Neonatal Wilson-Mikity Syndrome
Introduction
Introduction to newborn Wilson-Mikity syndrome This syndrome occurs mostly in premature infants. Due to immature lungs, some alveoli are collapsed due to poor inflation. Some alveoli are cystic emphysema due to hyperventilation, and more often occur at 1 week or later after birth. Intermittent or recurrent dyspnea is characterized by convulsions, which are outlined here in the typical Wilson-Mikity syndrome. basic knowledge Sickness ratio: 0.000125% Susceptible people: children Mode of infection: non-infectious Complications: neonatal respiratory distress syndrome acute pulmonary heart disease heart failure pulmonary hypertension respiratory infection emphysema
Cause
Causes of neonatal Wilson-Mikity syndrome
(1) Causes of the disease
The etiology has not yet been fully elucidated. Due to the immature lung, respiratory unit variation, the ventilatory pressure and resistance required for the variation of the number and morphology of the alveoli in the respiratory bronchioles increase, mainly in gestational age <32 weeks and birth weight <1500g. In premature infants, other factors related to this disease include oxygen poisoning, intrauterine infection and repeated milk inhalation, but the most important factor is the immature alveolar growth and uneven development after birth, and the immature part is poorly inflated. Collapsed, more mature part of the alveolar hyperventilation is cystic emphysema.
(two) pathogenesis
Due to the abnormal distribution of gas in the lungs, the proportion of ventilated blood flow is imbalanced, lung compliance is reduced, airway resistance is increased, CO2 is retained, PaO2 is lowered, and cyanosis and dyspnea appear. The more immature alveoli, the more severe the symptoms.
Early pathological changes are not easy to distinguish from immature lungs. Alveolar epithelium is linear, late alveolar swell, peripheral atelectasis, pulmonary vascular muscle thickening, pulmonary arteriolar radius 100U, middle layer amplitude 20U, fetal pulmonary vascular muscle layer The thickness of 1.3 times, BPD is 11 ~ 16U (fetal is 14.7U, newborn 9U, 6 months is 7.8U, 1 year is 7U). The pathogenesis of pulmonary vascular hypertrophy is related to chronic hypoxia.
Prevention
Neonatal Wilson-Mikity Syndrome Prevention
The cause has not yet been elucidated, but it is related to intrauterine infection, repeated inhalation of milk, oxygen poisoning or hypoxia. Therefore, it is necessary to do a good job in pregnancy, to prevent and treat various infectious diseases, to do perinatal health care, and to prevent intrauterine and Hypoxia after birth, various oxygen-deficient diseases during oxygen therapy, prevention of oxygen poisoning, etc., are all problems that should be paid attention to in preventing this disease.
Complication
Neonatal Wilson-Mikity syndrome complications Complications neonatal respiratory distress syndrome acute pulmonary heart disease heart failure pulmonary hypertension respiratory infection emphysema
Concurrent respiratory distress, hypoxemia, hyperphosphatemia, pulmonary heart disease, heart failure, pulmonary hypertension, repeated respiratory infections, emphysema, wheezing, etc.
Symptom
Newborn Wilson-Mikity syndrome symptoms common symptoms cyanosis hypoxemia dyspnea three concave heart failure neonatal laryngeal hypersensitivity hypercapnia
The onset is often on the first weekend after birth or later, the onset is slow, manifested as intermittent cyanosis, rapid breathing, three concave signs, respiratory symptoms gradually worsened after 2 to 6 weeks of onset, manifested as dependence on oxygen and severe respiratory distress For several months, Fujimura Masahiro divides the syndrome into 4 types according to the condition:
1. Type I (respiratory insufficiency, pulmonary heart type) Dyspnea for more than 12 months, hypoxemia, hypercapnia, some cases of pulmonary heart disease, heart failure, pulmonary hypertension, insufficiency It must be artificially breathed, due to repeated respiratory infections, oxygen dependence, and poor prognosis.
2. Type II (durable breathing type) Moderate three concave breathing, hypoxemia, hypercapnia, but may have mild heart failure, respiratory infection, wheezing, difficulty breathing and cyanosis 1 to 2 weeks improved, three The concave breath disappeared around the age of 1 year, and chronic emphysema remained.
3. Type III (three concave breathing type) The three concave sign is lighter than type II, and the breathing is increased rapidly. The blood gas analysis is in the normal range, and there is no need to give oxygen, and there is a transient wheezing.
4. Type IV (transient type of wheezing type) is the lightest type, breathing is fast, mild three concave, disappearing on average 2 to 3 months, and there is a transient wheezing in the baby.
Examine
Examination of neonatal Wilson-Mikity syndrome
Cord blood or early neonatal serum IgM 3.0g / L or more, placenta with chronic amnion and subacute umbilical inflammation, blood gas examination showed varying degrees of hypoxemia and CO2 retention, the three routines were normal.
1. Chest X-ray examination: X-ray features a wide range of cellular balloon swelling in both lungs, thick wall, hyperinflation of the two lungs, diffuse air swell of the first and second type of lungs, infiltration around the hilar, and On both sides, the lower lung field is a fusion emphysema, and there is a mediastinal fistula formation, and the third and fourth type chest radiographs are small round balloon swelling.
There are bone sparse and multiple fractures of the posterior ribs.
2. Pulmonary function measurement: The functional residual capacity and tidal volume are reduced, and the airway resistance is increased.
Diagnosis
Diagnosis and diagnosis of neonatal Wilson-Mikity syndrome
According to the medical history, clinical manifestations, combined with X-ray findings can be diagnosed.
Differential diagnosis
1. Chronic pulmonary insufficiency (CPIP) in preterm infants is differentiated from premature infants with chronic pulmonary insufficiency (CPIP). This disease occurs mostly in preterm infants below 1000g. The degree of lung immature can be light to heavy (ie severe Wilson-Mikity synthesis). Zheng), normal lung function at birth, partial inflation in 2 to 3 weeks after birth, partial atelectasis in the lungs, clinically asymptomatic 3 days after birth, hypoxemia and hypercapnia after the second week Symptoms may be accompanied by apnea. At this time, the X-ray film may still be normal, but there may be uneven distribution of gas or small balloon swelling. Symptoms are relieved in the third to fourth weeks, and completely recovered after 2 months. Pulmonary insufficiency is based on The degree of immature lung can be light or heavier. This type of child has anaerobic poisoning. Some cases have not received oxygen treatment before onset. The pathologically only the gas is unevenly distributed, and the necrosis and repair during anaerobic poisoning.
2. BPD: more common in premature or very low birth weight children, with a high concentration of oxygen and ventilator application history, children with chronic persistent or progressive respiratory insufficiency, hypoxemia, hypercapnia and Oxygen and ventilator dependence, chest radiographs continue to have dense shadows, early bronchial secretions have elevated ET-1 and IL-8.
3. NRDS: It is more common in premature infants to have progressive dyspnea within 6 to 12 hours after birth. In the early stage of X-ray, the general transmittance of the lungs is reduced. See the bronchial aeration sign, and the severe one is white lung.
