Surfactant for pulmonary haemorrhage in neonates Aziz A, Ohlsson A Published Online: July 11, 2012 Bleeding into the lungs (pulmonary haemorrhage) occurs mainly in infants born before term (37 weeks gestation) because of severe lung disease (particularly respiratory distress syndrome, a disease caused by the lack of the normal lining chemicals of the lung (surfactant)) and the need for a breathing machine (assisted ventilation). The risk factors for pulmonary haemorrhage include preterm birth, poor growth while in the womb (intrauterine growth restriction), respiratory problems, abnormal blood flow around the blood vessels in the lungs (patent ductus arteriosus), bleeding problems (coagulopathy), the need for a breathing machine and surfactant treatment. The underlining cause of pulmonary haemorrhage is thought to be a rapid increase in pulmonary blood flow due to a patent ductus arteriosus. Some studies have shown promising results with the use of surfactant treatment in infants with pulmonary haemorrhage. However, no randomised controlled trials were identified in this review. Currently, no recommendation for clinical practice based on randomised controlled trials can be presented Pulmonary hemorrhage has a high mortality rate, 30% to 40% Etiology and Pathogenesis Infant prematurity is the factor most commonly associated with Pulmonary Hemorrhage. Other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia[disambiguation needed] of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Infant respiratory distress syndrome (IRDS), administration of exogenous surfactants (in some studies) and Extracorporeal membrane oxygenation (ECMO). Although the pathogenesis is uncertain, it is probable that the symptoms are a consequence of hemorrhagic pulmonary edema, as the hematocrit is lower than normal blood (usually 15-20% less) and the concentration of small proteins is higher than in plasma. It is postulated that the infant suffers from asphyxia with resultant heart attack; this increases pulmonary microvascular pressure, resulting in pulmonary edema. Contributing factors include factors that favor increased filtration of fluid from pulmonary capillaries (e.g., low concentration of plasma proteins, high alveolar surface tension, lung damage, hypervolemia) Pulmonary Hemorrhage is present in 7 to 10% of neonatal autopsies, but up to 80% of autopsies of very preterm infants. The incidence is 1 in 1,000 live births. Pulmonary hemorrhage has a high mortality rate, 30% to 40% PH and PDA 60% of PH had clinical PDA (vs 30%, P=0.03) 92% of PH had PDA size >1.6mm Pediatric1994; 94: 719-723 J Pediatr 2000; 137: 68-72 Pulmonary Hemorrhage (PH) Incidence: 2-12% of VLBW Mortality: 50% - 80% Time: 2-4 th day of life Risk factors: Male, Premature, IUGR, RDS, Sepsis Surfactant, Patent Ductus Arteriosus (PDA) Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively. It involves liver capsule inflammation Pathophysiology Fitz-Hugh–Curtis syndrome occurs almost exclusively in women. It is usually caused by gonorrhoea (acute gonococcal perihepatitis) or chlamydia bacteria, which cause a thinning of cervical mucus and allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation. Occasionally, this inflammation can cause scar tissue to form on Glissons capsule, a thin layer of connective tissue surrounding the liver. The major symptom, following an episode of PID, is an acute onset, right upper quadrant (RUQ) abdominal pain aggravated by breathing, coughing or movement, which is referred to the right shoulder. Laparoscopy may reveal violin string adhesions of parietal peritoneum to liver. The lysis of adhesions may be performed laparoscopically. General rule: If imaging is indicated, it should be done 1 rad of exposure – no increase risk to the fetus 10 rad exposure – carries only a small increase in the number of childhood cancers 15 rads exposure - carries a 6% chance of MR, 3% chance of cancer, 15% chance of microcephaly >20 weeks, radiation is unlikely to cause fetal anomalies, particularly if the exposure is
Posted on: Fri, 05 Dec 2014 11:21:16 +0000
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