{"id":33624,"date":"2023-05-13T21:05:13","date_gmt":"2023-05-13T14:05:13","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33624"},"modified":"2023-05-13T21:05:13","modified_gmt":"2023-05-13T14:05:13","slug":"benh-mang-trong-o-tre-em-dich-te-co-che-chan-doan-bien-chung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/benh-mang-trong-o-tre-em-dich-te-co-che-chan-doan-bien-chung\/","title":{"rendered":"B\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb em: d\u1ecbch t\u1ec5, c\u01a1 ch\u1ebf, ch\u1ea9n \u0111o\u00e1n, bi\u1ebfn ch\u1ee9ng"},"content":{"rendered":"
B\u1ec7nh m\u00e0ng trong (Hyaline membrane disease-HMD): M\u1ed9t b\u1ec7nh l\u00fd g\u00e2y suy h\u00f4 h\u1ea5p, x\u1ea3y ra sau khi kh\u1edfi ph\u00e1t th\u1edf \u1edf tr\u1ebb s\u01a1 sinh b\u1ecb thi\u1ebfu surfactant \u1edf ph\u1ed5i. Thu\u1eadt ng\u1eef n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb ti\u00eau b\u1ea3n gi\u1ea3i ph\u1eabu b\u1ec7nh c\u1ee7a nh\u1eefng b\u1ec7nh nhi t\u1eed vong do m\u1eafc b\u1ec7nh. Ng\u00e0y nay, c\u00e1c nh\u00e0 khoa h\u1ecdc th\u01b0\u1eddng d\u00f9ng thu\u1eadt ng\u1eef \u201ch\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p\u201d (Respiratory distress syndrome-RDS).<\/strong><\/div>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc b\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb:<\/strong><\/h2>\n
B\u1ec7nh c\u00f3 th\u1ec3 g\u1eb7p \u1edf 1% t\u1ea5t c\u1ea3 tr\u1ebb s\u01a1 sinh v\u00e0 v\u00e0o kho\u1ea3ng 5 – 10% tr\u1ebb s\u01a1 sinh \u0111\u1ebb non. T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh t\u1ec9 l\u1ec7 ngh\u1ecbch v\u1edbi tu\u1ed5i thai.<\/div>\n
\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: Slide thuy\u1ebft tr\u00ecnh CLB N\u1ed9i khoa Hu\u1ebf 2018<\/figcaption><\/figure>\n<\/div>\n

2. Y\u1ebfu t\u1ed1 nguy c\u01a1 :<\/strong><\/h2>\n
\u2022 B\u00e9 trai<\/div>\n
\u2022 Ch\u1ee7ng t\u1ed9c da tr\u1eafng<\/div>\n
\u2022 Ti\u1ec1n s\u1eed gia \u0111\u00ecnh<\/div>\n
\u2022 M\u1ed5 l\u1ea5y thai.<\/div>\n
\u2022 Suy thai\/Sanh ng\u1ea1t<\/div>\n
\u2022 Sinh \u0111\u00f4i (tr\u1ebb ra sau c\u00f3 nguy c\u00f3 cao h\u01a1n)<\/div>\n
\u2022 M\u1eb9 b\u1ecb ti\u1ec3u \u0111\u01b0\u1eddng trong thai k\u1ef3<\/div>\n

3. C\u01a1 ch\u1ebf b\u1ec7nh sinh g\u00e2y b\u1ec7nh m\u00e0ng trong\u00a0 \u1edf tr\u1ebb em<\/strong><\/h2>\n

3.1 Ch\u1ea5t Surfactant<\/strong><\/h3>\n
\u2022 Do t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ph\u1ebf nang type 2 b\u00e0i ti\u1ebft<\/div>\n
\u2022 Chi\u1ebfm kho\u1ea3ng 10% di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t ph\u1ebf nang.<\/div>\n
Kh\u00f4ng ho\u00e0 tan trong n\u01b0\u1edbc m\u00e0 tr\u1ea3i tr\u00ean b\u1ec1 m\u1eb7t l\u1edbp d\u1ecbch l\u00f3t ph\u1ebf nang<\/div>\n

