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RESPIRATORY DISORDERS
DEFINITION :
DIAGNOSIS
Respiration : > 60 x/Min Physical Examination : Dyspnea Cyanosis Retractions Grunting
MANAGEMENT
Temperature : 36,50C 37,50C Oksigen Fluid Therapy Minimal Handling Position Chest Radiograph Antibiotics Blood pressure monitoring Arterial Blood gas Analysis and pH Laboratorium :
Blood Count and differential Culture
MECONIUM ASPIRATION
Definition :
Aspiration of mecoinum-stained amniotic fluid by the fetus in utero or by the newborn during labor and delivery
PATHOPHYSIOLOGY
Physiologic meconium passage (particulary if postdates) Fetal compromised (hypoxia, cord compression, etc.) meconium passage Meconium stainned amniotic fluid Post partum aspiration In utero gasping
Meconium aspiration Peripheral airway obstruction Complete Atelectasis V/Q mismatch Partial Ball valve effect Air - trapping Air - leaks Acidosis Hypoxemia Hypercapnia Proximal airway obstruction Inflammatory and chemical pneumonitis
Continued compromise
THERAPY
Delivery Room Management
Meconium in amniotic fluid
Thin Infant active Observe Resuscitate PRN Infant depressed Suction trachea
Thick
Resuscitate PRN
GENERAL MANAGEMENT
Temperature Metabolic Cardiopulmonary Function Fluid Antibiotics
OKSIGEN
PaO2 : 50 80 mmHg.
Also known as wet lung and type II respiratory distress syndrome. It is a benign disease of near term, term or large prematur infants who have respiratory distress shortly after delivery that usually resolves within 3 days. Delayed resorption of fetal lung fluid Pulmonary immaturity Mild surfactan deficiensy
PATHOPHYSIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION :
Term infant Family with risk factor Tachypnea ( > 60 x/min)
LABORATORIUM :
Hypoxemia Mild respiratory acidosis Improvement within 24 hours
RADIOLOGIC :
Hyperaeration, mild cardiomegaly Sunburst Resolves within 2 3 days
THERAPY
Oksigen Fluid restriction Resolves within 48 72 hours
APNEA
DEFINITION :
Absence of respiratory, with or without bradycardia or cyanosis
CLASSIFICATION :
ETIOLOGY, based on :
Disease Gestational age Post natal age
PATHOPHYSIOLOGY
Immaturity of respiratory control Sleep realted response Protective reflexes Muscle weakness All of the above point to an immature respiratory control mechanism in the pretern infant
DIAGNOSIS
HISTORY CLINICAL PRESENTATION :
Lethargy Hypothermia Intracranial High pressure Abdomen distention
LABORATORIUM :
Blood count and morphology Arterial blood gas Serum glucose, electrolyte
RADIOLOGY
Chest X Ray Abdominal X Ray Ultrasonography of the head CT Scan of the head
THERAPY
Preventive Aminophyllin Continuous positive airway presure (CPAP) Mechanical ventilation
DEFINITION :
Respiratory distress syndrome in a preterm newborn with respiratory difficulty, including tachypnea, chest retraction and cyanosis, that persists or progresses over the first 48 96 hours of life and with a characteristic chest x ray film (uniform reticulogranular pattern and air bronchograms)
PATHOPHYSIOLOGY
Prematurity
Surfactant synthesis and release
DIAGNOSIS
Preterm infant, respiratory difficulty Chest x ray : Uniform reticulogranular Pattern and Air Brochograms Laboratorium :
Blood count : No Infection Blood culture : Negative Arterial Blood gas : Hipoxemia and Acidemia L/S Ratio : <2:1
THERAPY :
Temperature Oksigen Fluid and Electrolyte Circulation Antibiotics