SOS！ Common respiratory diseases of newborns (2)

3. Etiology of respiratory distress syndrome (respiratory distress syndrome; RDS), also known as hyaline membrane disease, is due to the insufficient secretion of the second type of lung cells that make surfactant in alveoli, which leads to the collapse or incomplete expansion of alveoli and insufficient ventilation, leading to dyspnea and even respiratory failure. The etiology of neonatal respiratory distress syndrome can be found from lung, heart, blood, infection, congenital structural abnormality, metabolic diseases, etc. These diseases may directly or indirectly affect the lung. Lack of pulmonary surfactant can cause respiratory distress syndrome, leading to cyanosis and shortness of breath. Infection can cause pneumonia and show interstitial or lobar infiltration. Inhalation of meconium can lead to chemical pneumonia, leading to hypoxia and pulmonary hypertension. Fetal edema can cause anemia, and hypoproteinemia can be complicated with high output heart failure and pulmonary edema. Congenital or acquired pulmonary hypoplasia will cause pulmonary hypertension and pulmonary insufficiency. According to the gestational age of the fetus, the causes can be divided into the following categories: * Premature infants: respiratory distress syndrome, fetal polycythemia, non-immune fetal edema and pulmonary hemorrhage. * Full-term infants: neonatal primary pulmonary hypertension, meconium aspiration pneumonia, polycythemia, amniotic fluid aspiration. * Both premature and full-term infants can suffer from bacterial septicemia (group B streptococcus), neonatal temporary shortness of breath, spontaneous pneumothorax, congenital anomalies (such as congenital lobar emphysema, congenital cystadenoma-like pulmonary malformation, diaphragmatic hernia), congenital heart disease, pulmonary hypoplasia, viral infection (such as herpes simplex virus and cytomegalovirus) and metabolic diseases. The inducement of respiratory distress syndrome includes: premature delivery and low birth weight infants; Insufficient synthesis of pulmonary surfactant, such as pregnant women with gestational diabetes, perinatal asphyxia, elective caesarean section before labor pains, baby boy, family history of respiratory distress syndrome, twins with second child, and congenital abnormality such as diaphragmatic hernia leading to pulmonary hypoplasia. Symptoms The symptoms of respiratory distress syndrome include shortness of breath (more than 60 times per minute) and intercostal depression, thus reducing gas exchange, cyanosis when exhaling, * * * * and patting the nose, which is a non-specific response of the human body to serious diseases. Treatment and prevention To prevent and treat respiratory distress syndrome, we must first avoid premature delivery. Methods include: intrauterine device ligation to treat cervical atresia, bed rest, treatment of infection and use of anti-abortion drugs to avoid neonatal hypothermia, asphyxia and hypovolemia. If premature delivery is inevitable, steroids can be given to the mother before delivery to make the fetal lungs produce surfactant, and synthetic or natural surfactant can be given through endotracheal tube after birth to prevent the occurrence of respiratory distress or reduce its severity. As for its treatment, newborns should be continuously monitored and the following steps should be taken: 1. Oxygen therapy and continuous positive pressure ventilation to avoid hypoxemia and acidosis. 2. Supply proper water, electrolyte and nutrition. 3. Reduce unnecessary energy consumption. 4. Avoid lung collapse or pulmonary edema. 5. Reduce the damage of oxygen to the lungs. 6. Reduce the damage of mechanical ventilation to the lungs. Complications Complications caused by respiratory distress syndrome include premature delivery itself and complications after treatment. In infants with severe respiratory distress, due to the need for continuous positive airway pressure or ventilator treatment, gas can easily accumulate everywhere along interstitial tissue through ruptured alveoli. These air leaks can cause pneumothorax (air enters the pleural cavity), pneumothorax in the mediastinum cavity (air enters the mediastinum cavity), pneumopericardium (air enters the pericardium), and even pulmonary interstitial pus. However, due to the treatment of newborns with surfactants, these acute complications are also reduced. For premature infants weighing less than 1500 g, microbial infection, cerebral hemorrhage and arterial duct opening often occur together with respiratory distress syndrome. As for the long-term complications, including: pulmonary and bronchial hypoplasia, nervous system hypoplasia, retinopathy of prematurity and so on. The smaller the birth weight or gestational age, the more likely it is to happen. Many new treatments, such as early inhalation of nitric oxide and inositol, can prevent the long-term incidence of lung diseases. 