Carbon Monoxide Narcosis

ID/CC HPI PE Labs

Imaging

Gross Pathology

Micro Pathology Treatment

Discussion

A premature (32-week-old) male infant is brought to the intensive care unit after a cesarean delivery.

His mother had third-trimester bleeding and contractions that did not stop with rest and conservative treatment.

VS: tachypnea. PE: child weighs 3.8 lb; cyanosis; dyspnea; uses accessory muscles of respiration; nasal flaring.

ABGs: hypoxemia; hypercapnia. Decreased lecithin/sphingomyelin (L/S) ratio (L/S ratio normally > 2; 1.5-2.0 in 40% of newborns with respiratory distress syndrome).

CXR: bilateral reticular pulmonary infiltrates and atelectasis.

Generalized atelectasis in purple-colored lung; eosinophilic fibrinous hyaline membrane formation.

Ventilatory support, fluid, acid-base and electrolyte balance, antibiotics.

Idiopathic respiratory distress syndrome of the newborn is the most common cause of death in premature infants. It is due to a deficiency of suriactant, a lipoprotein produced by pneumocyte II cells that has detergent effects on alveolar superficial tension and contains the phospholipid dipalmitoyl lecithin. Fetal lung maturity may be measured by the IVS ratio. The syndrome might be prevented by giving betamethasone to pregnant women, since pneumocyte II differentiation is dependent on steroids. P-232

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