3.2 C\u1ea5u t\u1ea1o surfactant:<\/strong><\/h3>\n
C\u1ea5u t\u1ea1o surfactant:<\/strong> G\u1ed3m phospholipid v\u00e0 protein:<\/div>\n
\u2022 Phospholipid: ch\u1ee7 y\u1ebfu l\u00e0 Dipalmitoyl-Phosphatidylcholin (Leucithin), chi\u1ebfm vai tr\u00f2 quan tr\u1ecdng nh\u1ea5t, c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m s\u1ee9c c\u0103ng b\u1ec1 m\u1eb7t ph\u1ebf nang.<\/div>\n
\u2022 Protein: 4 apoprotein \u0111\u1eb7c hi\u1ec7u b\u1ec1 m\u1eb7t (SP-A, SP-B, SP-C, SP-D) c\u00f3 t\u00e1c d\u1ee5ng gi\u00fap phospholipid tr\u1ea3i r\u1ed9ng tr\u00ean b\u1ec1 m\u1eb7t l\u1edbp d\u1ecbch l\u00f3t ph\u1ebf nang.<\/div>\n

3.3 Vai tr\u00f2 c\u1ee7a surfatant trong b\u1ec7nh m\u00e0ng trong c\u1ee7a tr\u1ebb<\/strong><\/h3>\n
\u2022 \u1ea2nh h\u01b0\u1edfng l\u00ean t\u00ednh \u0111\u00e0n h\u1ed3i c\u1ee7a ph\u1ed5i<\/div>\n
\u2022 \u1ea2nh h\u01b0\u1edfng l\u00ean s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a ph\u1ebf nang<\/div>\n
\u2022 \u1ea2nh h\u01b0\u1edfng l\u00ean vi\u00eac ng\u0103n s\u1ef1 t\u00edch t\u1ee5 d\u1ecbch ph\u00f9 trong ph\u1ebf nang<\/div>\n
\u2022 \u1ea2nh h\u01b0\u1edfng l\u00ean s\u1ef1 trao \u0111\u1ed5i kh\u00ed<\/div>\n

3.4 Khi\u1ebfm khuy\u1ebft t\u1ed5ng h\u1ee3p surfactant <\/strong>trong b\u1ec7nh m\u00e0ng trong c\u1ee7a tr\u1ebb<\/strong><\/h3>\n
\u2022 S\u1ef1 thi\u1ebfu h\u1ee5t th\u00e0nh ph\u1ea7n ch\u00ednh l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p<\/div>\n
\u2022 B\u1ec7nh c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n n\u1ebfu c\u00f3 s\u1ef1 thi\u1ebfu h\u1ee5t hay r\u1ed3i lo\u1ea1n th\u00e0nh ph\u1ea7n ph\u1ee5<\/div>\n

3.5 Khi\u1ebfm khuy\u1ebft ti\u1ebft surfactant<\/strong><\/h3>\n
\u2022 T\u1eeb tu\u1ea7n 24 – 34 l\u00e0 qu\u00e1 tr\u00ecnh bi\u1ec7t h\u00f3a ph\u1ebf b\u00e0o I v\u00e0 II, b\u1eaft \u0111\u1ea7u s\u1ea3n xu\u1ea5t surfactant t\u1ea1i ph\u1ebf b\u00e0o II d\u01b0\u1edbi s\u1ef1 x\u00fac t\u00e1c c\u1ee7a h\u1ec7 th\u1ed1ng enzym. H\u1ec7 th\u1ed1ng men n\u00e0y ch\u1ec9 ho\u1ea1t \u0111\u1ed9ng t\u1ed1t nh\u1ea5t khi thai \u0111\u01b0\u1ee3c 34 – 35 tu\u1ea7n<\/div>\n
\u2022 Nh\u1eefng tr\u1ebb \u0111\u1ebb non th\u01b0\u1eddng c\u00f3 nguy c\u01a1 cao ph\u00e1t sinh b\u1ec7nh n\u00e0y<\/div>\n
\u2022 T\u00ecnh tr\u1ea1ng thi\u1ebfu oxy, nhi\u1ec5m toan, h\u1ea1 th\u00e2n nhi\u1ec7t v\u00e0 h\u1ea1 huy\u1ebft \u00e1p c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m s\u1ea3n xu\u1ea5t v\u00e0\/ho\u1eb7c gi\u1ea3m b\u00e0i ti\u1ebft surfactant<\/div>\n

