hypovolemia/hypotension, congenital heart disease, hypoxia, acidosis, cold stress, anemia,
  11. 11. Pulmonary diseases in the newborn period Respiratory Distress Syndrome(RDS( Transient Tachypnoe of newborn(TTN(. Pneumonia/Infection Meconium Aspiration Air Leaks Pulmonary hypertension Chronic Lung Disease (CLD(
  12. 12. Pulmonary causes Common Rare RDS Lung hypoplasia Trans tachypne Obstr upper airways Meconium asp Tumours Pneumonia Pulm hemorrhage Pneumothorax Malformations Cong diaprhagmatic hernia
  13. 13. Extra-pulmonary causes Common Rare Persist Fetal Circulat Cerebral edema Cong Cord Malfor Drugs Cerebral Hemorrhage Neuromuscular Polycythemia Asph, spinal cord Hypoglycemia Metabolic Diseases Hypothermia Acidosis
  14. 14. Evaluation of Respiratory Distress Administer Oxygen and other necessary emergency treatment Vital sign assessment Determine cause-- physical exam, Chest x-ray, ABG, Screening tests: Hematocrit, blood glucose, CBC Sepsis work-up
  15. 15. Principles of Therapy Improve oxygen delivery to lungs-- supplemental oxygen, CPAP, assisted ventilation, surfactant Improve blood flow to lungs-- volume expanders, blood transfusion, partial exchange transfusion for high hematocrit, correct acidosis (metabolic/respiratory( Minimize oxygen consumption-- neutral thermal environment, warming/humidifying oxygen, withhold oral feedings, minimal handling
  16. 16. Respiratory Distress Syndrome Also called as hyaline membrane disease Most common cause of respiratory distress in premature infants, correlating with structural & functional lung immaturity. 1/3infants born between 28 to 34 weeks, but less than 5% of those born after 34 weeks. Pathophysiology- surfactant deficiency- increase in alveolar surface tension- decrease in compliance.
  17. 17. CLINICAL FEATURES OF RDS Tachypnea/Apnea Dyspnea Grunting/Flaring Hypoxemia Radiographic Features Pulmonary Function Abnormalities
  18. 18. Early RDS
  19. 19. Progressive RDS
  20. 20. Late RDS
  21. 21. THERAPY FOR RDS Oxygen - maintain PaO2 > 50 torr Nasal CPAP Intermittent Mandatory Ventilation Surfactant Replacement High Frequency Ventilation Intercurrent Therapies
  22. 22. PIE
  23. 23. PIE Pathology
  24. 24. Pneumothorax/PIE
  25. 25. Pneumothorax
  26. 26. Pneumopericardium
  27. 27. TRANSIENT TACHYPNEA OF THE NEWBORN 40%cases Delayed Fluid Resorption Hard to differentiate early on from RDS both clinicaly and radiographicaly especially in the premature infant Initial therapy similar to RDS, but hospital course is quite different
  28. 28. Wet Lung
  29. 29. Meconium Aspiration Syndrome Incidence- 1.5- 2 % in term or post term infants. Meconium is locally irritative, obstructive & medium for for bacterial culture Meconium aspiration causes significant respiratory distress. Hypoxia occurs because aspiration occurs in utero. CXR- Patchy atelectasis or consolidation.
  30. 30. Meconium Aspiration
  31. 31. MAS
  32. 32. PERSISTENT PULMONARY HYPERTENSION Usually secondary to primary pulmonary disease state Pulmonary Vascular Lability Treat the underlying problem Maintain normo-oxygenation Selective Pulmonary Vasodilators Pray for good luck
  33. 33. PPHN
  34. 34. CONGENITAL PNEUMONIA Infectious; primarily GBS Amniotic Fluid aspiration Viral etiology Surfactant inactivation
  35. 35. GBS Pneumonia
  36. 36. Pneumonia
  37. 37. CONGENITAL MALFORMATIONS Choanal Atresia Tracheal Atresia/stenosis Chest Mass Diaphragmatic hernia Sequestration Lobar emphysema
  38. 38. Lobar Emphysema
  39. 39. Diaphragmatic Hernia
  40. 40. Chylothorax
  41. 41. Phrenic Nerve Paralysis
  42. 42. ACQUIRED DISEASES Infections Bronchopulmonary Dysplasia Sub-glottic stenosis Apnea of Prematurity
  43. 43. Early BPD
  44. 44. Progressive BPD
  45. 45. Late BPD
  46. 46. APNEA Definition: cessation of breathing for longer than a 15 second period or for a shorter time if there is bradycardia or cyanosis
  47. 47. Babies at Risk for Apnea Preterm Respiratory Distress Metabolic Disorders Infections Cold-stressed babies who are being warmed CNS disorders Low Blood volume or low Hematocrit Perinatal Compromise Maternal drugs in labor
  48. 48. Anticipation and Detection Place at-risk infants on cardio- respiratory monitor Low heart rate limit (80-100( Respiratory alarm (15-20 seconds(
  49. 49. Treatment Determine cause: x-ray blood sugar body and environmental temperature hematocrit sepsis work up electrolytes cardiac work up
  50. 50. Treatment CPAP Theophylline/Caffeine therapy Mechanical ventilation Apnea monitor
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