NEONATOLOGIE 2
INHOUD
1. Bloedgassen ....................................................................................................................................4
1.1 Beoordeel of het acidose, alkalose of normaal is ..........................................................................4
2. Hyaliene membraanziekte & beademing ............................................................................................5
3. CPAP ...............................................................................................................................................5
3.1 Nasale CPAP ..............................................................................................................................5
3.2 Endotracheale CPAP ...................................................................................................................5
4. Kunstmatige ventilatie: de conventionele beademing .........................................................................6
4.1 PIP = positieve inspiratoire druk ...................................................................................................6
4.2 PEEP = positieve eindexpiratoire druk ...........................................................................................6
4.3 ti = inspiratoire tijd .......................................................................................................................6
4.4 Te = expirattoire tijd .....................................................................................................................6
4.5 De frequentie ..............................................................................................................................6
4.6 FiO2 = percentage zuurstof die wordt toegediend ..........................................................................7
4.7 Flow ...........................................................................................................................................7
4.8 Factoren voor instellen beademing ..............................................................................................7
4.9 Tactiek .......................................................................................................................................7
4.10 Soorten beademingstoestellen ..................................................................................................7
4.11 Acroniem DOPES ......................................................................................................................7
5. Hoogfrequente beademing ...............................................................................................................8
6. Pneumothorax .................................................................................................................................8
6.1 Diagnose ....................................................................................................................................8
6.2 Pneumothoraxdrainage ...............................................................................................................8
6.2.1 Voorlopige drainage ..............................................................................................................8
6.2.2 Definitieve drainage ..............................................................................................................8
6.3 Drainagesysteem ........................................................................................................................9
6.3.1 Drieflessensysteem ..............................................................................................................9
6.3.2 Argyle Setinel Seal Chest Drainage Unit .................................................................................9
7. Bronchopulmonaire dysplasie ..........................................................................................................9
7.1 Definitie .....................................................................................................................................9
7.2 Fysiopathologie ..........................................................................................................................9
7.3 Oorzaken BPD .......................................................................................................................... 10
7.4 Belangrijkste klinische problemen BPD ...................................................................................... 10
7.4.1 Respiratoire problemen ...................................................................................................... 10
7.4.2 Cardiale problemen & pulmonale hypertensie ...................................................................... 10
7.4.3 Voedingsproblemen ........................................................................................................... 11
1
Liesbeth Thewissen
,NEONATOLOGIE 2
7.4.4 Neurologische problemen ................................................................................................... 11
7.5 Behandeling bij BPD .................................................................................................................. 11
7.5.1 Respiratoire & cardiale problemen....................................................................................... 11
7.5.2 Voedingsproblemen ........................................................................................................... 11
7.5.3 Neurologische problemen ................................................................................................... 12
7.6 Prognose van patiënten met BPD ............................................................................................... 12
7.6.1 Belangrijke ontslacriteria .................................................................................................... 12
8. Congenitale cardiopathie ............................................................................................................... 12
8.1 Neonatale cardiogene cyanose .................................................................................................. 12
8.1.1 Wanneer er onvoldoende mixing is ...................................................................................... 13
8.1.2 Wanneer er onvoldoende longperfusie is.............................................................................. 13
8.1.3 Veroorzakende aandoeningen bij cyanose op dag 0 .............................................................. 14
8.1.4 Differentiële diagnose ......................................................................................................... 14
8.2 Neonatale hartdecompansatie .................................................................................................. 14
8.2.1 Coarctatio aortae ............................................................................................................... 14
8.2.2 Onderbroken aortaboog ...................................................................................................... 14
8.2.3 Kritische aortaklepstenose .................................................................................................. 15
8.2.4 Hypoplastisch linkerhartsyndroom ...................................................................................... 15
8.3 Neonatale decompensatie na 14e dag ........................................................................................ 15
8.4 Behandeling van congenitale hartafwijkingen ............................................................................. 15
8.4.1 Prostaglandines ................................................................................................................. 15
8.4.2 Hartkatheterisatie .............................................................................................................. 15
8.4.3 Blalock-Taussigshunt ......................................................................................................... 16
8.4.4 Pulmonary banding ............................................................................................................. 16
8.4.5 Definitieve operatie............................................................................................................. 16
9. Necrotiserende enterocolitis .......................................................................................................... 16
9.1 Verschillende oorzaken ............................................................................................................. 16
9.2 Pathofysiologie ......................................................................................................................... 17
9.3 Symptomen .............................................................................................................................. 17
9.4 Diagnose .................................................................................................................................. 17
