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Complications of Prematurity
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Neonatal mortality
Causes of neonatal death in Cambridge Maternity Hospital
1982 - 89 1990 - 94
Respiratory distress syndrome 137* 38
Infection 24 13
Birth asphyxia 15 14
Extreme prematurity 14 44
Pulmonary hypoplasia 10 19
Other causes 10 0
Total non-malformed neonatal deaths 210 128
Malformations 84 46
Total neonatal deaths 294 174
* The majority of these babies had a periventricular haemorrhage
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Gestational age and RDS
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Predisposing factors
Gender
Caesarean section
Asphyxia
Maternal diabetes
Multiple birth
Hypothermia
IUGR (IntraUterine Growth Restriction)
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Role of antenatal steroids
Structural maturationIncrease in lung volume
Epithelial barrier function
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RDS pathophysiology
Alveolar damage
Formation of exsudate from leaky capillaries
Inflammation
Repair
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Surfactant deficiency - “vicious cycle”
Respiratory acidosis
Severe hypoxia
Further inhibitionof surfactant
by serum proteins
Epithelial damage occurs through suction effect of gasping
Depleted surfactant
Decreased FRCIncreased dead spaceAlveolar collapse
Reducedcompliance
Increased workof breathing
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Reduction in compliance
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Histology
RDSNormal
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Atelectasis
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Patent Ductus Arteriosus (PDA)
Premature infants at risk
Duct does not respond to “close” signals
Leads to symptoms of congestive heart failure
Oxygen requirements are high
Exacerbates RDS
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Pulmonary haemorrhage
Rare
Bleeding into the lungs
Increases the need for ventilatory support
Occurs mainly 2-4 days after birth
Predisposing factors include mechanical ventilation,
immaturity and PDA
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Pneumothorax
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Bronchopulmonary dysplasia
Simple definition
5-20% of ventilated neonates with RDS
Oxygen requirement at 36 weeks post conceptional age
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Lung damage
Barotrauma
Volutrauma
Oxygen toxicity
Inflammation
(Biotrauma)
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Oxygen free radicals
SuperoxideDismutase (SOD)
cell
O2,H2O2
O2
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Pressures
High pressures – damage walls
High volumes – over inflation
Large swings – cyclic collapse