3.6 H\u1eadu qu\u1ea3 thi\u1ebfu h\u1ee5t surfactant<\/strong><\/h3>\n
\u2022 D\u00e3n su\u1ea5t c\u1ee7a ph\u1ed5i gi\u1ea3m<\/div>\n
\u2022 Gi\u1ea3m dung t\u00edch c\u1eb7n ch\u1ee9c n\u0103ng (FRC: Functional Residual Capacity) c\u1ee7a ph\u1ed5i \u2192 ph\u1ed5i x\u1eb9p l\u1ea1i trong k\u1ef3 th\u1edf ra do v\u1eady s\u1ef1 trao \u0111\u1ed5i kh\u00ed ch\u1ec9 di\u1ec5n ra trong th\u1eddi k\u1ef3 th\u1edf v\u00e0o.<\/div>\n
\u2022 Gi\u1ea3m t\u01b0\u1edbi m\u00e1u mao m\u1ea1ch ph\u1ed5i (m\u1ea5t c\u00e2n b\u1eb1ng th\u00f4ng kh\u00ed – t\u01b0\u1edbi m\u00e1u-V\/Q) \u2192 nhi\u1ec5m toan c\u1ee5c b\u1ed9 g\u00e2y t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a m\u00e1u \u0111i v\u00e0o nhu m\u00f4 ph\u1ed5i<\/div>\n
\u2022 T\u1ea1o shunt P-T:V\u00f9ng ph\u1ed5i b\u1ecb x\u1eb9p s\u1ebd kh\u00f4ng tham gia trao \u0111\u1ed5i kh\u00ed v\u00e0 d\u1ec5 g\u00e2y t\u0103ng shunt trong ph\u1ed5i.<\/div>\n
V\u00ec ph\u1ed5i ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, \u0111\u1ed9 th\u1ea9m th\u1ea5u c\u1ee7a mao m\u1ea1ch ph\u1ed5i v\u00e0 m\u00e0ng ph\u1ebf nang t\u0103ng \u2192 c\u00e1c th\u00e0nh ph\u1ea7n huy\u1ebft t\u01b0\u01a1ng c\u1ee7a m\u00e1u nh\u01b0 c\u00e1c fibrin d\u1ec5 tho\u00e1t\u00a0 m\u1ea1ch \u0111i v\u00e0o t\u1ed5 ch\u1ee9c k\u1ebd v\u00e0 l\u00f2ng ph\u1ebf nang\u00a0 g\u00e2y ph\u00f9 ph\u1ed5i.<\/div>\n
<\/div>\n
\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: Slide thuy\u1ebft tr\u00ecnh CLB N\u1ed9i khoa Hu\u1ebf 2018<\/figcaption><\/figure>\n<\/div>\n
<\/div>\n
T\u00ecnh tr\u1ea1ng h\u1ea1 oxy m\u00e1u, nhi\u1ec5m toan v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang l\u1ea1i l\u00e0m x\u1ea5u \u0111i nh\u1eefng \u0111i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 t\u1ed5ng h\u1ee3p v\u00e0 ch\u1ee9c n\u0103ng surfactant. C\u00e0ng thi\u1ebfu surfactant th\u00ec t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan v\u00e0 h\u1ea1 oxy m\u00e1u l\u1ea1i c\u00e0ng th\u00eam n\u1eb7ng n\u1ec1. T\u00ecnh tr\u1ea1ng n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 v\u00f2ng lu\u1ea9n qu\u1ea9n b\u1ec7nh l\u00fd c\u1ee7a b\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb<\/a><\/div>\n

