by perinatologija | Okt 20, 2023 | cmcrf
Motnje dihanje so heterogena skupina bolezni, ki se v največji meri pojavljajo zaradi nezrelih mehanizmov kontrole dihanja, zaradi česar so pogostejše pri nedonošenih novorojenčkih. Motnje dihanja so obenem lahko del klinične slike številnih drugih bolezni neonatalnega obdobja, ob čemer je etiološka opredelitev včasih težavna. Dihalni premori zaradi nedonošenosti so večinoma mešane narave in vsebujejo tako centralno kot obstruktivno komponento. Farmakološko zdravljenje motenj dihanja temelji na uporabi zdravil iz skupine metilksantinov, med katerimi je najpomembnejši kofein. V prispevku opisujemo mehanizme njegovega delovanja, indikacije za pričetek zdravljenja, priporočeno uporabo odmerkov ter indikacije za varno ukinitev zdravljenja. V nadaljevanju naštejemo še nekatere druge oblike farmakološkega zdravljenja dihalnih premorov zaradi nedonošenosti.
Pharmacological Treatment of Breathing Disorders in Neonates
Breathing disorders are a heterogeneous group of diseases that mostly occurr due to immature breathing control mechanisms, which makes them more common in preterm neonates. Breathing disorders can also be part of the clinical presentation of many other neonatal diseases, making their etiological definition sometimes challenging. Apnoeas due to prematurity are mostly of mixed nature, involving both central and obstructive components. The pharmacological treatment of breathing disorders is based on the use of methylxanthine drugs, the most important of which is caffeine. In article we describe the mechanisms of its action, indications for treatment initiation, recommended dosages, and indications for safe treatment discontinuation. We also list some other forms of pharmacological treatment for apnoeas of prematurity.
Mihael Rus
by perinatologija | Okt 20, 2023 | cmcrf
Motnje dihanja so najpogostejša težava novorojenčkov, zaradi katerih je potrebna obravnava na oddelku za intenzivno nego ali trapijo. Dihalne težave novorojenčkov so lahko posledica akutno ali kronično prizadetih pljuč, dihanje pa je lahko prizadeto tudi zaradi motene regulacije, ki se pri novorojenčkih največkrat kažejo kot dihalni premori. Zdravstvena nega novorojenčka z dihalnimi premori temelji na dobrem kliničnem opazovanju, monitoriranju, zagotavljanju in vzdrževanju prehodnih dihalni poti in na rednem dajanju predpisane medikamentozne terapije. Posebna znanja in veščine so potrebni pri otrocih, zdravljenih z invazivno ali neinvazivno dihalno podporo. Posebej pomembno je v pacientovo dokumentacijo vpisovati evidenco apnoičnih dogodkov, da lahko spremljamo in ugotavljamo morebitni vzorec pojavljanja dihalnih premorov.
Nursing care of the neonate with breathing disorders
Breathing disorders are the most common neonatal complications that require admission to the Neonatal Intensive Care Unit (NICU). Breathing disorders can be caused by acute or chronic lung disease, or they can be caused by dysregulation, most commonly manifested as apnoeas in neonates. Nursing care of a neonate with apnoea consists of close clinical observation, monitoring, establishing and maintaining airway patency, and regular administration of medicamentous therapy. Special knowledge and skills are required in infants on invasive or non-invasive respiratory support. It is imperative to keep a record of apnoeic episodes in the patient’s medical records so that we can monitor and establish the likely pattern of apnoeic episodes.
Vlasta Lubej Kurtovič
by perinatologija | Okt 20, 2023 | cmcrf
Obstruktivne anomalije dihalnih poti lahko ogrožajo življenje, saj lahko vplivajo na dihanje in hranjenje novorojenčka. V klinični sliki se lahko obstrukcija kaže v budnem stanju in v spanju. Ko dokažemo motnjo dihanja, ki bi lahko bila posledica obstrukcije v dihalnih poteh, je indicirana otorinolaringološka obravnava. Pri novorojenčkih in dojenčkih so prirojene anomalije zgornjih dihal pogost vzrok za motnjo dihanja, vendar je lahko obstrukcija dihal tudi pridobljena. Zapora dihal lahko nastane kjer koli od nosu do sapnika in je lahko posledica več različnih dejavnikov. Nekatere pridružene bolezni in sindromi imajo višje tveganje za nastanek obstrukcije v dihalnih poteh. Zdravljenje vključuje poleg konservativnih in medikamentoznih ukrepov tudi kirurške posege, ki so lahko ob pravilni indikaciji zelo učinkoviti.
Obstructive Airway Abnormalities in Neonates – Surgical Approach and Management
Obstructive airway abnormalities can be life-threatening as they can affect the breathing and feeding in neonates. In the clinical picture the obstruction may manifest during awakeness or sleep. An otorhinolaryngological examination is in order in a suspected breathing disorder due to airway obstruction. In neonates and infants, the common cause of respiratory distress are congenital anomalies of the upper airways, however, airway obstruction can also be acquired. An airway obstruction can occur anywhere from the nose to the trachea and can be caused by several factors. Specific comorbidities and syndromes have a higher risk of airway obstruction. Surgical interventions, in addition to conservative measures and treatments, can be very effective if indicated correctly.
