Respiratory distress in newborn 4 th 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 houres Lung fluid X-ray