4. L\u00e2m s\u00e0ng b\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb<\/strong><\/h3>\n
\u2022 Suy h\u00f4 h\u1ea5p: kh\u1edfi ph\u00e1t v\u00e0i gi\u1edd sau sinh<\/div>\n
\u2022 R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf: \u226560 l\u1ea7n\/ph\u00fat<\/div>\n
\u2022 D\u1ea5u hi\u1ec7u th\u1edf g\u1eafng s\u1ee9c: ph\u1eadp ph\u1ed3ng c\u00e1nh m\u0169i, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c, th\u1edf r\u00ean<\/div>\n
\u2022 Xanh t\u00edm: PaO2 < 50mmHg<\/div>\n
\u2022 Ngo\u00e0i ra: th\u1edf ch\u1eadm(TST<30 l\u1ea7n\/ph\u00fat), ng\u01b0ng th\u1edf k\u00e9o d\u00e0i \u226515s, th\u1edf n\u1ea5c v\u00e0 nh\u1ecbp tim <80 l\u1ea7n\/ph\u00fat c\u1ea7n x\u1eed tr\u00ed h\u1ed3i s\u1ee9c ngay.<\/div>\n
<\/div>\n
Ch\u1ec9 s\u1ed1 APGAR<\/strong><\/div>\n
\u2022 Gi\u00fap \u0111\u00e1nh gi\u00e1 s\u1ef1 th\u00edch nghi c\u1ee7a tr\u1ebb ngay sau khi ra \u0111\u1eddi sau 1 ph\u00fat, 5 ph\u00fat v\u00e0 10 ph\u00fat g\u1ed3m 5 d\u1ea5u hi\u1ec7u, theo th\u1ee9 t\u1ef1 quan tr\u1ecdng: nh\u1ecbp tim, nh\u1ecbp th\u1edf, tr\u01b0\u01a1ng l\u1ef1c c\u01a1, s\u1ef1 ph\u1ea3n \u1ee9ng c\u1ee7a tr\u1ebb \u0111\u1ed1i v\u1edbi m\u00f4i tr\u01b0\u1eddng v\u00e0 m\u00e0u s\u1eafc da.<\/div>\n
<\/div>\n
\n\n\n\n\n\n\n\n\n\n
 <\/p>\n

D\u1ea4U HI\u1ec6U<\/strong><\/td>\n

\u0110I\u1ec2M S\u1ed0<\/strong><\/td>\n<\/tr>\n
0<\/strong><\/td>\n1<\/strong><\/td>\n2<\/strong><\/td>\n<\/tr>\n
Nh\u1ecbp tim<\/td>\nKh\u00f4ng c\u00f3<\/td>\n<100 l\/p<\/td>\n>100 l\/p<\/td>\n<\/tr>\n
H\u00f4 h\u1ea5p<\/td>\nKh\u00f4ng c\u00f3<\/td>\nCh\u1eadm, kh\u00f4ng \u0111\u1ec1u<\/td>\nT\u1ed1t, kh\u00f3c to<\/td>\n<\/tr>\n
Tr\u01b0\u01a1ng l\u1ef1c c\u01a1<\/td>\nM\u1ec1m o\u1eb7t, m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c<\/td>\nV\u00e0i \u0111\u1ed9ng t\u00e1c g\u1eadp c\u1ee7a t\u1ee9 chi<\/td>\nC\u1eed \u0111\u1ed9ng linh ho\u1ea1t<\/td>\n<\/tr>\n
\u0110\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch (x\u00fac gi\u00e1c, \u0111\u1eb7t catheter v\u00e0o m\u0169i)<\/td>\nKh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\nNh\u0103n m\u1eb7t, \u0111\u00e1p \u1ee9ng k\u00e9m<\/td>\nHo, h\u1eaft h\u01a1i, kh\u00f3c<\/td>\n<\/tr>\n
S\u1eafc da<\/td>\nXanh ho\u1eb7c t\u00e1i nh\u1ee3t<\/td>\nTh\u00e2n h\u1ed3ng, chi xanh t\u00edm<\/td>\nH\u1ed3ng h\u00e0o to\u00e0n th\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
T\u1ed5ng \u0111i\u1ec3m:<\/strong><\/div>\n
    \n
  • 7-10: b\u00ecnh th\u01b0\u1eddng<\/li>\n
  • 4-6 : ng\u1ea1t nh\u1eb9 ho\u1eb7c trung b\u00ecnh<\/li>\n
  • 0-3 : ng\u1ea1t n\u1eb7ng, c\u1ea7n h\u1ed3i s\u1ee9c ngay<\/li>\n<\/ul>\n
    Ch\u1ec9 s\u1ed1 Silverman > 5 \u0111i\u1ec3m<\/strong><\/div>\n
    \n\n\n\n\n\n\n\n\n
     <\/p>\n

