BRONCHOPULMONARY DYSPLASIA
Chronic respiratory distress following prolonged high pressure IPPV.Repeated
overdistension of the alveoli and alveolar ducts due to mechanical ventilation.There are
three criteria for diagnosis:
1-Mechanical ventilation in the neonatal period.
2-Continued supplemental oxygen at day 28 of life.
3-Pulmonary insufficiency.
Clinical presentation:
1-Respiratory distress,cyanosis.
2-Chest retractions.
3-Wheezing.
4-Feetures of cor pulmonale.
5-Common in<30 w gestation
Histology:wide spread dystruction of pulmonary tissue, areas of collapse and
emphysema,peribronchial fibrosis,pulmonary edema.
CXR:It depends on stage of the disease, the lung may be homogeneously opaque,with
systic lesions,patches of fibrosis,emphysematous areas.
Treatment:
1-Oxygen to raise saturation to >92 %.
2-Nebulized bronchodilator.
3-Antibiotics if there are signs of infection.
4-Dexamithasone.
5-Diuretics.
Passive immunoprophylaxis with palivizumab , a monoclonal antibody to RSV, decreases
RSV-related hospitalizations and ICU stays
Systemic or inhaled corticosteroids are discouraged except as a last-resort therapy
Vit.A If administered at least 3 times per week for those at risk, vitamin A has been
shown to decrease
the incidence of BPD
Superoxide dismutase is an antioxidant substance
Neonatal reflexes;
1-Moro response: The baby is put supine, head is lifted a little off table and then
dropped suddenly supported by the examiner's hand. There is abduction and
extension of arms with opening of hands followed by adduction. It disappears by the
age of 3-4 months.
Asymmetrical Moro Reflex
Hemiplegia
Fracture Humerus
Fracture Clavicle
Dislocation of the Shoulder
Erbs Palsy
Klumpke's Paralysis
2-Rooting reflex: When the corner of the mouth is touched, the lower lip is lowered and
the tongue moves toward the stimulus.
3- Sucking reflex: When a clean finger is introduced in the mouth, sucking starts.
Absent sucking reflex
A defect in development
Septicemia
Perinatal asphyxia
Birth trauma
Inborn error of metabolism
Cold injury
4-Doll’s eye response: There is a delay of eye movement if the head is turned to one
side. It disappears by 2-3 weeks.
5-Stepping reflex: The contact of the sole of the foot on the table causes stepping. It
disappears by 5-6 weeks.
6- Palmar grasp reflex: The insertion of an object or finger in the palm of the hand of
the baby causes reflex flexion of the fingers. It disappears by 2-3 months.
7-Asymmetrical tonic neck reflex: The turning of the head to one side causes extension
of the arm and leg on the same side and flexion on the other side. It simulates
fencing. It disappears by 2-3 months. It persists in cerebral palsy.
8- Plantar reflex: It is similar to palmar grasp reflex.