Bronchopulmonary dysplasia (BPD) is a lung disease that primarily affects extremely premature infants. The most severe cases occur in babies born between 23-26 weeks gestation. While corticosteroids and diuretics can provide short-term improvement for ventilator-dependent infants, there are safety concerns about steroid use. When transitioning infants with BPD from the neonatal intensive care unit to other facilities, it can be difficult for parents to adjust to new practices and staff. Oxygen management also varies, as there is no consensus on optimal weaning.
Bronchopulmonary dysplasia is a pathologic process leading to signs and symptoms of chronic lung disease that originates in the neonatal period.
Presented by Dr. Tahir
Bronchopulmonary dysplasia is a pathologic process leading to signs and symptoms of chronic lung disease that originates in the neonatal period.
Presented by Dr. Tahir
Pneumothorax is one of the most common air leak syndromes that occurs more frequently in the neonatal period than in any other period of life and is a life-threatening condition associated with a high incidence of morbidity and mortality.
Presented by Dr. Rupom
Pneumothorax is one of the most common air leak syndromes that occurs more frequently in the neonatal period than in any other period of life and is a life-threatening condition associated with a high incidence of morbidity and mortality.
Presented by Dr. Rupom
Strategies for the Prevention of Bronchopulmonary Dysplasia: Wishful Thinking...MCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Современные проблемы неонатологии. Институт перинатологии и педиатрииФедеральный специализированный перинатальный центр. Презентация. Общество православных врачей, www.opvspb.ru
Abdomen and liver case presentation by PGKurian Joseph
Abdomen and liver case presentation by PG
Chronic decompensated parenchymal liver disease - cirrhosis with portal hypertension probably of alcoholic etiology with no ascites with no features of hepatic encephalopathy and coagulopathy
To rule out malignancy
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Approach to cardiac murmurs and cardiac examination in childrenVarsha Shah
Cardiovascular examination in children for MBBS undergraduate, Residents, Trainees, pediatricians, GP, family physicians, nursing , dental, allied health students
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Bronchopulmonary
Dysplasia
• Summary
• Introduction
• Risk Factors
• Clinical Features
• Management of BPD in Level 3 Units
• Respiratory Criteria for Transfer to a Level 2 Hospital
• Management in the Level 2 SCN
• Oxygen
• Home oxygen
• Follow up
3. SUMMARY
• the most severely affected babies are the
most premature, particularly 23-26 week
gestation babies
diuretics and corticosteroids are effective in
achieving short-term improvement in the status
of ventilator dependant babies. Safety issues
of steroid use are unresolved. There is no place
for long term therapy with diuretics in level 2
SCN's
there is no consensus on how to wean oxygen in
babies with BPD
• the transition from a tertiary hospital nursery
to a level 2 SCN is a difficult time for parents
as they adjust to different staff and practices
4. INTRODUCTION-1
• In line with the recommendations from a recent
workshop in North America the term
bronchopulmonary dysplasia (BPD) will be used in
this chapter rather than Chronic Lung Disease.
• Over the past decade the clinical definition of
BPD has evolved from oxygen dependency at 28
days of age to oxygen dependency at 36 weeks
corrected gestational age.
•
5. INTRODUCTION-2
• The National Institute for Health in the USA has further
divided this definition into mild (in supplemental oxygen at
28 days of age, but in air by 36 weeks corrected age),
moderate (requiring <30% supplemental oxygen at 36 weeks
corrected age and severe (in >30% supplemental oxygen
and/or requiring positive pressure support, CPAP or
ventilation, at 36 weeks corrected age).
• BPD is the single most important factor determining length
of stay in babies born at less than 29 weeks. The most
severely affected babies are the most premature,
particularly 23 - 26 week gestation babies.
6. RISK FACTORS
• prematurity
• peripartum inflammation/infection
associated with preterm labour and/or
clinical or subclinical chorioamnionitis
• postnatal lung Injury due to volutrauma,
barotrauma,oxygen toxicity, hypocarbia or
infection
7. CLINICAL FEATURES
• babies dependant on endotracheal
mechanical ventilation (MV)
• babies dependant of Nasal CPAP
• babies who are oxygen dependant,
usually by nasal prongs
8. MANAGEMENT
• endotracheal ventilation is increasingly being replaced by NCPAP, for even
the tiniest babies many are being managed with NCPAP from birth. Results
from a recent randomised controlled trial have shown that 50% of babies
25-28 weeks gestation are able to manage without ever requiring intubation
and ventilation, and that infants of this age who commence NCPAP from
birth have no increased risk of death or BPD, and in fact are less likely to
be in oxygen at 28 days of age.
• for those who do require intubation and ventilation there is an intense
focus on minimizing ventilator associated lung injury from the moment a
baby is placed on a ventilator. Synchronised modes of MV with close
monitoring of tidal volumes are key features of current practice. In
addition there is a more liberal approach to carbon dioxide control, allowing
CO2 to rise into the 50's and 60's providing the pH remains better than
7.25
9. MANAGEMENT 2
• oxygen damages delicate lung tissue as well as the immature
retina. Pulse oximetry targets are typically set between 85 to 94%
in the first weeks after birth
• ongoing randomised trials (BOOST2 trial in Australia) are
attempting to determine whether we should be aiming for the
bottom or top end of this target range. Babies in this trial may be
transferred to level 2 nurseries with their trial saturation
monitors in place as we continue to try to answer this question.
