Infant Lung Disease and Associated Complications

Infant Lung Disease and Associated Complications
By:Mary P. Martinasek, BS, RRT
Director of Clinical Education
Hillsborough Community College

Respiratory Distress Syndrome
* RDS , formerly called Hyaline Membrane disease (HMD)
* Primary cause of respiratory disorders
* 70% preterm deaths, 30% neonatal deaths
* Etiology - deficiency in surfactant
o Premature pulmonary system

Risk Factors associated with RDS
* Less than 35 weeks gestation
* Maternal diabetes
* Hx of RDS in sibling
* White male
* PFC (Persistent Fetal Circulation)
* Prenatal maternal complication
* Abnormal placental conditions
* Umbilical cord disorders

Pathophysiology of RDS
Decreased surfactant
Surface Tension
Compliance
Stiffer Lungs
Wide spread atelectasis
Worsening V/Q
FRC
WOB
PaO2& __ PaCO2
Respiratory Acidosis
Capillary damage
Alveolar Necrosis
Clinical Signs of RDS
* Respiratory Rate > 60 bpm
* Grunting
* Retracting
* Nasal flaring
* Cyanosis
* Hypothermia
* CXR = underaeration, opaque, ground glass appearance

Treatment of RDS
* Maternal steroids
* Artificial surfactant therapy
* Adequate hydration
* Thermoregulation
* Goal = support the patient’s respiratory system while minimizing complications

Complication of RDS
* ICH occurs in 40% of < 1500 grams
* Barotrauma = pulmonary air leaks
* Infection
* PDA

Airleak Identification
Clinical Scenario
BPD
Pathophysiology of BPD
CXR in BPD
* Stage I
o First 3 days of life
o Ground glass appearance on x-ray
* Stage II
o 3 - 10 days
o Opaque, obscure cardiac markings
* Stage III
o 10 - 20 days
o Cyst formations
* Stage IV
o 28 days
o Increased lung density, larger cysts
Treatment of BPD
* Avoidance of factors that lead to development
* Adequate ventilatory humidification
* CPT and bronchodilators
* Fluid management
* Nutrition

Persistent Pulmonary Hypertension
Treatment of PPHN
* Nitric Oxide (NO)
* Hyperventilation
* Tolazoline
* Dopamine
* ECMO (extracorporeal membrane oxygenation
* High frequency ventilation
Reverse Jeopardy
* What color tank is NO?
* What color tank is NO2?

Transient Tachypnea of the Newborn
* TTN
* Aka RDS II
* Term infants delivered via cesarean section
* Signs of RDS
* CXR - streaky infiltrates
* R/O pneumonia
* Treatment

TTN x-ray
Meconium Aspiration Syndrome
* Term and Postterm infan
Diagnosis and Treatment
* Aspiration of meconium
* Classic sign of RDS
* Irregular densities on CXR
* Treatment
o Suction meconium
o Peep
o Low peak pressures
o Antibiotics
o amnioinfusion

MAS x-ray
Asphyxia
* Major complication is hypoxic-ischemic encephalopathy
o Periventricular leukomalacia
* Tubular necrosis of kidneys and GI effects
* Liver damage
* Lung damage
PVL
Wilson- Mikity Syndrome
* AKA - Pulmonary dysmaturity
* BPD lung changes in unventilated infant
* Signs
o Hyperpnea, cyanosis, retractions, hypercarbia, respiratory acidosis
* Treatment
o Supportive
o Ventilated to treat apnea
o O2 to treat hypoxemia
Air leak syndrome
PIE x-ray
Apnea
Central or Nonobstructive Apnea
* Apnea of prematurity
* Chemoreceptor sensitivity
* Arousal response
* Stimulation of airway reflexes
* Dysfunction of the respiratory centers
* Dysfunction of the ventilatory muscles
* Dysfunction of the peripheral nervous system
* Treatment = caffeine or theophylline
Obstructive apnea
* Anatomic abnormalities
* Pierre Robin Syndrome (micronathia)
* choanal atresia, laryngeal webs, vocal cord paralysis, enlarged tonsils and adenoids
* Treatment = pharmacologic agents, surgery

What is choanal atresia and what is the classic sign?
Pierre Robin Syndrome
What is this x-ray terminology for this condition?
Retinopathy of Prematurity
Pathophysiology
Treatment of ROP
Intracranial/Intraventricular
Hemorrhage
* ICH and IVH
* Majority of hemorrhages in neonate are periventricular/ Intraventricular (IVH)
* Preterm and Infants <1500 grams high risk
* Germinal matrix most common

IVH
Signs of germinal matrix bleeding
IVH Classifications
Complications/ Treatment of IVH

Infant Lung Disease and Associated Complications.ppt