NICU Presentation 08312010

8/8/2019 NICU Presentation 08312010

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Case 1Infant is born to a 32 yr old mom. Minutes after birth the baby has pink arms and cyanotic legs.VS BP: 60/40, RR: 85, P: 190, O 2% 82.Physical exam shows a systolic murmur andsoft S1. Blood gas shows high pC O 2 and lowpO 2. Platelets 80,000. What is the most likely

diagnosis?


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Persistent Pulmonary Hypertension

of the NewbornStatsWhats wrong?

Can we treat it?Whos at risk?


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interactions?


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of the NewbornClinical PresentationA re you sure its PPHN?


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Echocardiogram of PPHN


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of the NewbornManagementComplications


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Case Example 2

41 week baby girl was born to a 35 yr oldmom. The pregnancy was complicated byhypertension and gestational DM. Duringdelivery a meconium stained amniotic fluidis noted. PE reveals nasal flaring,cyanosis, desaturations, coarse rhonchi,

green umbilical cord and mouth. CXRshows. What are the chances this babywill die?


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Meconium A spiration


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Meconium A spiration

PrognosisTreatment

Signs and SymptomsDiagnosisChemical Pneumonitis


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Case Example 4

29 year old mother gives birth to a boy at 30 weeksgestation. During labor the mother was reported tohave a fever and tender uterus. Babys VS: T37.2,

P155, BP 60/40, wt 973g, R 30. Breathing is laboredwith subcostal retractions are noted and the pt is puton assisted ventilation. A ttempts to wean the newbornover 2wks are unsuccessful. F/u echocardiogram

shows a closed PD A .


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Case Example 4


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Case Example 4

Blood gases show pH 7.23, pC O 2 65. BMP showsCO 2 24. By 39 weeks cG A the patient graduallyimproves and is discharged home to mom. What

kind of prophylaxis does this patient need upondischarge from the hospital?


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Bronchopulmonary Dysplasia

Synagis/PalivizumabClinical Course of BPD

Have increased risk of developingpulmonary hypertension


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Bronchopulmonary Dysplasia

DefinitionPathology

Risk factorsTreatment


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Ventilator ManagementConcepts


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Ventilation vs O xygenationVentilation O xygenation

Respiratory Rate Mean A irway Pressure

Tidal Volume Fi O 2

PEEP PEEP

PIP PIP

Patient status V/Q Mismatch

M A P = K(PIP PEEP) x (Ti/Ti+Te) + PEEP


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Mechanical Ventilation

Concepts and DefinitionsMinute Ventilation V E

VT; V A , VD, VE=VT x RR

VT=

PEEP similar to M A P in HF O VMean A irway Pressure M A P = K(PIP PEEP) x (Ti/Ti+Te) + PEEP


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Supplemental O xygen

Hypoxic infants able to maintain anadequate minute ventilation are assistedwith free-flow oxygen or air-oxygenmixtures.Nasal CannulaHoodsMask


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Supplemental O xygen

Flow 1-8 L/minFiO 2

Nebulization/VaporizationTemperature


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CP A P

Nasal ProngsNasal Pharyngeal

Nasal VentilationMask


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CP A P

PressureFlow

Humidified


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High Frequency

High Frequency O scillatory Ventilators(HF O V)

High Frequency Jet VentilatorsHigh Frequency Flow Interruptors


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HF O V

Mean A irway PressureA mplitude analogous to PIP

FlowFrequencyInspiratory time


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Pressure ControlledVolume Controlled

Patient InitiatedPatient TriggeredSynchronized Intermittent Mandatory

VentilationProportional A ssist


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Increase in: pCO2 pO2 MAP

FiO2 no change increase no change

Rate decrease usually no change increase

PIP/TV decrease increase increase

Inspiratory time usually no change increase increase

PEEP usually no change increase increase

The question becomes: In what kind of mechanicalventilation are these constant or set by the operator?


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Volumecontrolled

Pressure Cycled(Pressure Control vPressure Support)

VolumeCycled(SIMV v A /C)

IMV HFO V CP A P

PEEP y y y O perator set y

PIP O perator Set O perator Set A /C

FiO 2 Usually


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Variables


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Websites

http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/pulmonary/index.html

http://forums.studentdoctor.net/archive/index.php/t-498040.htmlhttp://www.hawaii.edu/medicine/pediatrics/pedtext/s14c05.html

http://www.merck.com/mmpe/sec06/ch065/ch065b.html#sec06-ch065-ch065b-339Stat!Ref


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Books

Klaus


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Questions


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Documents

NICU Presentation 08312010