Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) Pediatrics Respiratory Distress in Newborn Handwritten Notes
RESPIRATORY
DISTRESS IN
NEWBORN
FEATURES
? Tachypnea ? respiratory rate > 60/min
? Chest retractions
? Grunting
? Flaring of ala enasi
? Cyanosis
CAUSES
MEDICAL
Pulmonary
? Respiratory distress syndrome
? Meconium aspiration syndrome
? Pneumonia
? Transient tachypnea of newborn
? Persistent pulmonary hypertension
? Pneumothorax
NON PULMONARY CAUSES
Cardiac
congenital heart disease, congestive heart failure
Metabolic
Hypothermia, hypoglycaemia, metabolic acidosis
CNS
Asphyxia, cerebral oedema, haemorrhage
Chest wall
Asphyxiating thoracic dystrophy, Werdning-Hoffman
disease
SURGICAL
? Trache-oesophagal fistula
? Diaphragmatic hernia
? Lobar emphysema
? Choanal atresia
APPROACH TO RESPIRATORY
DISTRESS
HISTORY
? Onset of distress
? Gestation
? Antenatal steroids
? Predisposing factors ? PROM, fever
? Meconium stained amniotic fluid
? Asphyxia
EXAMINATION
? Severity of respiratory distress
? Neurological status
? Blood pressure
? Hepatomegaly
? Cyanosis
? Features of sepsis
? Malformations
CHEST EXAMINATION
? Air entry
? Mediastinal shift
? Adventitious sounds
? Hyperinflation
? Heart sounds
ASSESMENT OF RESPIRATORY
DISTRESS
PRE-TERM POSSIBLE ETIOLOGY
EARLY
RESPIRATORY DISTRESS
PROGRESSIVE
SYNDROME
EARLY
ASPHYXIA, METABOLIC
TRANSIENT
CAUSES, HYPOTHERMIA
ANYTIME
PNEUMONIA
TERM ? POSSIBLE ETIOLOGY
EARLY WELL LOOKING
TTNB, POLYCYTHEMIA
EARLY SEVERE
MAS, ASPHYXIA, MALFORMATIONS
DISTRESS
LATE SICK WITH
CARDIAC
HEPATOMEGALY
LATE SICK WITH
ACIDOSIS
SHOCK
ANYTIME
PNEUMONIA
SUSPECT SURGICAL CAUSE
? Scaphoid abdomen
? Frothing
? History of aspiration
INVESTIGATION
? Chest X-ray
? Polymorph count
? Gastric aspirate
? Sepsis screen
? Blood gas analysis
MANAGEMENT
? Monitoring
? Supportive
?
IV fluids
?
Maintain vital signs
?
Oxygen therapy
? Respiratory support
? Specific
RESPI
RATO
RY
DIST
RESPIRATORY DISTRESS
RESS
SYNDROME \ HYALINE
MEMBRANE DISEASE
RISK FACTORS
? PREMATURITY
?
Common in preterm babies less than 34 weeks of
gestation
?
80% neonates < 28 weeks
? Maternal diabetes
? Asphyxia
? Acidosis
ETIOPATHOGENISIS
? Decreased or abnormal
surfactant
? Alveolar collapse
? Impaired gas exchange
? Respiratory failure
CLINICAL FEATURES
? Usually within minutes of birth
? Tachpnea
? Retractions
? Grunting
? Cyanosis
? Breath sounds normal or diminished
DIAGNOSIS
CHEST X-RAY
? Reticogranular pattern
? Ground-glass opacity
? Low lung volume
? Air bronchogram
? White out ling in severe disease
MANAGEMENT
? Cared in NICU with IV fluids and oxygen.
? Continuous positive airway pressure (CPAP).
? Mechanical ventilation.
? Exogenous surfactant ? intratracheal.
DOSE: 100mg/ kg
CPAP
It is non invasive modality where continuous
distending pressure ( 5-7 cm of water) applied at
nostril level to keep the alveoli open in a
spontaneously breathing baby
Minimises lung injury, air leak and sepsis.
PREVENTION-
ANTENATAL STERIODS
To mother in preterm labour (<35 weeks).
DOSE: Inj. Betamethasone 12mg IM every 24hrs- 2
doses OR Dexamethasone 6mg IM every 12 hrs.- 4
doses.
MECONIUM
ASPIRATION
SYNDROME
? Meconium staining of amniotic fluid(MSAF) occur
in 10-14%pregnancies
? Meconium staining on cord, nails, skin
? Onset within 4-6 hrs.
? Hyper inflated chest
THICK : Atelectasis, air blockage, air leak syndrome
THIN : Chemical pneumonitis
Chest X-ray
Bilateral heterogeneous
opacities, areas of hyper
expansion and
atelectasis and air leak
MANAGEMENT
? Good supportive care ? body temperature, blood
glucose and calcium levels ensuring analgesia and
avoiding unnecessary fiddling.
? Oxygenation and ventilation.
TRANSIENT TACHYPNEA OF
NEWBORN
It is a benign self liming disease usually in term
neonates and is due to clearance of lung fluid
These babies have tachypnea with minimal or
nonrespiratory distress.
Chest X-ray ? hyperxpanded lung fields,
prominent vascular marking and prominent
imterlobar fissure
Treatment ? oxygen treatment is adequate.
PNEUMONIA
Caused by bacteria ? E.coli, S.aureus, K.pneumonia,
occasionally due to fungal and viral infections
PREDISPOSING FACTORS
PROM> 24 hrs., peripartal fever, unclean or multiple
per vaginal delivery, foul smelling liquor
Chest X-ray shows pneumonia, blood counts are
raised, blood culture ay be positive
TREATMENT ?
Supportive care and antibiotic therapy ( ampicillin
or cloxacilllin with gentamycin)
ASPHYXIA
? Myocardial dysfunction
? Cerebral oedema
? Asphyxia lung injury
? Metabolic acidosis
? Persistent pulmonary hypertension
PNEUMOTHARAX
ETIOLOGY
Spontaneous, MAS, positive pressure ventilation
CLINICAL FEATURES
Sudden distress, indistinct heart sounds
MANAGEMENT
Needle aspiration, chest tube
PERSISTANT PULMONARY
HYPERTENSION
? Neonates preset with severe respiratory distress and
cyanosis.
? CAUSES
? Primary
? Secondary : MAS, asphyxia, sepsis
? MANAGEMENT
Ventilatory support , pulmonary vasodilators like Nitric oxide
SURGICAL PROBLEMS
TRACHEOESOPHAGAL
FISTULA should be
suspected in case of
excessive frothing.
Plain X-ray with a red rubber
catheter inserted in stomach
: the catheter generally stops
at tenth thoracic vertebrae in
presence of oesophageal
attrition. Presence of gastric
bubble suggest TEF.
? Diaphragmatic hernia
suspected in neonates was
respiratory distress and ha
scaphoid abdomen. Chest
X-ray shows bowel loops
in the thoracic cavity. This
can detected during
antenatal USG scanning.
THANK YOU
This post was last modified on 11 August 2021