9.5 Behandeling ............................................................................................................................. 17
9.6 Preventie .................................................................................................................................. 17
9.7 Prognose .................................................................................................................................. 17
10. Intraventriculaire bloedingen & posthemorrhagische hydrocephalie ............................................... 18
10.1 Het ontstaan van intraventriculaire bloedingen ......................................................................... 18
10.1.1 De germinale matrix .......................................................................................................... 18
10.1.2 De cerebrale autoregulatie ................................................................................................ 18
2
Liesbeth Thewissen
, NEONATOLOGIE 2
10.2 Wanneer & bij wie ontstaan intraventriculaire bloedingen .......................................................... 18
10.3 Uitgebreidheid van de bloeding ................................................................................................ 18
10.4 Symptomen van intraventriculaire bloedingen .......................................................................... 19
10.5 Diagnose van intraventriculaire bloedingen .............................................................................. 19
8.6 Behandeling van intraventriculaire bloedingen ............................................................................ 19
10.6.1 Goede bloeddrukondersteuning ........................................................................................ 19
10.6.2 Goede sedatie .................................................................................................................. 19
10.6.3 Comfortverpleging ............................................................................................................ 19
10.6.4 Behandelen van de open ductus Botalli .............................................................................. 19
10.6.5 Goede glycemie behouden ................................................................................................ 19
10.7 Posthemorrhagische hydrocefalie ............................................................................................ 19
10.7.1 UItvoeren van lumbale puncties ........................................................................................ 19
10.7.2 Plaatsen van ventriculo-externe drainage ........................................................................... 20
10.7.3 Plaatsen van ventriculoperitoneale drain ........................................................................... 20
11. Periventriculaire leucomalacie ...................................................................................................... 20
12. Peripartale asfyxie ........................................................................................................................ 21
12.1 Definitie .................................................................................................................................. 21
12.2 Klinische presentatie ............................................................................................................... 21
12.2.1 Neurologisch .................................................................................................................... 21
12.2.2 Respiratoir ....................................................................................................................... 21
12.2.3 Cardiaal ........................................................................................................................... 21
12.2.4 Renaal ............................................................................................................................. 22
12.2.5 Lever ................................................................................................................................ 22
12.2.6 Gastro-intestinaal ............................................................................................................. 22
12.3 Besluit .................................................................................................................................... 22
3
Liesbeth Thewissen
INHOUD
1. Bloedgassen ....................................................................................................................................4
1.1 Beoordeel of het acidose, alkalose of normaal is ..........................................................................4
2. Hyaliene membraanziekte & beademing ............................................................................................5
3. CPAP ...............................................................................................................................................5
3.1 Nasale CPAP ..............................................................................................................................5
3.2 Endotracheale CPAP ...................................................................................................................5
4. Kunstmatige ventilatie: de conventionele beademing .........................................................................6
4.1 PIP = positieve inspiratoire druk ...................................................................................................6
4.2 PEEP = positieve eindexpiratoire druk ...........................................................................................6
4.3 ti = inspiratoire tijd .......................................................................................................................6
4.4 Te = expirattoire tijd .....................................................................................................................6
4.5 De frequentie ..............................................................................................................................6
4.6 FiO2 = percentage zuurstof die wordt toegediend ..........................................................................7
4.7 Flow ...........................................................................................................................................7
4.8 Factoren voor instellen beademing ..............................................................................................7
4.9 Tactiek .......................................................................................................................................7
4.10 Soorten beademingstoestellen ..................................................................................................7
4.11 Acroniem DOPES ......................................................................................................................7
5. Hoogfrequente beademing ...............................................................................................................8
6. Pneumothorax .................................................................................................................................8
6.1 Diagnose ....................................................................................................................................8
6.2 Pneumothoraxdrainage ...............................................................................................................8
6.2.1 Voorlopige drainage ..............................................................................................................8
6.2.2 Definitieve drainage ..............................................................................................................8
6.3 Drainagesysteem ........................................................................................................................9
6.3.1 Drieflessensysteem ..............................................................................................................9
6.3.2 Argyle Setinel Seal Chest Drainage Unit .................................................................................9
7. Bronchopulmonaire dysplasie ..........................................................................................................9
7.1 Definitie .....................................................................................................................................9
7.2 Fysiopathologie ..........................................................................................................................9
7.3 Oorzaken BPD .......................................................................................................................... 10
7.4 Belangrijkste klinische problemen BPD ...................................................................................... 10
