Neonatal pneumopathy

Neonatal pneumopathy (lung disease) includes:

respiratory distress syndrome (RDS - respiratory distress syndrome, IRDS - idiopathic RDS; hyaline membrane syndrome),
barotrauma: pulmonary interstitial emphysema (PIE), pneumothorax (PNO), pneumomediastinum, pneumopericardium, pneumoperitoneum,
persistent fetal circulation syndrome (PFC; persistent pulmonary hypertension of the newborn, PPHN),
meconium aspiration syndrome (MAS) and other aspiration syndromes,
congenital diaphragmatic hernia,
neonatal pneumonia,
pulmonary apoplexy,
bronchopulmonary dysplasia (BPD; CLD – chronic lung disease).

Brief overview[edit | edit source]

characteristic: acute disease mainly affecting premature and NNPH, caused by surfactant deficiency
clinical picture: tachypnea, alar flexion, retraction of jugular and subcostals, grunting, cyanosis
diagnosis: clinical picture, X-ray - reticulogranular pattern to gradual homogeneous shadowing ("white lung" picture)
therapy: provision of ventilation (oxygen therapy, distension therapy, UPV, administration of surfactant), circulation and parenteral nutrition
prevention: prevention of prematurity, preventive prenatal administration of steroids to the mother (so-called "induction of lung maturity")

For more information see Respiratory Distress Syndrome (Pediatrics).

characteristic: the presence of gas in the pleural cavity
clinical picture: sudden dyspnea, hypoxia, hypercapnia, cyanosis, inaudible respiration on the affected side, sometimes bulging hemithorax, circulatory failure
diagnosis: clinical picture, auscultation, translumination, X-ray
therapy: chest puncture, chest drainage, ensuring ventilation and oxygenation, ensuring circulation

For more information see Pneumothorax (Neonatology).

characteristic: persistence of right-to-left shunts in the circulation due to postnatal hypoxia and acidosis; normal heart structure; accompanies MAS, PNO, RDS, diaphragmatic hernia, sepsis, hypoxia
clinical picture': severe hypoxia, circulatory failure, picture reminiscent of cyanotic congenital heart disease
diagnosis: echocardiography
therapy: treatment of primary cause, UPV, NO, ECMO

characteristic: inhalation of meconium before, during or just after birth
clinical picture: presence of meconium in amniotic fluid and oral cavity, signs of ventilation and circulatory failure, meconium-colored skin
diagnosis: clinical picture, X-ray
therapy: suctioning of the oral cavity and airways laryngoscopically and via ET cannula, UPV, treatment of circulatory failure, treatment of PFC

characteristic: hemorrhagic pulmonary edema - bleeding into the lungs
clinical picture': the child's ventilation suddenly deteriorates - he is pale, dyspneic to apneic with bradycardia and cyanosis, pink-red secretion oozes from the oral cavity or endotracheal cannula
diagnosis: typical clinical picture: respiratory deterioration accompanied by bleeding from the respiratory tract
therapy: suction from the airways, optimization of ventilation and oxygen therapy, maintenance of basic vital functions, treatment of the primary cause and supportive treatment.

characteristic: congenital defect of the diaphragm with displacement of the abdominal organs into the chest; most often left-sided (Bochdale's)
clinical picture': according to the degree of the diaphragm defect - rapidly progressing shortness of breath and circulatory failure, inaudible breathing on the side of the defect, sunken abdomen
diagnosis: clinical picture, hearing findings, X-ray
therapy': intubation and UPV (as low as possible inspiratory pressures and peep), nasogastric tube, PFC treatment

characteristic: chronic lung involvement resulting from lung damage in neonatal age as a result of prolonged mechanical ventilation and high concentration of oxygen in inhaled air; caused by abnormal repair of lung tissue
diagnosis: oxygen dependence even after 28 days after birth, X-ray
therapy': oxygen therapy, UPV, proper nutrition, diuretics, steroids, theophylline, bronchodilation, treatment of infection, nursing care