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1、CHAPTER67PEDIATRICSURGERYDaiH.Chungarteriosus.Manyfactorscancontributetopersistentpulmonarynewbornphysiologyhypertension(PPHN)withright-to-leftshunt.Hypoxemia,aci-fluids,electrolytes,andnutritiondosis,andsepsisallcontributetoPPHN.Prematurityisalsoanecklesionssignificantriskfactorf
2、orpersistentductusarteriosus.Nonsteroi-extracorporeallifesupportdalanti-inflammatorydrugs(NSAIDs),suchasindomethacin,congenitaldiaphragmaticherniahavebeenusedtocloseapatentductusarteriosusinprematurebronchopulmonarymalformationsinfantspharmacologically.Ifunsuccessful,surgicalligat
3、ionmayalimentarytractbenecessary.Aninfanthearthasalimitedcapacitytoincreasehepatobiliaryconditionsthestrokevolumeand,therefore,cardiacoutputislargelyrate-abdominalwalldependent.Cardiacoutputissignificantlyaffectedbybrady-cardicepisodes.Capillaryrefillisanidealclinicalindicatorofch
4、estwalldeformitiesadequatecardiacperfusion.Aprolongedcapillaryrefilllongergenitourinarytractconditionsthan1to2secondsmayrepresentsignificantshuntingofbloodsolidtumorsofchildhoodfromtheperipheraltissuestothecentralorgans,asmayoccurtraumawithcardiogenicand/orhypovolemicshock.fetalsu
5、rgeryPulmonarySystemThelungsarenotfullymaturedatbirthandcontinuetoformnewterminalbronchiolesandalveoliuntilabout8yearsofage.Pediatricsurgeryremainsasatruegeneralsurgicalspecialty,Inprematureinfants,lungimmaturityisoneofthegreatestprovidingtotalcareforinfantsandchildrenofallages.Th
6、econtributorstomorbidityandmortality.ImmaturelungshaverangeofclinicalpathologyisbroadandnotlimitedtospecificfewertypeIIpneumocytesandalowerproductionofsurfactant,anatomicorgansystems.Pediatricsurgeonsarechallengedbywhichiscriticalforreducingalveolarsurfacetensionandtherebydealingw
7、ithawidespectrumofpathologiesinvolvingmultipleincreasingfunctionalresidualcapacity.Hence,prematureinfantsorgansystemsfromneonatestoyoungadults.Althoughtheareatsignificantrisksforalveolarcollapse,hyalinemembranepathogenesisofmanypediatricsurgicalconditionsremainsformation,andbarotr
8、auma.Surfactantisalipoproteinmixt
