Extrapulmnary Respiratry Prblems During the First Week f Life Jn Palmer, VMD, DACVIM Chief, Nenatal Intensive Care Service New Bltn Center, University f Pennsylvania, USA
Nenatal Respiratry Prblems Upper airway bstructin Pharyngeal cllapse Dysphagia Aspiratin pneumnia Central Respiratry Cntrl Tachypnea Tachypnea syndrmes
Terminal C sectin Histry Mare Metastatic melanmas Admitted as a high risk pregnancy Prgressive abdminal distentin Hemperitneum Terminal c-sectin during an acute bleed
Terminal C sectin Fal s majr prblems Nenatal Encephalpathy smnlent, hyptnia, seizures Cluster breathing with peridic respiratry pauses Nenatal Gastrenterpathy Dysmtility fr 6 days Nenatal Nephrpathy Oliguria High FxNa Fluid retentin Hypnatremia Lw creatinine clearance Other: Sepsis, cagulpathy, hyperglycemia, candidiasis
Pharyngeal Cllapse Hyptnia Sn after birth Upper airway flutter At 24 hr. Exaggerated respiratry effrt Quite lungs Paradxical respiratin Phenbarbital therapy Increase bstructin Pharyngeal Cllapse Primary Secndary
Hypventilatin Time 2:16a ph 7.174 Pc2 74.4 P2 75.8 SAT 96.2 INO2 7 lpm
Hypventilatin Time 2:16a 3:27a ph 7.174 7.266 Pc2 74.4 59.0 P2 75.8 84.4 SAT 96.2 100 INO2 7 lpm 10 lpm
Upper Airway Abnrmalities Transient Pharyngeal Paresis Hyptnic pharyngeal cllapse Primary Peripheral neurpathy? Nenatal Encephalpathy? Secndary Weakness/fatigue
Primary Pharyngeal Paresis Syndrme Appear nrmal initially Stressed Respiratry rate and effrt increase Negative pressure in the pharynx Pharyngeal cllapse Self perpetuating bstructin Respiratry failure fllwed by cardivascular failure Dysphagia may be present
Secndary Pharyngeal Paresis Generalized weakness Critically ill Generalized hyptnia Fatigue Recumbent Phenbarbital can induce Cause f hypventilatin in phenbarbital treated cases HYPP (Hyperkalemic Peridic Paralysis)
Endtracheal Tube Stent
Endtracheal Tube Stent
Dysphagia Milk regurgitatin frm the nares Cleft palate Very rare cause f milk at nares Pharyngeal dysfunctin Esphageal dysmtility
Dysphagia N Aspiratin Esphageal dysmtility Failure t clear the cervical esphagus Appear t nurse nrmally and effectively Lwer their head Sneeze r shake head Milk flw frm ne r bth nstrils Few drps t 60 ml Delay f up t 5 minutes
Dysphagia N Aspiratin Esphageal dysmtility Transient prblem Once t several days Etilgy? Nenatal Encephalpathy Esphageal dysmtility Aspiratin rare Swallwing nrmal Guard airway Aerphagia Mst cmmn reasn Fr milk cming frm the nstril
Dysphagia Aspiratin Pneumnia Dysphagia secndary t pharyngeal paresis Degree f dysfunctin variable Upper airway bstructin Pharyngeal cllapse With r withut dysphagia Mild dysphagia milk ut nse Severe dysphagia milk aspirated Mst severe - aspirate saliva Duratin variable days t mnths Therapy feeding management Cngenital esphageal stricture Secndary megaesphagus Mre danger f aspiratin
Dysphagia Aspiratin Pneumnia Other reasns - lder fal Btulism Chke Primary ral candidiasis Strangles
Aspiratin Pneumnia Nrmal Pharyngeal Functin Weak fals Nenatal Encephalpathy Prly crdinated swallwing Prematurity Fatigue Heavily prducing mares Musculskeletal prblems Cntracture Laxity Fractured ribs Tachypnea Bttle feeding Weak fals Inexperienced caregivers
Upper Airway Abnrmalities Upper Airway Obstructin Bilateral r unilateral chanal atresia Chanal hypplasia Epiglttic cysts/malfrmatins Wry nse/ facial defrmities Guttural puch Tympany Empyema Palate malfrmatins
Central Respiratry Cntrl Nenatal Encephalpathy Changes in respiratry patterns Apneustic breathing Peridic breathing Cluster breathing With peridic respiratry pauses With apnea Apnea (> 20 secnds) Perids f up t 3-4 minutes Ataxic breathing
Central Respiratry Cntrl Nenatal Encephalpathy Changes in ventilatin Hypventilatin Respiratry acidsis Central - inapprpriate hypercapnia Mechanical - upper airway bstructin Weakness Apprpriate hypercapnia Balancing a metablic alkalsis Nrmal/alkaltic ph
Central Respiratry Cntrl Nenatal Encephalpathy Changes in ventilatin Hyperventilatin Respiratry alkalsis Abnrmal central cntrl Diagnsis by exclusin Hyperthermia Pain, excitement Apprpriate hypcapnia Balancing a metablic acidsis Nrmal /acidtic ph Hypxia May nt be tachypneic
Reasns fr Tachypnea Pulmnary disease Diaphragmatic hernia Pain Cntracture Fractured ribs Distress/fear Hyperthermia fr any reasn Tachycardia fr any reasn Tachypnea Syndrmes
Tachypnea Syndrmes Central hyperthermia/tachypnea Temperatures as high as 42 C Lss f diurnal variability Transient Tachypnea Transient Tachypnea f the Nenate (TTN) Begin Nenatal Tachypnea Central Hyperventilatin Usually have nrmal respiratry rates/ TV
Case: Central Hyperventilatin 48 hr ld STD Filly Nenatal Encephalpathy (NE) Histry Premature placental separatin Nenatal encephalpathy 48 hr std n wn 1 st time Prblems NE, Septic shck, anemic, etc. Salmnella shedder 8 day hspital stay
Adm ph 7.449 Pc 2 26.1 P 2 58.4 SAT 91.7 Cnt 10.8 HCO 3 18.3 BE -4.2 FIO 2 Lac RA
Adm 1 hr ph 7.449 7.433 Pc 2 26.1 28.8 P 2 58.4 135.6 SAT 91.7 99.4 Cnt 10.8 9.4 HCO 3 18.3 19.4 BE -4.2-3.7 FIO 2 RA 5 lpm Lac 5.7
Adm 1 hr 4 hr 24 hr 60 hr ph 7.449 7.433 7.471 7.452 7.474 Pc 2 26.1 28.8 32.5 28.3 33.9 P 2 58.4 135.6 136.3 127.7 68.8 SAT 91.7 99.4 99.6 99.4 94.9 Cnt 10.8 9.4 10.1 10.1 9.2 HCO 3 18.3 19.4 23.9 20 25.1 BE -4.2-3.7 1-2.9 2.1 FIO 2 RA 5 lpm 5 lpm 3 lpm RA Lac 5.7 6.2 6.5 3.7