2. Nonatology: Neonatal Respiratory Distress

3. Lecture Points Neonatal pulmonary function Clinical Manifestation The main causes Main types of the disease Case discussion and presentation Summary and conclusion

4. Pulmonary function of the newborns in particular Relative small capacity of the lungs ： limited reserved volume  poor compensation, likely to be distressed Respiratory on abdomen and diaphragmatic movement  Distension: likely to be respiratory distressed pulmonary surfactant (PS) relative in small amount in preterms and easily to be deficiency Diseased lungs trends poor compliance and even ARDS

5. Neonatal Respiratory Distress General picture commonly occurs during neonatal period caused by various pathogeneses breath  or  、 irregular, apnea With or without retraction at breathing, suprasternal and intercostal usually with cyanosis more or less

6. Causation of neonatal respiratory distress Upper respiratory tract ： choana, macrotongue, micrognathia Larynx/throat and trachea ： intenerate pulmonary disease ： inflamation 、 abnormality or hypogenesis others ： congenital heart disease metabolic problems, CNS caused

7. Pathophysiology in neonatal respiratory distress hypoxic and /or hypoventilation  hypoxemia, PCO 2   respiration center peripheral biochemical sensors  breath  or  、 irregular, apnea

8. Neonatal Respiratory Distress Hyaline Membrane Disease （ HMD 、 RDS) Neonatal infectious Pneumonia Meconium Aspiration Syndrome (MAS) for differentiation

9. Hyaline Membrane Disease （ HMD/RDS ） Clinical manifestation preterms normal at birth, respiratory distressed in several hours after birth progressively developing and deterioration self cured process during the sickness

10. Clinical manifestation After birth commonly seen, intrauterine infectious pneumonia relatively less seen Occurring in neonates with different GAs and ages General appearance of infection Various in severity of respiratory distress Blood-gas ： PaO 2  、 PaCO 2  Neonatal infectious Pneumonia

11. Meconium Aspiration Syndrome (MAS) Clinical manifestation Terms and post-terms commonly seen History of intrauterine distress amniotic fluid stained by meconium Lower Apgar’s score Distress occurs soon after birth Tachypnea and withdrawal at breathing Blood-gas ： PaO2 , PaCO2  and acidosis

12. CXR:HMD

13. CXR: pneumonia

14. CXR:MAS

16. Clinical management for neonatal respiratory distress Monitoring General appearance ： T; response, skin color, feeding tolerance respiration （ frequency, pattern and apnea ） Other systems: HR, liver, abdomen Blood-gas, Pa O 2 、 SaO 2

17. Clinical management for neonatal respiratory distress Oxygen therapy Nasal tube Mask and tent Pressed facial mask Attention! fio 2 O 2 concentration ROP,CLD/BPD

18. Clinical management for neonatal respiratory distress Mechanical ventilation Target ： early intervention and early withdraw Indication ： persistent cyanosis under oxygen therapy Remarkable SaO 2  PaO 2  and /or PaCO 2  indicated by ABG

19. Clinical management for neonatal respiratory distress Mechanical ventilation Ventilation modes and parameters Continuous positive airway pressure (CPAP) ： 4 - 8 cmH2O; Assistant/control (A/C) ： PIP 15-25 cmH 2 O ； RR 25-35 ； I/E ： 1 ： 1.5-2.5 ； PEEP ： 4 - 12 cmH 2 O Pressure support ventilation ( PSV ) ： 6-10 cmH 2 O High frequency oxillation ventilation: HFOV

20. Clinical management for neonatal respiratory distress Medication antibiotics penicillin: 10-40 万 u/kg/d ampicillin: 50-75mg /kg/d cephalosporin: 25-50mg /kg/d PS: 80-120 mg /kg, 1 to 2 dose

21. Clinical management for neonatal respiratory distress Keep the baby warm Incubator Radiator Stable room tempereture

22. Clinical management for neonatal respiratory distress Clinical nutrition Feeding: Breast milk/Formulas decreasing volume feeding as needed Parenteral nutrition （ T/PPN ）

23. Thanks for listening Questions please?