Neonatal Diseases

Posted by e-Medical PPT Sunday, September 11, 2011
Perinatal Diseases and Other Problems with Prematurity
Retinopathy of prematurity (ROP)
Patent Ductus Arteriosus
Hypoglycemia
Cold Stress
Intraventricular and Intracerebral hemorrhaging
Bronchopulmonary dysplasia
Wilson Mikity Syndrome
Apnea of prematurity
Necrotizing enterocolitis
RDS

Retinopathy of Prematurity (ROP)
Formerly known as Retrolental Fibroplasia (RLF).
Initially described in 1940/1950s following increased incidence of blindness with babies in incubators.
Incidence today:
25 to 35% of preemies up to 35 weeks

Physiology of the Developing Eye
Capillaries of retina begin branching at 16 weeks.
End of pseudoglandular period.
Capillaries begin at optic nerve and grow anteriorly toward the ora serrata which is the anterior end of the retina.
Growth is not complete until 40 weeks.
Premature infants don’t have complete growth.
As the capillary network expands, arteries and veins form in its path.
ROP is the failure of this network to develop.

Oxygen and ROP
In the presence of high PaO2, the retinal vessels constrict.
Prolonged exposure to high PaO2 will lead to necrosis of the vessels (vaso-obliteration).
The body attempts to correct for this by over perfusing the “good” arteries, which leads to hemorrhage in the vitreous.
This hemorrhage leads to scar tissue development and blindness.

RDS  - Respiratory Distress Syndrome
IRDS or Hyaline Membrane Disease
Associated with lung immaturity and a deficiency in surfactant production.
Immaturity of other organ systems.
Decreased Compliance & increased WOB.
Severe hypoxemia may result in multiple organ failure.
May be associated with PPHN (PFC) or PDA.
Symptoms worsen for first 48-72 hours.
 Stabilization
 Slow recovery
With progression of the disease, scar tissue replaces the normal alveolar tissue.
 Hyaline Membrane

Bronchopulmonary Dysplasia
Other Name
Neonatal Chronic Lung Disease (NCLD)
Progressive chronic lung disease that presents with persistent respiratory problems at 28 days or later, radiographic changes and oxygen dependency
Criteria
 Preterm infants
 Prolonged oxygen concentrations (O2 toxicity)
 Positive pressure ventilation (barotrauma)
 Patent ductus arteriosus (PDA)
 Time exposure to oxygen and positive pressure
 Malnutrition

Lung Pathology
 Mucosal hyperplasia of small airways.
 Destruction of type I cells.
 Inflammation and destruction of alveoli and capillary bed.
 Lungs are cystic in some areas and atelectatic in others.

Radiology
“Honeycomb” appearance
Diaphragms are flattened
Cystic appear (hyperlucent)
Atelectasis (radiopaque)

Necrotizing Enterocolitis (NEC)
Injury to the intestinal mucosa due to hypoperfusion, hypoxia or hyperosmolar feedings.
The mucosa cannot secrete the protective layer of mucus and it becomes vulnerable to bacterial invasion.
Intestinal ischemia may result in necrosis and gangrene of the intestine.
Complication of RDS.
Highest incidence in lowest birth weight infants.
Intestinal dilation (distended loops of intestine with gas).
Gastric ileus (obstruction)
Abdominal distention.
Rectal bleeding
Bloody stool
Feeding is difficult.

Intraventricular Hemorrhage (IVH)
Premature infants and low birth weight infants are the greatest risk.
Diagnosed by ultrasound or CT scan.
Seen with increased incidence in children of alcoholic mothers.
4 grades of IVH.
Grade 1 - Bleeding occurs just in a small area of the ventricles.
Grade 2 - Bleeding also occurs inside the ventricles.
Grade 3 - Ventricles are enlarged by the blood.
Grade 4 - Bleeding into the brain tissues around the ventricles.

Wilson-Mikity Syndrome
Seen in premature and LBW infants.
Less than 1500 grams at birth.
“Emphysema” of little babies.
Lung immaturity with rupture of the alveolar septa.
Similar to BPD except babies have not been ventilated.
Treatment is supportive.
Oxygen and mechanical ventilation.
Some question as to whether it is a separate syndrome or not.

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