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PRESENTED BY, MS.L.SOUNDARYAM.SC.NURSING (PEDIATRICS)
BRONCHO-PULMONARY DYSPLASIA
•Broncho-pulmonary dysplasia is chronic lung disease of the neonate that typically is caused by prolonged ventilation and is further defined by age of prematurity and extent of O 2
requirement.(OR)
•A progressive chronic pulmonary condition characterized by pulmonary edema and a prolonged requirement of oxygen in infants who have been treated for respiratory distress syndrome.
CAUSES Significant risk factors include•Prolonged mechanical ventilation•High concentrations of inspired O 2
•Infection (eg, chorio-amnionitis or sepsis)
•Degree of prematurity
Additional risk factors include
•Pulmonary interstitial emphysema
•High peak inspiratory pressures
•Large end-tidal volumes
•Repeated alveolar collapse•Increased airway resistance•Increased pulmonary artery pressures
pathophysiology 4-pathological changes:STAGE –I (MILD): Clinically identical to IRDS lasts from 2-3 days during this time, there are profuse hyaline membrane,
patchy mucosal cilia and slight edema of the interstitium but no necrosis of alveolar cells.
STAGE-II (MODERATE): it last from 4-10 days, during this time, there are hyaline membrane present, but
extensive loss of cilia,Some focci of atelectasisSmall amount of esino-philic exudates in the brochioles,
Wide spread edema of the interstitium
Necrosis of alveolar cells are evident.
STAGE-III (SEVERE): Lasts from 10-20 days.Increased of alveolar
cells and bronchiolar mucosa
Wide spread alveolar collapse
Increased interstitial fibrosis
Hypertensive changes occur in arterioles and arteries
Oxygenation is difficult.
STAGE-IV (ADVANCE CHRONIC):
Lasts for a monthWide spread necrosis, interstitial fibrosis
Emphysema presentPulmonary failure cardiomegaly with cor-pulmonale
ASSESSMENT IT is evident when there is increased need of oxygen
Crepitant rales and diminished breathing sounds
Barrel shape chest appearanceEmphysema Oxygenation difficult and carbon dioxide retention
Respiratory acidosis occurs
DIAGNOSTIC EVALUATIONHistory collectionPhysical examinationRadiological findingsBlood investigations for o2 tension, and acidosis
TREATMENT•Nutrition supplementation
•Fluid restriction•Diuretics•O 2 supplementation as needed
•Respiratory syncytial virus (RSV) monoclonal antibody
NURSING MANAGEMENT
•Oxygen therapy can be provided
•Supportive measurements- *Nutritional supplementation,*Fluid restriction, diuretics, * Bronchodilators.
PREVENTION•Use of antenatal corticosteroids•Prophylactic use of exogenous surfactant in selected high-risk infants (eg, weighing < 1000 g and requiring ventilator support)
•Early therapeutic continuous positive airway pressure
•Early use of surfactant for treatment of RDS
•Prophylactic use of methylxanthines (eg, caffeine 5 to 10 mg/kg po once/day), particularly when birth weight is < 1.250 kg
•Permissive hypercarbia and hypoxemia to achieve low ventilator pressures, volumes, or both
•Prophylactic use of vitamin A (5000 units IM 3 times/wk for a total of 12 doses) for infants with birth weight < 1000 g
PROGNOSIS•Prognosis varies with severity.
•Infants who still depend on mechanical ventilation at 36 wk gestation have a 20 to 30% mortality rate in infancy.
•1/3rd of affected infants die by 7-8 months of age.
•If the child is survive –corpulmonary function can be expected by 5-6 years.
•Infants are at increased risk of lower respiratory tract infections (particularly viral pneumonia or bronchiolitis) and may quickly develop respiratory decompensation if pulmonary infection occurs.
THANK YOU
THANK YOU