Daša Gluvajić
by perinatologija | Okt 20, 2023 | cmcrf
Novorojenčki in dojenčki predstavljajo posebno skupino otrok s sindromom obstruktivne apneje v spanju (OSAS). Polisomnografija (PSG) in respiratorna poligrafija (RP) sta standardni preiskavi pri diagnostiki OSAS in dajeta pomembne informacije o njeni resnosti. Še več, PSG in RP nas vodita pri izbiri zdravljenja in sta pomembni pri spremljanju teh otrok, ker pomagata pri izbiri med neinvazivnimi in invazivnimi načini zdravljenja. Izvid PSG ali RP je pomemeben pri ukinitvi neinvazivne dihalne podpore in pri dekanulaciji otroka s traheostomo. PSG ali RP imata tudi svoje omejitve, sta časovno dolgotrajni preiskavi, dragi, v večini centrov slabo dostopni in zahtevni za interpretacijo, tako na PSG ali RP pride le omejno število otrok. V prihodnosti bi bilo zato smiselno razvijati posebne algoritme in enostavne naprave, s katerimi bi presejalno izbirali otroke, ki potrebujejo napotitev na PSG ali RP.
Obstructive Breathing Disorders in Neonates – the Role of Polygraphy in the Diagnosis and Follow-up
Neonates and infants with upper airway obstruction represent a specific group of children with obstructive sleep apnoea syndrome (OSAS). Polysomnography (PSG) and respiratory polygraphy (RP) are the gold standard tests for the diagnosis of OSAS and provide important information about its severity. Moreover, PSG/RP guide treatment choices and are crucial for the follow up by allowing physicians to choose between invasive and non-invasive strategies. They also guide weaning from non-invasive respiratory supports or decannulation in children with a tracheostomy. However, PSG/RP are time consuming, expensive, poorly available in most centrs, and difficult to interpret. Thus, only a limited number of children will undergo a PSG. Therefore, it is imperative to develop specific algorithms that may prioritize children who must undertake such tests using more simple tools.
Alessandro Amaddeo
by perinatologija | Okt 20, 2023 | cmcrf
Motnje dihanja pogosto nastopijo pri novorojenčkih zaradi specifičnih anatomskih in fizioloških razmer v zgornjih dihalih. Pomembno je, da motnje čimprej opazimo in ustrezno opredelimo. Najpomembnejšo vlogo pri tem ima pediater neonatolog. S podrobno anamnezo in kliničnim pregledom pridobi osnovne podatke, ki so bistveni za nadaljnjo izbiro diagnostičnih postopkov. Če sumi na zaporo v zgornjih dihalih, ima pomembno vlogo tudi specialist otorinolaringolog. Najprej se je treba odločiti, ali motnja novorojenčka akutno ogroža ali ne. Polisomnografija zagotovi pomembne podatke, ki pojasnijo vrsto in jakost motnje dihanja novorojenčka. Ob sumu na obstrukcijo na območju zgornjih dihal, so na voljo naslednje diagnostične metode: ambulantna fleksibilna nazolaringoskopija, endoskopska ocen zgornjih dihal v sedaciji pri spontanem dihanju, rigidna laringoskopija, fiberendoskopska ocena požiranja in slikovna diagnostika (rentgenski posnetek v lateralni projekciji s cefalometrijo, CT ali MRI). Cilj je pridobiti čimbolj popolno informacijo o tipu, lokaciji in jakosti zapore v zgornjih dihalih, ki povzroča motnjo dihanja, da se multidisciplinarni tim lahko čim lažje in čim ustrezneje odloča o terapevtskih možnostih za bolnika.
Otorhinolaryngological Diagnostic Methods in the Identification of Breathing Disorders in Neonates
Breathing disorders in neonates are common due to specific anatomical and physiological conditions of the upper respiratory tract. It is essential to detect and define them as soon as possible. Neonatal pediatricians play a critical part in this process as they collect the basic data to assist with further diagnostic options by thorough medical history-taking and clinical evaluation. In cases of suspected upper airway obstruction, ear, nose and throat (ENT) specialist joins the multidisciplinary team. First, it is necessary to assess whether or not the condition poses an immediate risk to the neonate. Polysomnography (PSG) provides the team with important information to define the type and significance of neonatal breathing disorder. The following diagnostic methods are available in suspected upper airway obstruction: outpatient flexible nasolaringoscopy, drug-induced sleep endoscopy (DISE), rigid direct laryngoscopy, fiberoptic endoscopic evaluation of swallowing (FEES), lateral cephalometric radiograph, coputed tomography (CT), and magnetic resonance imaging (MRI). The aim is to obtain as complete information as possible on the type, location and severity of the upper airway obstructin, so that the multidisciplinary team can make the best and most appropriate decisions about the therapeutic options for the patient.
Miha Zabret
