neonatal wet lung
Introduction
Introduction to neonatal wet lung Neonatal wet lung (born), also known as neonatal transient dyspnea or type II respiratory distress syndrome (RDStype II), is a self-limiting disease. Short-term shortness of breath after birth, slightly similar to neonatal respiratory distress syndrome and amniocentesis syndrome, but more common in full-term or full-term cesarean section, the symptoms quickly disappeared, the prognosis is good. basic knowledge The proportion of sickness: 0.01% Susceptible population: newborn Mode of infection: non-infectious Complications: respiratory acidosis, neonatal asphyxia
Cause
Neonatal wet lung cause
Lung lymphatic drainage is insufficient (35%):
This disease is related to the increase of fluid in the lungs and the lack of pulmonary lymphatic drainage, which is a temporary respiratory insufficiency. The normal fetus has about 30 ml of liquid in the alveoli before birth. In the normal production process, it passes through the narrow birth canal. When the head is delivered and the thorax is squeezed, about 1/2 to 2/3 of the alveolar fluid is excreted.
Other factors (35%):
Excessive alveolar fluid and/or incomplete fluid transport can cause the disease. Premature infants, whether they are full-term, expired, and gestational age >35 weeks, can develop this disease. Intrauterine distress, asphyxia, and cesarean section have a higher incidence of wet lungs.
Prevention
Neonatal wet lung prevention
Do not use excessive amounts of sedative drugs. Unnecessary cesarean section should be limited. Positional drainage can be done in time when needed. Pay attention to avoid long labor during childbirth, placenta or umbilical cord causes fetal blood circulation, resulting in fetal intrauterine hypoxia, stimulating fetal respiratory center excitement, breathing-like breathing, causing amniotic fluid or meconium inhalation. Pay attention to the feeding method. An abnormal situation occurred in time for treatment.
Complication
Neonatal wet lung complications Complications, respiratory acidosis, neonatal asphyxia
Severe children may have respiratory acidosis and metabolic acidosis, and even asphyxia, should be closely observed.
Symptom
Neonatal wet lung symptoms Common symptoms, shortness of breath, snoring, alar, fan, pleural effusion, suffocation, wet sputum, three concave signs
Most of the children are full-term infants. Most of them have accelerated breathing (>60 beats/min) within 6 hours after birth. The symptoms are more severe, and the symptoms last only 12 to 24 hours. Severe cases are rare and can be delayed to 2~ 5 days, manifested as low crying, bruising, mild sputum, nasal fan, three concave signs, rapid breathing (can exceed 100 times per minute), lung positive signs are not many, auscultation can have respiratory sound reduction and coarse wet Luo Yin, PaO2 slightly decreased, vomiting can be seen in some cases, PaCO2 rise and acidosis are not common, the child is generally in good condition, can cry, can also suck milk.
Examine
Neonatal wet lung examination
1, blood gas analysis: more in the normal range, heavier people may have respiratory and metabolic acidosis.
2, X-ray examination: lung lesions are widely diverse, but absorbed quickly, most disappeared within 4 days.
1 alveolar effusion: the light and uniform patchy shadows of the two lung fields can be fused into a piece or into a nodular shape.
2 emphysema: caused by compensatory expansion of part of the alveoli.
3 pulmonary interstitial fluid: visible widening strip shadow around the blood vessels and bronchioles.
4 interlobular and / or pleural effusion: mostly for the right interlobular pleural effusion.
5 lung texture increased and thickened: due to the increase of interstitial fluid, the lymphatic and vein transport increased, causing lymphatic vessels and veins to expand.
Diagnosis
Diagnosis of neonatal wet lung diagnosis
diagnosis
(1) Most of the breathing at birth is normal, about 6 hours after birth, shortness of breath, cyanosis, light breathing 60 to 80 times / min, generally good, no effect on breast pumping, occasionally heavy, breathing up to 100 times /min, accompanied by sputum, poor response, do not eat, do not cry, etc., suffocation baby after rescue and resuscitation, symptoms appear, the condition is more serious.
(2) The body temperature is mostly normal.
(3) The signs of the lungs are not obvious, only the breath sounds are reduced or there is a thick wet voice.
(4) The shortness of breath disappeared within 24 hours.
(5) X-ray examination, X-ray examination showed that the lung fields on both sides were less transparent, the lung texture increased, the thickening and the density of the spotted density increased, and sometimes the interlobular or pleural effusion was observed due to compensatory emphysema. In the lung field, there is a wide and scattered small translucent area. The anteroposterior diameter of the thorax is widened, and the transverse apex is flat and lowered. After the second day, these abnormalities can be seen to return to normal quickly. The performance is not proportional to the signs. There are the following five manifestations: 1 alveolar effusion, which is a broad patchy density or granular nodular shadow, 2 interstitial fluids, thick and short strip density increased shadow, slightly rough edges, 3 interlobular and / or pleural effusion, mostly in the right lung lobe, the amount of fluid is not much, 4 pulmonary vascular congestion, resulting in deepening of the lungs, lung lines thickening, radial outward, 5 emphysema More common, can have the above several performances.
Differential diagnosis
1. Lung hyaline membrane disease: premature infants are more common, poor general condition, dyspnea and bruising are progressively aggravated, serious condition, poor prognosis, lung maturity examination and chest) X-ray examination have special changes.
2. Aspiration pneumonia: more history of asphyxia and inhalation history, often shortness of breath after resuscitation, clinical symptoms, X-ray showed changes in bronchial pneumonia, few interlobular and / or pleural effusion, the lesion disappeared longer.
3. Amniotic fluid inhalation syndrome: this disease has a history of asphyxia or respiratory distress, shortness of breath occurs after resuscitation, while neonatal wet lungs are normal at birth, respiratory distress occurs later, X-ray examination also helps identify
4. Cerebral hyperventilation: This is caused by cerebral edema, which is common in term infants with asphyxia, shortness of breath, but no signs in the lungs. The prognosis is related to the cause.
