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o SP-A, B,C,D
10% neutral lipid primarily cholesterol
phosphatidylglycerol
Surfactant Protein A
water soluble collectin
required for tubular myelin formation
contributes to the biophysical porp of surfactant
regulates surfactant secretion and catabolism
major function is as a non immune host defense
protein and regulator of inflammation in the lung
not present in sysnthetic surfactant used for RDS
treatment
Surfactant Protein B
small hydrophobic protein
facilitates surface absorption of lipids and the devt of
low surface tension on surface area compression
lack of SP-B causes a loss of lamellar bodies in type
II cells
genetic absence of SP-B leads to a lethal form of
RDS after term birth
Surfactant Protein C
also a small hydrophobic protein
cooperates w/ SP-B for lipid absorption
main role is to spread phospholipids on alveolar
surface
Surfactant Protein D
hydrophilic protein w/ structural similiatities to SPA
binds pathogens and facilitates clearance
surfactant
Atelectasis
V/Q
inequality
hypoxemia
hypoventilation
hypercarbia
Pulmonary vasoconstriction
fig:
-
Surfactant
70-80% phospholipids (sat phosphatidylcholine)
10% protein
Structural
lung
immaturity
Proteinaceous exudates
Phsyiologic Abnormalities
dec lung compliance
large areas of lung not ventilated (v/Q)
large areas of lung not perfused (V/q)
dec alveolar ventilation and inc work of breathing
reduced lung volume (dec FRC)
Pathologic Findings
Anatomic
gross: collapsed lung, firm, dark red and liver like
microscopic: alveolar collapse, pink staining
membrane on alveolar ducts (hyaline membrane),
thickened arteriolar wall
EM: disappearance of lamellar bodies, damage and
loss of type II pneumocytes
Biophysical and Biochemical
deficient or absent pulmonary surfactant
abnormal pressure volume curve
X-Ray
reticulgranular, ground glass appearance
(homogenous & bilateral)
bronchogram
diffuse haziness
white out lungs in severe RDS
General Preventive Measures
prolongation of pregnancy / inhibit premature labor
induction of pulmo surfactant w/ maternal steroids
(Bethamethasone)
X-Ray
-
o persistently high RR
other symptoms
o mild insignificant cyanosis, good air
exchange, minimal respiratory distress
confirm Dx
central perihilar streaking
hyperaeration
fluid in the minor fissure
increase in the vascular markings
Pathophysiology
delayed resorption of fetal lung fluid -> distress
inc risk
o cesarean delivery w/o labor fluid resorption
starts during labor
o infants of diabetic mothers
self limited course, resolves within 72 hours
Neonatal Pneumonia
route of transmission
o ascending infection from the genital tract
o transplacental passage
o predisposing factor
o prolonged rupture of membranes 18 hours
Group B Strep
major pathogen producing pneumonia
Clinical Management
Specific Treatment
exogenous surfactant administration
assisted ventilation
Other bacteria
E. coli most common in the Phil
Listeria
Klebsiella
Enterococcus
Clinical Course
signs of RDS
o tachypnea
o retractions
o cyanosis
-
X-Ray
-
Dx
-
Treatment
Penicillin (Group B Strep) and aminoglycoside (E.
coli)
late onset
o Staphylococcus Oxacillin / Vancomycin
o Chlamydia erythromycin
o Fungi ampothericin B
Duration of treatment 10 days
Neuromuscular
Werdnig-Hoffmann disease (Infantile Spinal Muscular
Atrophy)
Myasthenia gravis
Hypotonia and respiratory insufficiency
Airway Obstruction
location of obstruction
o larynx and upper trachea -> stridor
laryngomalacia, tracheomalacia
o mediastinal trachea -> wheezing
will require auscultation
Choanal Atresia
obstruction of nasal passage by a membrane
cyanosis relieved w/ crying of the infant
dx established by inability to pass a catheter through
the nose
o quiet -> blue; crying -> pink
Laryngomalacia
most common cause of stridor in an infant
stridor lessens in the prone position; tends to
exacerbate during agitation
fiberoptic nasolaryngoscopy
Cystic Hygroma
anomalous devt of lymphatic channels in the neck
surgical excision
Fig: Pneumomediastinum
lungs being compressed
lobulated -> accumulation of air in the mediastinum
Pulmonary Interstitial Emphysema
rupture of air from alveoli or small airways into the
perivascular tissues of the lung
primary a radiographic diagnosis