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Tachypnoea> 60

Retractions

Grunting

NasalFlaring

Cyanosis

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Most common diagnosis of respiratory distress

in the newborn

Also known as RDS type II/ Wet LungSyndrome

Usually follows uneventful normal preterm or

term vaginal delivery or cesarean delivery

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Believed to be secondary to slow absorptionof fetal lung fluid resulting in

•decreased pulmonary compliance and tidal volume

•increased dead space

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Early onset of tachypnea

Sometimes with retractions, or expiratory

grunting Occasionally cyanosis that is relieved by

minimal oxygen (<40%)

Lungs are generally clear

Usually recover rapidly within 3 days

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Labs

FBC within normal limits

ABG showing mild to moderate hypercapnia,hypoxemia with a respiratory acidosis

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Findings..

prominent pulmonary vascular markings

fluid lines in the fissures

hyperaeration

flat diaphragms

occasionally, pleural fluid

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Transient tachypnea of the newborn. CXR showhyperexpanded lungs, strandlike opacities, and fluid inthe fissures. These findings cleared in 24 hours

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Supportive treatment :

Oxygen box

CPAP

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Meconium-stained amniotic fluid is found in

10–15% of births and usually occurs in term or

post-term infants Meconium aspiration pneumonia develops in

5% of such infants

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Infant passes meconium due to varying degreesof asphyxia in utero

Obstruction of large and small airways withaspirated meconium

Aspiration may occur:

in utero

intrapartum postpartum period

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Meconium consists of

secretion of the intestinal glands

bile pigmentsfatty acids

aminiotic fluid

intrauterine debris

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Respiratory distress within the first hours, with

tachypnea, retractions, grunting, and cyanosis

Partial obstruction of some airways may lead topneumothorax or pneumomediastinum, or

both

Overdistention of the chest may be prominent

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Clinical assesment..

Meconium-stained amniotic fluid Meconium in trachea Respiratory distress

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In this picture,

meconium staining

can be appreciated

on the fingernails.

Normally, the nailsare white. The

yellow tint is

meconium staining.

This suggests thatthe meconium was

present in utero for

some time prior to

delivery.

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Meconium

StainedUmbilical

Cord

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inhomogenous patchy infiltrates

coarse streaking of both lung fields

air traping air leak

pleural effusion

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Frontal chest shows large, ropey and strand-like densities in

a post-mature infant consistent with Meconium Aspiration Syndrome

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Non-vigorous infant endotracheal intubation

and suction

The oxygenation : PEEP Antibiotics

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Aspiration of amniotic fluid

Pathogenic bacteria may accompany theaspirated material, and pneumonia may ensue

Most common organisms :

GBS

E.coli

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PROM > 18 hr

Chorioamnionitis

Foul smelling amniotic fluid

Maternal fever before delivery

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Congenital Pneumonia

Intrapartum Pneumonia

Postnatal Pneumonia

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Lab Ix ;

Septic work up : CBC, CRP, ESR

CXR

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Patchy infiltration or bronchopneumonia

Hypoaeration

Ground glass appearanceAir bronchogram

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Antibiotics

IV C Penicillin 50000unit/kg 12hly

IV Gentamycin 4mg/kg daily

Oxygen therapy

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Occurs primarily in premature infants

60–80% : GA < 28 wk

15–30% : GA 32-36 wk5% : GA >37 wk

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increased frequency is associated with

diabetic mothers

delivery before 37 wk gestation

multifetal pregnancies

cesarean section delivery

precipitous delivery

asphyxia cold stress

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Plasma leakage into alveoli Hyaline membrane formation

Surfactant deficiency Increased alveolar surface tension

Atelectasis Impaired gas exchange Hypoxemia & acidosis

Alveolar & Capillary damage

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Usually appear within minutes of birth

Characteristically

tachypnea, prominent (often audible) grunting,

intercostal and subcostal retractions, nasal flaring

cyanosis

Breath sounds : or ↓

Fine rales, especially over the lung bases posteriorly

Progressive worsening of cyanosis and dyspnea

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Fine reticulogranular appearance (ground

glass appearance)

Air bronchogramHypoaeration

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Classic respiratory distress syndrome (RDS). Bell-shapedthorax is due to generalized underaeration. Lung volumeis reduced, the lung parenchyma has a diffusedreticulogranular pattern, and peripherally extending airbronchograms are present.

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Specific treatment : Surfactant

surfactant therapy should be instituted only if

there are facilities for ventilation.

The efficacy of surfactant in reducing the

duration of ventilation is proven.

Prophylactic surfactant use is recommended

for any neonate< 28 weeks and < 1000 gms.

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1. Survanta

– 100mg of phospholipids/kg/dose (4mL/kg)

– Repeat > 6H after the previous dose if the infant

remains intubated and requires at least 30% O2 tomaintain PaO2 <80mmHg

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Supportive treatment

CPAP

Ventilator

Apnea

PaCO2 > 60 mmHg

Low PaO2 (on CPAP with high FiO2)

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ROP

BPD

Pneumothorax Infection

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Most important is prevention of prematurity Avoidance of unnecessary or poorly timed

cesarean section Prenatal administration of corticosteroids

between 24- 34 wks gestation reduces risk ofrespiratory distress when risk of preterm

delivery is high. Post natal steroids may decrease mortality but

may increase risk of cerebral palsy.

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Antenatal steroids will prevent the occurrence andseverity of RDS in preterm babies between 24 and34 weeks of gestation.

Optimal effect of antenatal steroids is seen if

delivery occurs after 24 hours of the initiation of therapy. Effect lasts for 7 days If delivery is anticipated below 34 weeks of

gestation.Dose recommended is:Inj Betamethasone 12 mg 1M every 24 hrs x 2 doses; or

Inj Dexamethasone 6 mg 1M every 12 hrs x 4 doses.

Multiple courses of antenatal steroids are not beneficialand hence are not recommended

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