    \u0110i\u1ec3m<\/strong><\/td>\n

    		0<\/strong><\/td>\n1<\/strong><\/td>\n2<\/strong><\/td>\n<\/tr>\n
    Di \u0111\u1ed9ng ng\u1ef1c b\u1ee5ng<\/strong><\/td>\nC\u00f9ng chi\u1ec1u<\/td>\nNg\u1ef1c \u00edt di \u0111\u1ed9ng<\/td>\nNg\u01b0\u1ee3c chi\u1ec1u<\/td>\n<\/tr>\n
    C\u00e1nh m\u0169i ph\u1eadp ph\u1ed3ng<\/strong><\/td>\nKh\u00f4ng<\/td>\nV\u1eeba<\/td>\nM\u1ea1nh<\/td>\n<\/tr>\n
    R\u00fat l\u00f5m h\u1ecfm \u1ee9c<\/strong><\/td>\nKh\u00f4ng<\/td>\nV\u1eeba<\/td>\nM\u1ea1nh<\/td>\n<\/tr>\n
    Co k\u00e9o li\u00ean s\u01b0\u1eddn<\/strong><\/td>\nKh\u00f4ng<\/td>\nV\u1eeba<\/td>\nM\u1ea1nh<\/td>\n<\/tr>\n
    Ti\u1ebfng r\u00ean<\/strong><\/td>\nKh\u00f4ng<\/td>\nQua \u1ed1ng nghe<\/td>\nNghe b\u1eb1ng tai<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
    T\u1ed5ng s\u1ed1 \u0111i\u1ec3m:<\/strong><\/div>\n
      \n
    • Kh\u00f4ng suy h\u00f4 h\u1ea5p: < 3 \u0111i\u1ec3m<\/li>\n
    • Suy h\u00f4 h\u1ea5p nh\u1eb9: 3 – 5 \u0111i\u1ec3m<\/li>\n
    • Suy h\u00f4 h\u1ea5p n\u1eb7ng: > 5 \u0111i\u1ec3m<\/li>\n<\/ul>\n

      5. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

      5.1 C\u1eadn l\u00e2m s\u00e0ng \u1edf b\u00e9<\/strong><\/h3>\n
      \u2022 Kh\u00ed m\u00e1u:<\/div>\n
      \u2022 \u2193 PaO2 <50mmHg<\/div>\n
      \u2022 \u2191 PaCO2\u00a0 >70mmHg<\/div>\n
      \u2022 \u2193 pH <7<\/div>\n
      \u2022 Nhi\u1ec5m toan h\u00f4 h\u1ea5p sau k\u00e8m theo toan chuy\u1ec3n h\u00f3a<\/div>\n
      \u2022 XQuang<\/div>\n
      o G\u0110 1: L\u01b0\u1edbi h\u1ea1t r\u1ea3i r\u00e1c, ph\u1ed5i n\u1edf t\u1ed1t.<\/div>\n
      o G\u0110 2: H\u00ecnh \u1ea3nh kh\u00ed ph\u1ebf qu\u1ea3n \u0111\u1ed3,th\u1ec3 t\u00edch ph\u1ed5i gi\u1ea3m.<\/div>\n
      o G\u0110 3: Ph\u1ed5i m\u1edd \u0111\u1ec1u, b\u1edd tim kh\u00f4ng r\u00f5, kh\u00ed qu\u1ea3n \u0111\u1ed3 r\u00f5 r\u1ec7t.<\/div>\n
      \u2022 G\u0110 4: Ph\u1ed5i tr\u1eafng x\u00f3a, ch\u1ec9 th\u1ea5y 2 nh\u00e1nh\u00a0kh\u00ed ph\u1ebf qu\u1ea3n.<\/div>\n

      5.2 C\u1eadn l\u00e2m s\u00e0ng c\u1ee7a m\u1eb9<\/strong><\/h3>\n
      \u2022 Sinh h\u00f3a d\u1ecbch \u1ed1i:<\/div>\n
      \u2022 T\u1ef7 l\u1ec7 Lecithin\/Sphingomyelin < 2<\/div>\n
      \u2022 Kh\u00f4ng c\u00f3 Phosphatidyl Glycerol<\/div>\n

