SPECIAL NEONATAL DISORDERS

Presented by,L.SOUNDARYAM.SC.NURSING(PEDIATRICS)

• APNEA• MECONIUM ASPIRATIONS • ATELECTASIS• BRONCHOPNEUMONIA DYSPLASIA• PULMONARY DYSMATURITY• RETROLENTAL FIBROPLASIAS• NECROTISING ENTEROCOLITIS• INTRAVENTRICULAR HAEMORRHAGE• HYPERBILIRUBINEMIA• IRDS

APNEA

• When the cession of respiration is more prolonged than that associated with periodic breathing, usually 10-20 seconds or longer and is followed by color change and bradycardia, the condition is called apnea.

DEFINITION

• Apnea is a "pause in breathing of longer than 10 to 15 seconds, often associated with bradycardia, cyanosis, or both." (Martin et al)..

Etiology• Intracranial hemorrhage• Physiological anemia• Patent ductus arteriosis• Pneumonia or sepsis• Hypoglycemia, hypocalcaemia • Gastrointestinal - NEC or gastro-esophageal reflux• Temperature Regulation - Hypothermia or

hyperthermia • Drugs - (narcotics, beta-blockers). Postnatal

exposure to sedatives, hypnotics or narcotics.

PATHOPHYSIOLOGY1.Central apnea

2.Obstructive apnea

3. Mixed apnea

features

• Bradycardia (below 80-100 beats /minute) appears 30 seconds after cessation of respiration.

• Apnea in premature infants can result in a failure of the mechanisms that protect cerebral blood flow, resulting in ischemia and eventually leukomalacia.

• During apneic episodes, in an attempt to protect cerebral blood flow cardiac output is diverted away from the mesenteric arteries resulting in intestinal ischemia and possibly NECROTIZING ENTEROCOLITIS (NEC).

Nursing Management Close monitoring of the baby• Gentle sensory stimulation-to initiate the

breathing• (Rubbing the back, stroking the face, chest,

and legs.) • suctioning and resucitation• Oro-gastric tube can be inserted – to

decompress the stomach• Bradycardia- continues- mechanical ventilation

is necessary• Primary management is Oxygen therapy

• Theophylline can be given as intravenously.

• When alarm sounds, the nurse must make an immediate effort to stimulate or resuscitate the infant.

• Caffeine has also been found to improve ventilation and to establish more regular breathing pattern through CNS stimulation.

Pharmacotherapy :*caffeine iv Loading dose : 20mg /kg/doseMaintenance dose: 5mg / kg/ day*theophylline: loading dose:6mg/kg/doseMaintenanance dose: 6mg/kg/day iv

• Continuous Positive Airway Pressure (CPAP) - CPAP is effective in treating both obstructive and mixed apnea, but not central apnea.

• CPAP is most commonly delivered by nasal prongs or by an endotracheal tube placed in the nasopharynx.

Problems of apnea

• Hypoxia• Cyanosis• Brain damage• Death

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