4. Incidence of meconium aspiration syndrome Usually, the fetus does not solve meconium until after birth, and the probability of meconium staining in amniotic fluid will increase with the increase of pregnancy weeks; Premature infants 38 weeks, about 10%, gestational age > 42 weeks, about 22%, gestational age > 44 weeks, about 44%, so meconium aspiration syndrome is a disease of full-term or overdue pregnant newborns, which rarely occurs in premature infants, especially those less than 34 weeks, unless there is microbial infection in the uterus. Therefore, meconium aspiration syndrome refers to the newborn's first breath before or during or after birth, inhaling amniotic fluid contaminated by meconium, which leads to complete or partial obstruction of respiratory tract and hinders lung gas exchange function. Moreover, meconium itself may also cause chemical pneumonia, cause pulmonary vascular pressure to rise and tissue hypoxia, which may lead to various clinical symptoms. In all production situations, 5? 10% will have amniotic fluid stained with meconium, but only 5% will have meconium inhalation and need oxygen inhalation or ventilator treatment, and about 4% of them may die. Causes The common causes of meconium aspiration syndrome include: (1) overdue pregnancy and delivery. (2) The mother suffers from pregnancy-induced hypertension syndrome (preeclampsia or eclampsia). (3) The mother has diabetes. (4) Abnormal fetal heart sounds and prenatal fetal distress. (5) intrauterine growth retardation. (6) Mother smokes for a long time. (7) The mother suffers from chronic cardiovascular or respiratory diseases. Newborns with meconium aspiration symptoms have poor mobility, meconium staining on umbilical cord, armpit, skin and nails, shortness of breath, anoxia and hypercapnia, tangy nose and depressed sternum, and even cyanosis in severe cases, resulting in perinatal asphyxia, such as asphyxia, hypoxia, persistent pulmonary hypertension, hypoglycemia, hypocalcemia and polycythemia. To deal with the fetus with meconium in amniotic fluid at birth, if its mobility is not good, it is necessary to explore its vocal cords with laryngoscope when the fetus is born but not crying. If there is a fetus, insert an endotracheal tube through the mouth as soon as possible for direct suction, and repeat it several times until it is clean. If its mobility is good, the respiratory tract is not blocked and breathing is smooth, the new concept does not need to insert an endotracheal tube for suction. Once meconium aspiration syndrome occurs. In mild cases, the phenomenon of accelerated breathing is in 2? It will gradually stabilize in three days. In severe cases, mechanical treatment and high-frequency positive pressure ventilator are still needed. Fetus can promote bacterial growth, and antibiotics should be given to correct severe metabolic acidosis, hypoglycemia and hypocalcemia often accompanied by asphyxia, and water restriction should be used to treat and prevent brain edema. In case of hypoxic cardiomyopathy complicated with heart failure, diuretics and cardiotonic agents should be given. The possible impact of follow-up on the future growth and development of survivors depends on whether the degree of hypoxia is serious during the course of the disease. Do you have ischemic brain damage caused by hypoxia? In terms of lung function, obstructive respiratory changes will occur, and the sensitivity of respiratory tract to allergens and the outside world will also increase. Xu Hongzhi's current position: Attending Physician of Obstetrics and Gynecology in Taian Hospital, Attending Physician of Obstetrics and Gynecology in Taipei Branch of Affiliated Hospital of China Medical University, Attending Physician of Obstetrics and Gynecology in Boren General Hospital, Associate Professor of Obstetrics and Gynecology in Taipei Medical College, Experience: Chief Resident of Obstetrics and Gynecology in MacKay Hospital, Chief Resident of Greater Baltimore Medical Center in Maryland, USA, Attending Physician of Obstetrics and Gynecology in Chang Gung Hospital, Dean of Obstetrics and Gynecology, Author: Xu Hongzhi, Attending Physician of Obstetrics and Gynecology in Taian Hospital The picture is provided by Mingxin Photography Cute Baby, Wang (this article has nothing to do with the content of healthy baby) * For more information, please refer to: BabyLife Parenting Life 2065438+May 2005. Mababy/ subscribe to the healthy Aloha audio-visual channel, read health knowledge more easily, and pay attention to your health every day! Line @ ID: @:/supply/article/21035/SOS Common respiratory diseases of newborns (below) Keywords: five-month-old baby and mother, respiratory system, wet lung, wet lung.