      6. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/strong><\/h2>\n

      D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng b\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb:\u00a0<\/strong><\/h3>\n
      \u2022 Tr\u1ebb \u0111\u1ebb non ho\u1eb7c c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111ang th\u1edf b\u00ecnh th\u01b0\u1eddng th\u00ec xu\u1ea5t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p nhanh ch\u00f3ng, t\u00edm t\u00e1i, th\u1edf r\u00ean, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m d\u1ea7n \u1edf c\u1ea3 hai ph\u1ed5i.<\/div>\n
      \u2022 C\u00f3 th\u1ec3 tr\u1ee5y tim m\u1ea1ch.<\/div>\n

      7. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h2>\n
      – 80% do c\u00e1c nguy\u00ean nh\u00e2n:<\/strong><\/div>\n
      \u2022 B\u1ec7nh m\u00e0ng trong<\/div>\n
      \u2022 H\u00edt \u1ed1i ph\u00e2n su<\/div>\n
      \u2022 C\u01a1n kh\u00f3 th\u1edf tho\u00e1ng qua<\/div>\n
      \u2022 Vi\u00eam ph\u1ed5i n\u1eb7ng<\/div>\n
      <\/div>\n
      – 20% do c\u00e1c b\u1ec7nh c\u1ea3nh kh\u00e1c nh\u01b0:<\/strong><\/div>\n
      \u2022 B\u1ec7nh tim b\u1ea9m sinh<\/div>\n
      \u2022 Ng\u1ea1t chu sinh<\/div>\n
      \u2022 Toan chuy\u1ec3n h\u00f3a<\/div>\n

      8. Bi\u1ebfn ch\u1ee9ng b\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb<\/strong><\/h3>\n
      \u2022 C\u1ea5p t\u00ednh:<\/div>\n
      \u2022 Nhi\u1ec5m tr\u00f9ng<\/div>\n
      \u2022 C\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch (PDA) v\u1edbi gia t\u0103ng shunt ph\u1ea3i-tr\u00e1i<\/div>\n
      \u2022 Xu\u1ea5t huy\u1ebft ph\u1ed5i<\/div>\n
      \u2022 Ng\u01b0ng th\u1edf s\u1edbm<\/div>\n
      \u2022 M\u1ea1n t\u00ednh:<\/div>\n
      \u2022 Lo\u1ea1n s\u1ea3n ph\u1ebf qu\u1ea3n ph\u1ed5i<\/div>\n
      \u2022 V\u1ee1 ph\u1ebf nang<\/div>\n
      \u2022 C\u00e1c khi\u1ebfm khuy\u1ebft v\u1ec1 m\u1eb7t th\u1ea7n kinh<\/div>\n
      <\/div>\n
      Ngu\u1ed3n tham kh\u1ea3o:<\/div>\n
        \n
      • CLB Nhi khoa \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Hu\u1ebf2018<\/li>\n<\/ul>\n
        <\/div>\n
        <\/div>\n
        usechatgpt init success<\/div>\n
        usechatgpt init success<\/div>\n
        usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"

        B\u1ec7nh m\u00e0ng trong (Hyaline membrane disease-HMD): M\u1ed9t b\u1ec7nh l\u00fd g\u00e2y suy h\u00f4 h\u1ea5p, x\u1ea3y ra sau khi kh\u1edfi ph\u00e1t th\u1edf \u1edf tr\u1ebb s\u01a1 sinh b\u1ecb thi\u1ebfu surfactant \u1edf ph\u1ed5i. Thu\u1eadt ng\u1eef n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb ti\u00eau b\u1ea3n gi\u1ea3i ph\u1eabu b\u1ec7nh c\u1ee7a nh\u1eefng b\u1ec7nh nhi t\u1eed vong do m\u1eafc b\u1ec7nh. Ng\u00e0y nay, c\u00e1c nh\u00e0 khoa h\u1ecdc […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[],"yoast_head":"\nB\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb em: d\u1ecbch t\u1ec5, c\u01a1 ch\u1ebf, ch\u1ea9n \u0111o\u00e1n, bi\u1ebfn ch\u1ee9ng<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb (Hyaline membrane disease-HMD): M\u1ed9t b\u1ec7nh l\u00fd g\u00e2y suy h\u00f4 h\u1ea5p, x\u1ea3y ra sau khi kh\u1edfi ph\u00e1t th\u1edf \u1edf tr\u1ebb s\u01a1 sinh\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh m\u00e0ng trong \u1edf tr\u1ebb em: d\u1ecbch t\u1ec5, c\u01a1 ch\u1ebf, 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