Endothelial disease in newborns

The disease occurs a few minutes to two hours after birth with severe respiratory distress syndrome without finding causes such as infection, amniotic fluid, inhalation of meconium. The disease manifests as shortness of breath and shortness of breath, breathing rate above 60 times / minute.

Expression

The intercostal cavities, recesses on the brisket, contraction, bulging nostrils, purple body. Give oxygen without support. Pulmonary examination revealed a decrease in alveolar murmur, a rash in the bottom of the lungs. A normal or rapidly changing chest X-ray is a blurred lung lesion, so the lungs should be taken multiple times to compare. If mild and correct treatment, after 72 hours the symptoms decrease, gradually regress.

Surfactant causes bronchial dilatation (Photo: TTO)

If severe, signs of cyanosis, difficulty breathing increases, lower blood pressure, lower body temperature, children will die after a few hours. If you are lucky, you can leave sequelae such as cerebral hypoxia, cerebral hemorrhage, hypoglycemia . Full-term babies recover well and die less than premature babies.

The formation of the inner membrane

In normal human lungs, inside the alveoli contains a surfactant, also known as a surfactant (GHBM) or active substance, which helps the alveoli not collapse. GHBM in fetal lungs appears relatively in the 20th week. It covers the inner wall of the alveoli and is present in amniotic fluid at week 28-36.

In premature, immature lungs, GHBs are lacking in both quantity and quality, so alveolar collapse, alveolar plasma flow into the alveoli, fibrin in the plasma deposited in the alveoli and bronchioles , forming a membrane, called the inner membrane. Looking through a microscope sees a pink membrane, acid, on the membrane with red blood cells, fibrin fibers and some cellular debris. This membrane interferes with air circulation and the exchange of oxygen and CO2 from the alveoli through capillaries. Gives signs of respiratory failure and death very quickly.

Favorable factors cause endothelial disease

1. Premature babies under 28 weeks, the incidence of endothelial disease is 50-60%, especially the weight of children under 1,000g or twins.
2. During labor, the mother has a long labor, haemorrhage, fetal distress or birth suffocation.
3. During pregnancy the mother has diabetes or treatment of a certain disease with prolonged corticosteroids.
4. Genetic factors

Diagnose

Early diagnosis: Quantify GHBM in amniotic fluid. Ratio of lecithin / sphingomyelin (L / S). Normal L / S> 2. If L / S <2, the newborn is at risk of endothelial disease.

Postpartum children: If L / S PaO ₂ blood gas measurement decreased, PaCO ₂ increased, X-ray changes in lungs, the diagnosis of endometriosis was diagnosed.

Treatment

1. Place the child in an incubator 36.5 ⁰ - 37 ⁰ .
2. Infusion of glucose, fat, bicarbonate.
3. Respiratory support.
4. Drop the surfactant solution through the endotracheal tube into the young lungs.

Preventive

For mother : Good treatment of diabetes, no abuse of corticosteroids during pregnancy. Determine the L / S ratio in amniotic fluid to predict the risk of children with endothelial disease.

For premature , preterm , and low birth weight infants , it is recommended to actively inject surfactant into the lungs through the endotracheal tube to prevent endothelial disease.

Dr. DAO KUNG HUNG