apnea in newborns分析课件

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1、ApneainnewbornsMichaelFlavinApneaofprematurityPhysiologicimmaturityofbreathingcontrolimmaturebreathingresponsestohypoxia,hypercapniaApneaofprematurityCentralorobstructive?ApneaofprematurityMixedMostoccursinREMsleep-clusteringpathogenesisRoleofcentralinhibitoryneuromodulators

2、includingprostaglandins,GABAandadenosineexaggeratedinhibitorypulmonaryreflexescontributetofrequencyandseverityThefetusstopsbreathingifexposedtohypoxiahypoxia-inducedapneicepisodesTonicactivityinexpiratoryneuronsmaycontributeApneaofprematurity–impactofnewtargetO2saturationgui

3、delinesSepsis,GERandapneaPotentialcauseofapneainsepsis:IL-1receptoractivationincreasePGE2synthesiswhichdepressesbreathingGERandapnea:GERandrefluxoftenco-existbutrarelytemporallyrelated.GERdoesnotprolongconcurrentapnea.NoevidencethatGERdrugsreduceapnea.CPAPfixesgruntingand…CP

4、APreducescentralapneaSplintspharynxwhichdecreasesinhibitoryafferentsIncreasedFRCincreasesexcitatoryafferentsIncreasedforceofdiaphragmImprovedoxygenationpreventsfetal/neonatalapnearesponseCPAPimprovesobstructiveapneaApneumaticsplinttotheupperairwayIncreasedlungvolumeleadstoar

5、eflexincreaseinpharyngealdiameterStimulationofmechanoreceptorsincreasesairwaytoneCPAP…morebenefitsIncreasesFRCwhichinturn:prolongstimetodesaturationandbradycardiaintheeventofapneaHighflownasalcannula-poorman’s“CPAP”PioneeredbyaformerQueen’sPediatricsResidentConventionalCPAPc

6、ancause:discomfort,pressurenecrosis,nasalinfection,instabilityHighflown=40,28w,1-2wold,Esophagealpressuremeasured.OnventilatorCPAPfor6hN/CflowadjustedtomatchCPAPfor6hNodiffinfrequencyofapneaFlowlitre/min=0.92 + 0.68x(x=wtinkg)XanthinesreduceAOPIncreaseminuteventilation,incre

7、aseCO2sensitivity,decreasehypoxicdepressionofbreathing,enhancediaphragmcontractionanddecreaseperiodicbreathingIncreasemetabolicrateby~20%Caffeineeffectsonneurodevelopmentaloutcomeare…Apneaofprematurity-whentoexpectresolution?Apneaofprematurity-whentoexpectresolutionMostprema

8、turearelesslikelytoresolveby36-40weeksInveryprematurebabiesAOPshouldresolve