Question

Two infants are in NICU. One has meconium aspiration syndrome (MAS) while the other has an alpha 1- antitrypsin (AAT) deficiency, which has led to development of sever emphysema. Briefly discuss the basis behind these tow pathophysiological states. For both these patients, what is the change in lung compliance and why does this change occur? Which of these patients would benefit from artificial surfactant treatment?

Answer 1

Meconium aspiration syndrome.

It is the breathing problem that occurs in the new born babies due to aspiration of meconium into the lungs.Meconium is thick green brown and blackish substance that makes the fetal stool.The newborn has trouble in breathing due to the presence of meconium in the lungs.The skin color of the baby becomes bluish.

Pathophysiology of meconium aspiration syndrome.

Meconium causes mechanical obstruction band air trapping occurs and uneven ventilation occurs and air leaks leads to hypoxemia acidosis and that leads to pulmonary hypertension.

Meconium causes chemical inflammation that leads to Atelectasis and causes intrapulmonary shunting.Intrapulmonary shunting causes hypoxemia acidosis and leads primary hypertension.

Meconium also causes surfactant inactivation and causes Atelectasis and causes intrapulmonary shunting and primary hypertension.

​​​​​​Artificial surfactant is beneficial for meconium aspiration syndrome because meconium inactived surfactant so if supply artificial surfactant it will help in reducing suface tension and relives some trouble from alveolar collapse and from meconium aspiration syndrome.

Emphysema

It is a hereditary disorder that is due to deficiency of alpha-1 antitrypsin.

Alpha 1 antitrypsin is a blood protein produced by liver cells . Function of Alpha 1 antitrypsin is to protect the lung tissue inflammatory cells.when alpha 1 antitrypsin deficiency occurs the enzyme neutrophils elastase damges the lung tissues and destucts the elastic tissue and cauy emphysema.

Pathophysiology of emphysema.

Deficiency of Alpha 1 antitrypsin cause the inflammatory cells to damage lung tissue.First destruction of elastic fibers occurs.It causes loss of elastic recoil of lungs,which leads narrow of small air passage and leads to airflow obstruction.it also cause destruction of alveolar septa and reduces the surface area for gases exchange and leads to hypoxia.

Artificial surfactant is beneficial in emphysema too because surfactant decreases the surface tension in the alveoli of the lung.it also prevent alveolar collapse which helps in emphysema.