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Pulmonary Systemic
Metabolic (e.g.,
Anatomic
Transient tachypnea of hypoglycemia, hypothermia
the newborn (TTN) or hyperthermia)
Upper airway
metabolic acidosis obstruction
Respiratory distress
syndrome (RDS) Airway
anemia, polycythemia malformation
Pneumonia Rib cage anomalies
Cardiac
• Congenital heart disease;
Meconium aspiration Diaphragmatic
cyanotic or acyanotic
syndrome (MAS) disorders
• Congestive heart failure
• Persistent pulmonary (e.g., congenital
Air leak syndromes hypertension of the newborn diaphragmatic
(PPHN) hernia,
Pulmonary
hemorrhage diaphragmatic
Neurological (e.g., prenatal paralysis)
asphyxia, meningitis)
Pulmonary
1- Transient tachypnea of newborn
4- Pneumonia
Risk factors:
Maternal asthma
C- section
Fluid in the
fissure
General Management of Respiratory Distress
4- Pneumonia
Volume Maximal volume
Pressure Opening pressures
17
Risk factors
Prematurity
Maternal diabetes
Multiple births
Perinatal asphyxia
Cold stress
Genetic disorders
Decreased risk
In most cases, symptoms and signs reach a peak within 3 days, after
which improvement occurs gradually.
Chest x-ray:
Findings can be graded according to the severity:
ALEC
Lucinactant (Surfaxin)
Surfactant Therapy for RDS
30
Mode of administration of Surfactant
Dosing may be
divided into 2
alliquots and
adminitered via
a 5-Fr catheter
passed in the
ET
Insure technique
Intubation-
surfactant-
extubation to CPAP
Pulmonary
1- Transient tachypnea of newborn
4- Pneumonia
Risk Factors:
Post-term pregnancy
IUGR
In the NICU:
Empty stomach contents to avoid further aspiration.
4- Pneumonia
Candida.
44
Management
4- Pneumonia
prematurity
pneumonia
Clinical Manifestations
Spontaneous pneumothorax may be asymptomatic or
only mildly symptomatic (i.e., tachypnea and ↑O2
needs).
In unilateral cases, chest asymmetry is noted,
mediastinum shift to the opposite side.
If the infant is on ventilatory support will have sudden
onset of clinical deterioration (i.e., cyanosis, hypoxemia,
hypercarbia & respiratory acidosis associated with
decreased breath sounds and shifted heart sounds).
Tension pneumothorax
(a life-
threatening
condition) →
↓cardiac
output and
obstructive
shock; urgent
drainage prior
to a radiograph
is mandatory.
Chest x-ray: Right-sided pneumothorax
Right-sided tension pneumothorax with mediastinal shift. Both
lungs demonstrate opacification of alveolar collapse.
Left-sided pneumothorax under tension. There is pulmonary interstitial
emphysema in the right lung and a small basal right pneumothorax.
Others
Pneumomediastinum
Pneumopericardium
Pneumoperitoneum
Subcutaneous emphysema
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