BRONCHOPULMONARY DYSPLASIA FOR NEONATAL CLASS 2013 (1).pptx

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1. BRONCHOPULMONARY DYSPLASIA BY D. AGEDO

2. OBJECTIVES By the end of the lesson the students will be able to define BPD. by the end of the lesson The students will be able to describe the etiology and pathophysiology of BPD. By the end of the lesson the students should be able to outline the clinical presentation of BPD. 2/10/2022 11:21:18 AM NEONATAL NURSING 2

3. DEFINITION A chronic lung disease that develops in infants treated with oxygen and positive pressure ventilation for a primary lung disorder. 2/10/2022 11:21:18 AM NEONATAL NURSING 3

4. INCIDENCE Vary because of difference in diagnostic criteria. Estimates: Less than 700gms: 85% affected Greater than 1500gms: 5% affected. 2/10/2022 11:21:18 AM NEONATAL NURSING 4

5. AETIOLOGY Oxygen toxicity. Assisted ventilation with positive pressure(barotrauma and volutrauma ).. Increased shunting Excessive fluid intake in the 1 st 4 days. 2/10/2022 11:21:18 AM NEONATAL NURSING 5

6. PREDISPOSING FACTORS Oxygen, intubation and assisted ventilation. Gestational age the lower the age the greater the incidence. Nutritional deficiencies. Underlying lung disease. Air leaks. 2/10/2022 11:21:18 AM NEONATAL NURSING 6

7. PATHOPHYSIOLOGY Formation of hyaline membrane regeneration and repair of alveolar epithelium necrosis of alveolar epithelium bronchial smooth muscle metaplasia interstitial fibrosis formation of emphysematous bullae Pulmonary hypertension 2/10/2022 11:21:18 AM NEONATAL NURSING 7

8. PATHOPHYSIOLOGY CONT’ This results in decreased pulmonary compliance and increased airway resistance secondary to fibrosis. Ventilation/perfusion mismatch occurs resulting in increasing oxygen requirements to maintain partial pressures of oxygen. Excessive mucous secretion and air trapping occur leading to hypercarbia . 2/10/2022 11:21:18 AM NEONATAL NURSING 8

9. PATHOPHYSIOLOGY CONT’ Interstitial edema and excess lung fluid develops. Many have left to right shunting through a PDA which causes pulmonary congestion. This results in hypoxemia, pulmonary hypertension and cor pulmonale (right heart failure secondary to lung disease). 2/10/2022 11:21:18 AM NEONATAL NURSING 9

10. CLINICAL PRESENTATION Increase in ventilatory requirement or inability to be weaned of ventilator. Hypoxia, hypercapnia and respiratory acidosis. Audible rales, rhonchi and wheezing. Retractions Bronchospasms 2/10/2022 11:21:18 AM NEONATAL NURSING 10

11. CLINICAL PRESENTATIONS Increased secretions. ECG: right ventricular hypertrophy and right axis deviation. CXR: hyperinflation and cardiomegaly. Fluid intolerance evidenced by: increase in weight, edema and decrease in urine output despite no change in fluid intake. 2/10/2022 11:21:18 AM NEONATAL NURSING 11

12. DIAGNOSIS CXR Clinical signs e.g. tachypnea, hypoxia, hypercapnia, and rales. 2/10/2022 11:21:18 AM NEONATAL NURSING 12

13. DIFFERENTIAL DIAGNOSIS Sepsis Pneumonia Airway obstruction PDA 2/10/2022 11:21:18 AM NEONATAL NURSING 13

14. MANAGEMENT Mechanical ventilation (minimal pressure and tidal volume). Supplemental oxygen Surfactant replacement therapy Monitoring (ABG’S, pulse oximetry , pulmonary function testing). Fluid management; minimal requirement 2/10/2022 11:21:18 AM NEONATAL NURSING 14

15. NURSING MANAGEMENT Assessment Respiratory distress Blood gas analysis Fluid balance Discomfort/pain 2/10/2022 11:21:18 AM NEONATAL NURSING 15

16. NURSING DIAGNOSIS Ineffective breathing pattern related to lung injury as evidenced by tachypnea, grunting respirations and nasal flaring. Fluid volume deficit related to fluid restriction and diuretic use as evidenced by dehydration. 2/10/2022 11:21:18 AM NEONATAL NURSING 16

17. INTERVENTION Monitoring of respiratory rate Administer oxygen Use of bronchodilators/nebulization. Monitor fluid input and output Monitor electrolytes Administer analgesics Nutrition 2/10/2022 11:21:18 AM NEONATAL NURSING 17

18. OUTCOME Mortality rate is approximately 10-15% by 1 year of age. Some infants will de discharged home with supplemental oxygen. Recurrent pulmonary infections. Growth retardation.. Neurologic and developmental sequelae : cerebral palsy, sensorineural hearing loss and retinopathy of prematurity . 2/10/2022 11:21:18 AM NEONATAL NURSING 18

19. COMPLICATIONS Intermittent bronchospasms. Inability to be weaned from ventilator and/or oxygen supplementation. Recurrent infections. Congestive heart failure. BPD spells. Gastroesophageal reflux. Developmental delays. 2/10/2022 11:21:18 AM NEONATAL NURSING 19

20. PREVENTION Administration of steroids antenatally . Surfactant replacement therapy. Gentle ventilation and early extubation. Some evidence supports the use of early postnatal steroids. Synchronized intermittent mandatory ventilation. 2/10/2022 11:21:18 AM NEONATAL NURSING 20

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22. THE END . 2/10/2022 11:21:18 AM NEONATAL NURSING 22 THANK YOU