RESIPIRATORY SYNDROMES IN PEDIATRIC.pptx

Respiratory syndromes in pediatrics is most commom disaster world wide

1. IDIOPATHIC RESPIRSTORY DISTRESS SYNDROME

2. IRDS Idiopathic Respiratory Distress Syndrome (Hyaline membrane disease) is a condition which is seen almost exclusively in premature infants. It is caused by lack of pulmonary surfactant and structural immaturity of the lungs. It can also be a consequence of neonatal infection. It can also result from genetic problem with the production of surfactant associated protein

3. IRDS( pathophysiology ) The alveoli of the lungs of a premature infant( the terminal air spaces are in a collapsed state. Since the fetus is surrounded with fluid, the collapsed walls of the alveoli are separated by a film of water. These molecules attract each other causing a surface tension. Developmentally the lungs are also deficient in a material called surfactant. Surfactant is a component of lecithin – a saturated phosphatidylcholine and sphyngomyeline – a phospholipid . Lecithin is produced by type II alveolar cells. Sphyngomyeline is produced predominantly in body tissues other than the lungs.

4. Pathophysiology (cont) N/B lecithin increases in late gestation but sphyngomyelin remains constant. Lethicin sphyngomyelin ratio(L:S ) is used to determine the maturity of the fetal lung -L:S 1.5:I 73% will develop IRDS -L:S 1.5 -1.9:1 50% will develop IRDS -L:S 2:1 lungs are mature, only 2% will develop IRDS

5. PATHOPHYSIOLOGY(cont) -surfactant helps prevent collapse of the alveoli on exhalation -the deficiency of surfactant is related to inhibition from insulin that is produced in the newborn and especially of a diabetic mother. It is also seen in Rh isoimmunization associated with hydrops fetalis -microscopically the lungs are characterized by collapsed air spaces alternating with hyper expanded area, vascular congestion.

6. PATHOPHYSIOLOGY(cont) -hyaline membrane is composed of fibrin, cellular debris, RBC, neutrophils and macrophages. Blood passing through the lungs is unable to pick up oxygen and unload carbon dioxide SIGNS:- -IRDS starts shortly after birth:- fast breathing >60/min, fast heart rate, chest wall retraction, expiratory grunting, nasal flaring, cyanosis

7. IRDS(treatment) -oxygen given in small amounts of continuous positive pressure(CPAP) -support breathing if condition worsens - hydrate the child -give antibiotics N/B:- the X-ray presents with a bilateral and symmetric diffuse ground glass lungs and a bell shaped thorax

8. MECONIUM ASPIRATION SYNDROME(MAS) Meconium is a collection of desquamated cells from the digestive tract, bile salts amniotic fluid (80-85 %) is water. It starts to appear towards the beginning of the second trimester and accumulates in the colon until birth Meconium is sometimes passed into the amniotic fluid before or around the time of birth Passage of meconium occurs in response to stress or inadequate oxygen levels in the blood

9. PATHOPHYSIOLOGY Passing of meconium in the preterm baby is not normal unless the fetus develops an infection while in utero MAS occurs when stress such as infection or low oxygen level causes the fetus to take forceful gasps so that the amniotic fluid containing meconium is aspirated (when oxygen tension is low, majority of sphincters including the anal sphincter will relax) releasing meconium

10. PATHOPHYSIOLOGY(cont) The aspirated meconium is deported to the lungs. After delivery, the aspirated meconium may block the newborn’s airways causing regions of lungs to collapse. Sometimes airways are partially blocked allowing air to reach the parts of the lungs beyond the blockage but preventing it from being breathed out. Thus, the involved lung may become over distended. When a portion of the lung continues to over expand it can rupture and then collapse the lung causing pneumothorax

11. Meconium is irritant and can cause inflammation of the lungs(chemical pneumonitis and increase the risk of infection Symptoms:- -respiratory distress:- rapid breathing, chest wall in drawing expiratory granting, cyanosis -the umbilical cord and nails are stained greenish yellow due to meconium

12. DIAGNOSIS Diagnosis:- -meconium in the oral pharynx -trouble breathing -chest X- ray shows hyperinflation and variable areas of atelectasis and flattening of the diaphragm

13. Treatment:- -suction the airway -support breathing(CPAP) -antibiotics incase of infection -hydrate the infant Prognosis:- -in the majority , good -few may develop persistent pulmonaru hypertension of newborn