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Respiratory Distress Respiratory Distress in in
NeonatesNeonatesDr.Mohammad Saquib Mallick, Dr.Mohammad Saquib Mallick,
FRCSFRCS Consultant Paediatric Surgeon ,Consultant Paediatric Surgeon ,
King Fahd Medical City.King Fahd Medical City.
Riyadh Riyadh
Principles of Principles of Neonatal Surgery Neonatal Surgery
Types of Newborns:– Full-term: >38 weeks and weight >
2.5 kg – preterm infant: <38 weeks with
appropriate weight– SGA: >38 weeks and weight< 2.5 kg– VLBW: <32 weeks and <1.5 kg
There are physiologic differences between all these infants
Respiratory DistressRespiratory Distress The newborn suspected of having
respiratory distress should be studied in a logical step by step manner.
It is important to establish that the infant has a surgical problem before surgery is performed.
Resuscitation must be done before operation
Every condition will be dealt Every condition will be dealt accordinglyaccordingly
Respiratory DistressRespiratory Distress
Causes– Surgical
Upper airway obstruction Congenital diaphragmatic hernia Eventration of Diaphragm Esophageal atresia with TOF Pneumothorax Congenital lobar emphysema Congenital cystic adenomatoid
malformation Pulmonary Sequestration
Respiratory DistressRespiratory Distress
Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia
Incidence: 1:2000 to 5000,
female more affected,
prematurity and low BW,
Left side
Diaphragmatic Diaphragmatic HerniaHernia
SymptomsNone to severePolyhydramniosPresents birth to after many days
SignsScaphoid abdomenAudible bowel sound in the chest
Diaphragmatic Diaphragmatic HerniaHernia
Diagnosis:– Prenatal <25wks, prognosis
bad– Clinical– CXR– 10% >after neonatal period
Diaphragmatic Diaphragmatic HerniaHernia
Diaphragmatic Diaphragmatic HerniaHernia
Management– Reussciataion and
stabilization– Laparotomy
Primary Patch by silo or
muscle– Laparoscopic repair
Eventration of Eventration of DiaphragmDiaphragm
Def: Abnormal elevation of diaphragm Def: Abnormal elevation of diaphragm that results in paradoxical motion of that results in paradoxical motion of affected hemidiaphragm during affected hemidiaphragm during inspiration and expirationinspiration and expiration
Cause:Cause:– Congenital Congenital – AcquiredAcquired
Symptoms: Symptoms: – NoneNone– Resp. distressResp. distress– Wheezing, repeated URI, Wheezing, repeated URI,
Eventration of Eventration of DiaphragmDiaphragm
Diagnosis:Diagnosis:– CXRCXR– Fluoroscopy or Fluoroscopy or – Real time USReal time US
Eventration of Eventration of DiaphragmDiaphragm
Management:Management:–ConservativeConservative–plicationplication
Oesophageal atresia & TOFOesophageal atresia & TOF Incidence: 1: 5000 Incidence: 1: 5000 live births, 50% associated with live births, 50% associated with
anomaliesanomalies
Types: Types:
Symptoms and Signs:Symptoms and Signs:– Excessive salivation Excessive salivation – Respiratory DistressRespiratory Distress– Inability to pass NG tubeInability to pass NG tube– Choking and coughing on feedingChoking and coughing on feeding
VACTERLSyndrome
Oesophageal Oesophageal atresia & TOFatresia & TOF
Diagnosis Diagnosis – Clinical & CXR – Clinical & CXR Management: Management: ResuscitationResuscitation
– Common typeCommon type Right thoracotomyRight thoracotomy
Division and repair of TOFDivision and repair of TOF Primary anastomosisPrimary anastomosis
– Pure TOFPure TOF Division and repairDivision and repair
– Isolated atresiaIsolated atresia >3 vertebra>3 vertebra
Staged surgery (gastrostomy and Staged surgery (gastrostomy and followed in 3-6 months by delayed followed in 3-6 months by delayed repair. If fails then need esophageal repair. If fails then need esophageal replacement (stomach or colon)replacement (stomach or colon)
Respiratory DistressRespiratory Distress
Pneumothorax: The collection of air in the
pleural cavity in neonates.Causes: Hyaline membrane disease Meconium aspiration Pulmonary hemorrhage
Traumatic Rupture of cong.lung cyst
Respiratory DistressRespiratory Distress
Diagnosis: Clinical
Radiological
Respiratory DistressRespiratory Distress
Respiratory DistressRespiratory Distress Treatment: 1, Decompression by inserting chest tube
2, Treat the cause
Respiratory DistressRespiratory Distress
Congenital Lobar Emphysema:
“ massive over distension of a lobe or a segment of the lung that causes compression of normal lungs and medistinum“
Respiratory DistressRespiratory Distress
Etiology; air trapping due to abnormalities in
the bronchial cartilages.
bronchial cartilage may be
absent, hypoplastic, or dysplastic
Respiratory DistressRespiratory Distress
X-rays
Respiratory DistressRespiratory Distress CT Scan:
Respiratory DistressRespiratory Distress
Management:
Surgical excision of of the involved lobe or lobes is the treatment of choice.
QUESTIONS ?QUESTIONS ?