• babies who require endotracheal ventilation are aggressively
weaned and extubated to NCPAP often within 1-2 days of birth
10. DRUG THERAPY-
Corticosteroids
•
• dexamethasone is effective in achieving short-term improvement in the status of
ventilator dependant babies as well as longer term reductions in BPD, however, there
is now level evidence showing that dexamethasone in the first week of life is
associated with an increased risk of cerebral palsy in survivors
• safety of corticosteroids used later in the course of evolving BPD between 14 - 28
days is unresolved and the Cochrane review of current evidence suggests reserving
the use of late corticosteroids to infants who cannot be weaned from mechanical
ventilation, and minimising the dose and duration of treatment.
• in light of this evidence frequency of the use of steroids for BPD in NICUs has
dramatically declined in the past 5 years and a "low" dose regimen (eg 0.15 - 0.25mg/
kg/day) weaned and ceased over a 7 - 10 day period is recommended
• typical clinical scenarios where steroids would be considered are a baby > 2 weeks of
age who is unable to be weaned from endotracheal MV
• there is no place for the use of steroids in the treatment of BPD outside a tertiary
neonatal unit
• early use of inhaled steroids is ineffective in preventing BPD, although there is some
evidence they can be used to assist extubation in ventilator dependant infants. More
work is needed in this area before this approach is taken.
11. NUTRITION
• provision of adequate calories in a nutritionally appropriate form
is critical, infants with BPD utilise 20-40% more kcal than infants
without BPD
• caloric requirements of babies with moderate to severe lung
disease can be as high as 130 - 150 calories/kg/day
• babies with BPD tolerate fluid overload poorly and are modestly
fluid restricted (150 - 160mL/kg/day) and fed fortified breast
milk or low birthweight formula
• growth is closely monitored and caloric intake titrated
against growth
• Vitamin A supplementation reduces death and oxygen requirements
at 36 weeks corrected gestational age. Vitamiin A is currently
given as Pentavite to all infants from day 5 until discharge.
• babies sufficiently stable to transfer to a level 2 unit should not
require a caloric density of > 24 cal/30mls
12. OXYGEN
• oxygen is the one constant in the treatment of BPD but it has been poorly studied
• once weaned from NCPAP, oxygen is delivered by nasal prongs using low flow
(<0.5L/min)
• there is no consensus on how to wean oxygen in babies with BPD
• weaning is dictated to some extent by the equipment available. Some tertiary centres
have only recently moved from having flow meters with a lower limit of 0.25L/min/O2.
Other units use flow meters that allow weaning down to as low as 0.005mL/min/O2.
Most believe that weaning should be slow, but what this means varies from institution
to institution
• babies with BPD have a degree of pulmonary hypertension, and are therefore likely to
benefit from a more generous oxygen administration regimen rather than from a
restrictive policy, however the corrected gestational age and the state of
vascularistion of the retina needs to be taken into consideration before saturation
targets are liberalised . Whilst there is some logic to this approach, there is indirect
evidence from randomized controlled trials conducted for other reasons suggesting
that a more liberal oxygen policy in these babies can actually increase the pulmonary
morbidity. RCT's are in progress to address this question
13. Criteria for Home Oxygen - General
• Appropriate social/home environment including reasonable
accessibility to medical care
• Baby is on 4 hourly or demand oral feeding regimen
• Baby is normothermic in an open cot
• Satisfactory growth
• All babies discharged from tertiary units on home oxygen
have specific Paediatric Thoracic specialist follow up. It is
strongly recommended that Paediatricians manage babies on
home oxygen in collaboration with a Paediatric Thoracic
physician
14. Criteria for Home Oxygen -
Respiratory
• Baby must pass an "air test". The oxygen is
turned off, the nasal prongs removed and the
baby monitored over 30 minutes
• If saturations are maintained >86% for 30
minutes the test should be repeated in 48 hours.
If a second test is satisfactory the baby is
eligible for discharge on home oxygen on
respiratory grounds. In other words the baby has
demonstrated a reasonable level of respiratory
reserve
15. FOLLOW UP
• These babies require term follow up throughout childhood
• There is an increased pulmonary morbidity in the first 2 years of
life. Parents should be counselled about this morbidity and ways to
minimise it.
• Influenza vaccine is recommended for infants with ongoing
cardiac, respiratory or neurological illnesses at 6 months of age.
Recommendations are 2 doses, 4 weeks apart
• Influenza vaccine is not officially recommended for these babies
• RSV prophylaxis is not routinely recommended, the American
Academy of Pediatrics recommends use of RSV prophlaxis for
infants <2yrs, with BPD requiring treatment within the last 6
months, who are discharged home prior to the RSV season. The
Department of Health in the UK recommends its use in children
<2yrs with BPD on home oxygen or who have had prolonged use of
oxygen
16. DRUG THERAPY0-Diuretics
• insufficient studies of suitable size reporting on important outcomes exist
to strongly support the use of diuretics for the treatment of BPD
• diuretics are an effective short term therapy for ventilated babies
• There is no evidence for efficacy in non ventilated babies therefore
diuretic therapy should be weaned and ceased once babies are stable off
mechanical ventilation
• typical combinations include hydrochlorothiazide and spironolactone
• NaCl and KCl supplementation are commonly required
• chronic frusemide administration is generally avoided, as it has been
associated with the development of nephrocalcinosis and hyperchloremic
metabolic alkalosis
• there is no place for long term therapy with diuretics in level 2 SCN's