7.4.1 Respiratoire problemen ...................................................................................................... 10
7.4.2 Cardiale problemen & pulmonale hypertensie ...................................................................... 10
7.4.3 Voedingsproblemen ........................................................................................................... 11
1
Liesbeth Thewissen
,NEONATOLOGIE 2
7.4.4 Neurologische problemen ................................................................................................... 11
7.5 Behandeling bij BPD .................................................................................................................. 11
7.5.1 Respiratoire & cardiale problemen....................................................................................... 11
7.5.2 Voedingsproblemen ........................................................................................................... 11
7.5.3 Neurologische problemen ................................................................................................... 12
7.6 Prognose van patiënten met BPD ............................................................................................... 12
7.6.1 Belangrijke ontslacriteria .................................................................................................... 12
8. Congenitale cardiopathie ............................................................................................................... 12
8.1 Neonatale cardiogene cyanose .................................................................................................. 12
8.1.1 Wanneer er onvoldoende mixing is ...................................................................................... 13
8.1.2 Wanneer er onvoldoende longperfusie is.............................................................................. 13
8.1.3 Veroorzakende aandoeningen bij cyanose op dag 0 .............................................................. 14
8.1.4 Differentiële diagnose ......................................................................................................... 14
8.2 Neonatale hartdecompansatie .................................................................................................. 14
8.2.1 Coarctatio aortae ............................................................................................................... 14
8.2.2 Onderbroken aortaboog ...................................................................................................... 14
8.2.3 Kritische aortaklepstenose .................................................................................................. 15
8.2.4 Hypoplastisch linkerhartsyndroom ...................................................................................... 15
8.3 Neonatale decompensatie na 14e dag ........................................................................................ 15
8.4 Behandeling van congenitale hartafwijkingen ............................................................................. 15
8.4.1 Prostaglandines ................................................................................................................. 15
8.4.2 Hartkatheterisatie .............................................................................................................. 15
8.4.3 Blalock-Taussigshunt ......................................................................................................... 16
8.4.4 Pulmonary banding ............................................................................................................. 16
8.4.5 Definitieve operatie............................................................................................................. 16
9. Necrotiserende enterocolitis .......................................................................................................... 16
9.1 Verschillende oorzaken ............................................................................................................. 16
9.2 Pathofysiologie ......................................................................................................................... 17
9.3 Symptomen .............................................................................................................................. 17
9.4 Diagnose .................................................................................................................................. 17
9.5 Behandeling ............................................................................................................................. 17
9.6 Preventie .................................................................................................................................. 17
9.7 Prognose .................................................................................................................................. 17
10. Intraventriculaire bloedingen & posthemorrhagische hydrocephalie ............................................... 18
10.1 Het ontstaan van intraventriculaire bloedingen ......................................................................... 18
10.1.1 De germinale matrix .......................................................................................................... 18
10.1.2 De cerebrale autoregulatie ................................................................................................ 18
2
Liesbeth Thewissen
, NEONATOLOGIE 2
10.2 Wanneer & bij wie ontstaan intraventriculaire bloedingen .......................................................... 18
10.3 Uitgebreidheid van de bloeding ................................................................................................ 18
10.4 Symptomen van intraventriculaire bloedingen .......................................................................... 19
10.5 Diagnose van intraventriculaire bloedingen .............................................................................. 19
8.6 Behandeling van intraventriculaire bloedingen ............................................................................ 19
10.6.1 Goede bloeddrukondersteuning ........................................................................................ 19
10.6.2 Goede sedatie .................................................................................................................. 19
10.6.3 Comfortverpleging ............................................................................................................ 19
10.6.4 Behandelen van de open ductus Botalli .............................................................................. 19
10.6.5 Goede glycemie behouden ................................................................................................ 19
10.7 Posthemorrhagische hydrocefalie ............................................................................................ 19
10.7.1 UItvoeren van lumbale puncties ........................................................................................ 19
10.7.2 Plaatsen van ventriculo-externe drainage ........................................................................... 20
10.7.3 Plaatsen van ventriculoperitoneale drain ........................................................................... 20
11. Periventriculaire leucomalacie ...................................................................................................... 20
12. Peripartale asfyxie ........................................................................................................................ 21
12.1 Definitie .................................................................................................................................. 21
12.2 Klinische presentatie ............................................................................................................... 21
12.2.1 Neurologisch .................................................................................................................... 21
12.2.2 Respiratoir ....................................................................................................................... 21
12.2.3 Cardiaal ........................................................................................................................... 21
12.2.4 Renaal ............................................................................................................................. 22
12.2.5 Lever ................................................................................................................................ 22
12.2.6 Gastro-intestinaal ............................................................................................................. 22
12.3 Besluit .................................................................................................................................... 22
3
Liesbeth Thewissen
