Lung Maturation in Preterm Infants

8/11/2019 Lung Maturation in Preterm Infants

1/23

LUNGMATURATIONINPRETERMINFANTS

Pembimbing :

dr. Gioseffi, Sp.OG

Disusun oleh :

Karlina Liwang / 406121003Krisma Kristiana / 406121004


2/23

PRELIMINARY

To this day, neonatal mortality and morbidity in

preterm infants is still high.

This is related to the maturity of the babysorgans

such as the lungs, brain, and gastrointestinal.

Good obstetric approach to preterm labor will give

hope to the survival and quality of life of premature

infants.

Respiratory distress syndrom is the leading cause

of death for babies born prematurely.


3/23

LUNGMATURATIONINPRETERMINFANTS

Premature babies are babies born at gestational

age less than 37 weeks.

Antenatal corticosteroid therapy in women who are

at high risk for preterm delivery has been

recommended.

Corticosteroid therapy in pregnant women who will

deliver prematurely used to enhance fetal lung

maturation.


4/23

DEFINITIONSANDCRITERIAOFRESPIRATORY

DISTRESSSYNDROM

Dypsnea

Tachypnea

Persistent cyanosis

On chest radiograph: patchy alveolar infiltrates,atelectasis, vaskular congestion, hemorrhage,

pulmonary edema


5/23

IMPORTANTFACTORINTHESURFACTANT

DEFICIENCY

Premature

Perinatal asfiksia

Maternal diabetic

Seksio sesaria


6/23

Respiratory Distress Syndrom (RDS) or Hyaline

Membran Disease (HMD) obtained in 10% ofpremature infants, due to a deficiency of surfactant

in infants born with a gestational age of less.

Surfactant is usually found in the mature

pulmonary. Surfactant function : keep the alveoli pockets keep

growing and air filled. So in preterm infants, where

surfactant undeveloped cause growing power of

lung reduced and the infants experiencing

shortness of breath. The symptom appeared soon

after the baby is born and getting worse.


7/23

Clinical symptoms were seen:

Takipnea in newborns (>60x/minutes)

Nostril breathing

Grunting

Intercostal retraction

Sianosis

The symptom settled within 48-96 hours after birth.


8/23

On chest radiograph, criteria Bomsel there are 4

stage, namely :

Stage 1 : there are very few spots retikulogranular and

few airbronchogram.

Stage 2 : spots retikulogranular homogeneous on bothlungs and air bronchogram seen more clearly and

extends to the peripheral cover the heart shadow with

decreased lung aeration.

Stage 3 : collection of collapsed alveoli so both lungs

field appear more opaque and the heart shadow almost

invisible, airbronchogram wider.

Stage 4 : all of thorax very opaque (white lung) so the

heart cantbe seen.


9/23

PATHOPHYSIOLOGYRESPIRATORYDISTRESS

SYNDROMONPREMATUREINFANTS

Thoraks wall still weak

Production of surfactantisnt perfect

Collaps alveolus

The lungs become stiff


10/23

CORTICOSTEROIDSINLUNGMATURATION

Physiological effect glucocorticoid on lung

maturation is increase lung surfactant.

And also increased lung compliance and maximal

volume of lungs.

Glucocorticoid its also increase activity of

antioxidant enzym and induce proteins involved in

the clearance of air lung. This is used to help

breathing.


11/23

THEUSEDOFCORTICOSTEROIDSON

ANTENATAL

Corticosteroid antenatal on pregnant women at risk

of preterm birth is one therphy the most efective

and important.

Corticosteroids can repaired function of infants lung

and protected infants of premature death.


12/23

INDICATIONOFANTENATALCORTICOSTEROIDAT24

34 WEEKSOFGESTATION

Preterm labor

Haemorragic antepartum

Premature ruptur of the membran (PROM)


13/23

Doses used for :

Deksametason 6mg intramuskular : 4 times at intervals

of 12 hours.

Betametason 12 mg intramuskular : 2 times at intervals

of 24 hours.

Higher dose or more frequency, its not enhance

benefits of corticosteroid theraphy and actually

increase the loss of effect.


14/23

TIMINGOFCORTICOSTEROID

Based on between the time interval and birth, the

baby will born 48 hours up to 7 days after theraphy

of glucocorticoid, provide the greatest benefit.

Levels of surfactant can decreases again in time 8

up to 10 days.

Repeated theraphy if baby birth has not occurred

on 7 days since the first theraphy and the risk of

premature birth still have.


15/23


16/23

Antenatal corticosteroid its not recommended

before gestational age 24 weeks and after 34

weeks.

All fetuses at risk preterm delivery can be

considered antenatal corticosteroid theraphy on

gestational age 2434 weeks.


17/23

CORTICOSTEROIDINMULTIPLEPERGNANCY

Multiple pregnancy can increased the risk for

premature labor.

Twin pregnancy have the risk >40% for premature

labor.

Antenatal corticosteroid in multiple pregnancy its

recommended, but significant reduction RDS not

been demonstrated.


18/23

ADVANTAGEANTENATALCORTICOSTEROIDS

Theraphy antenatal corticosteroid in preterm infants

shown to reduce neonatal mortality and incident

RDS.


19/23

DISADVANTAGEOFGIVINGANTENATAL

CORTICOSTEROID

Risks to the fetus and neonatus after giving

antenatal glucocorticoid is rare to happens and

reversible.

The most common complications of corticosteroids

antenatal is infection and supretion adrenal.


20/23

REPEATANTENATALCORTICOSTEROID

Not known advantages and effects of theraphy

repeat antenatal corticosteroid. But, many docters

used theraphy repeat antenatal corticosteroid every

weeks until 34 weeks gestational weeks.


21/23

CONCLUSION

Premature babies are born on gestational age < 37

weeks have a high risk for prematurity diseases.

Antenatal corticosteroid used to helped matury of

infants lungs.

Antenatal cortocosteroids on pregnant women is

recommended for who have the risk have

premature delivery up to 7 days ahead.

Drugs used are betametason and deksametason,

often called glococorticoid, given antenatal for push

ahead maturity of infants lung.


22/23

Antenatal corticosteroid can increased outcome on

babies who have born on gestational age 24 -34

weeks.

And also more usefull if childbirth happens at least

on 24 hours after first dosing and before 7 days

after the last dosing drug.


23/23

Documents

Lung Maturation in Preterm Infants