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Tanl power point


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Tanl power point

  1. 2. Objectives of the study <ul><li>To study the severe newborn’s respiratory diseases, especially RDS. </li></ul><ul><li>To know about relationship of gestational age, body weight of newborns and RDS. </li></ul><ul><li>To evaluate the effectiveness of antibiotic treatment in severe newborn’s respiratory diseases. </li></ul>
  2. 3. <ul><li>Study design </li></ul><ul><li>30 newborns in Neonatal Department and Neonatal Intensive Care Unit, Thushinskaya Children Hospital. </li></ul><ul><li>Data collected from January 2008 to February 2008. </li></ul><ul><li>Data included both male and female, Preterm and term newborns. </li></ul>
  3. 4. Frequency of Respiratory Distress Syndrome <ul><li>RDS has been reported in all races worldwide, especially in premature infants. </li></ul><ul><li>RDS affects about 1% of newborn infants and is the leading cause of death in preterm infants. </li></ul><ul><li>In US, RDS occurs in 20,000- 30,000 newborns each year </li></ul><ul><li>50% of RDS occurs at 26-28wks of gestation </li></ul><ul><li><30% of RDS occurs at 30-31wks of gestation </li></ul><ul><li>RDS is encountered less frequently in the developing countries, because most deliveries occur at home and accurate records are unavailable. </li></ul>
  4. 5. Percentage of Term and Preterm newborn Total 30 patients: Boys 20(67%) & Girls 10(30%) 5
  5. 6. Body weight of patients
  6. 7. Pathologic events in RDS Rosario N. Santos--Chua, et al , UpToDate , 2009.
  7. 8. Investigation of Respiratory Distress Syndrome in newborn
  8. 9. Radiographic appearance of children in Respiratory Distress Syndrome <ul><li>The chest radiograph demonstrates low lung volume and the characteristic diffuse reticulogranular ground-glass appearance with air bronchograms. </li></ul>
  9. 10. Differential Diagnosis of Respiratory Distress Syndrome <ul><li>Transient Tachypnea of Newborn </li></ul><ul><li>Bacterial pneumonia </li></ul><ul><li>Aspiration syndrome e.g. Meconium </li></ul><ul><li>Pulmonary air leaks e.g. Pneumothorax </li></ul><ul><li>Congenital anomalies </li></ul><ul><li>Diaphragmatic Hernia </li></ul><ul><li>Cardiac anomalies </li></ul><ul><li>Anemia </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Hypothermia </li></ul>
  10. 11. 11
  11. 12. Treatment of Respiratory Distress Syndrome <ul><li>Surfactant therapy </li></ul><ul><li>CPAP and Mechanical Ventilation </li></ul><ul><li>Inhaled Nitric Oxide </li></ul><ul><li>Antenatal, natal and postnatal corticosteroids </li></ul><ul><li>Supportive care </li></ul>
  12. 13. Surfactant therapy Alveofact, Curosurf, Infasurg, Survanta Curosurf Dosage: Intratracheal: Initial: 2.5 mL/kg/dose (200 mg/kg/dose); may repeat 1.25 mL/kg/dose (100 mg/kg/dose); at 12-hour intervals for up to 2 additional doses; maximum total dose: 5 mL/kg. Curosurf It produces rapid improvements in lung oxygenation and compliance that may require immediate reductions in ventilator settings and FiO2.
  13. 14. Surfactant versus placebo treatment from Liechty EA; et al, July 1991.
  14. 15. Differences between the percentage of following cases in Newborn’s Department and NICU
  15. 16. Antibiotic usage for newborn’s 3 diseases in following department *3 diseases are Aspiration pneumonia, Respiratory distress syndrome & Congenital pneumonia. Patient’s number Antibiotics in NICU (N=21) Antibiotics in Newborn Department (N=9) Antibiotics in Newborn department after treated from NICU (N=21) Netilmicin ( Нетилмицин ) 13 Cefotaxime (Клафоран) 8 Ceftriaxone 10 Ceftriaxone ( Роцефин ) 13 Fluconazole 2 Ciprofloxacin 8 Ciprofloxacin ( Ципробай ) 10 Amikacin 1 Fluconazole 7 Vancomycin ( Ванкомицин ) 6   Netilmicin 4 Fluconazole ( Дифлюкан ) 6   Vancomycin 2 Metronidazole (Метрогил) 5   Metronidazole 2 Ceftazidime (Фортум) 4   Ceftazidime 1 Rifampicin (Рифампицин) 3   Imipenem (Имипенем) 1 Amikacin (Амикацин) 3   Imipenem+Cilastatin (Тиенам) 1     Linezolide (Линизолед) 1    
  16. 17. Differences between antibiotics combination in Newborn Department, Newborn Department after treated from NICU and NICU
  17. 18. Combine antibiotic treatment according to following diseases
  18. 19. CPAP and Mechanical Ventilation
  19. 20. Duration of stay in Neonatal Intensive Care Unit and Newborn’s department NICU Newborn’s department duration 20
  20. 21. Conclusion <ul><li>According to my study results, aspiration pneumonia is one of the common cause of newborns admission in Neonatal Intensive Care Unit and Newborn’s department, but RDS is common among preterm newborn. </li></ul><ul><li>Antibiotic is one of the best treatments for aspiration pneumonia, congenital pneumonia and some cases of respiration distress syndrome. </li></ul><ul><li>The amount and duration of antibiotic depends on the diagnosis and severity of newborn. Most of the cases in NICU need 2 or more combine antibiotics, but in Newborn’s department could be successfully treat with 1-2 antibiotics. </li></ul><ul><li>Finally the general principles of neonatal care and a team approach should be applied to maximize the occurrence of good short-term and long-term outcomes. </li></ul>