Respiratory distress in newborn

4th year seminar

RDS

• Most common respiratory illness in NICU

• Occur in premature neonate

• Surfactant deficiency

• Risk factors– Asphyxia and stress– Male– Acidosis– DM mother

signs

• tachypnea

• retraction

• grunting

• Nasal flaring

• apneic episode

• cyanosis

• extremities puffy or swollen

Chest X-ray

• Ground glass appearance

• Reticulogranular

• With air bronchograms

Physiologic abnormalities

• Lung compliance 10-20% of norm

• Atelectasis…areas not ventilated

• Areas not perfused

• Decrease alveolar ventilation

• Reduce lung volume

surfactant

• Type 2 pneumocytes lamillar body 22weeks…34-36wks

• Phosphatidylcholine

• Surfactant specific protein

• Recycling and regeneration (including externally given surfactant)

surfactant

• Decrease surface tension at air liquid level

• Equalize tension in alveoli of different size

• Increase in lung compliance.

• Absence of surfactant cause RDS

• Pulmonary hypertension

Treatment

• Surfactant Fujiwara…1990s– Prevention– rescue

• Supportive– Thermal– Fluid and nutrition– oxygen

• Mechanical ventilation

Acid base In RDS

• pH

• PaCO2

• PaO2

• HCO3

• Base deficit

complications

• Pneumothorax

• PDA

• Chronic lung disease

• Sepsis

• Line problems

Meconium aspiration

• First stool that constitutes the GI epithilium and secretion during fetal life

• Stress and intra-uterine meconium in term infant• Gasping cause the aspiration• Chemical diffuse peumonitis • Same signes of distrss and PPHN.• Treatment maily supprtive

Congenital pneumonia

• Sepsis risk factors– PROM– Preamturity– Maternal fever, dicharge, abdominal pain,

leukocytosis– Colonization with GBS

• Same signs of RDS

• X-ray

Transient tachypnia of newborn

• Term

• Cesarian delivery

• Usually tachypnia without O2 requirment

• Resolve in 48-72 houres

• Lung fluid

• X-ray