Respiratory distress syndrome in a premature baby


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Respiratory distress syndrome in a premature baby

  2. 2. PREMATURE BABY A baby born before 37 weeks of gestation have passed. The current World Health Organization definition of prematurity is a baby born before 37 weeks of gestation, counting from the first day of the Last Menstrual Period (the LMP).
  3. 3. Different degrees of prematurity are defined by gestational age (GA) or birth weight. Newborn classification based on gestational age  Preterm (premature)  —  born at 37 weeks' gestation or less  Term  —  born between the beginning of week 38 and the end of week 41 of gestation  Post-term (postmature)  —  born at 42 weeks' gestation or more Newborn classification based on birth weight  Low birth weight (LBW)  —  less than 2500 g  Very low birth weight (VLBW)  —  less than 1500 g  Extremely low birth weight (ELBW)  —  less than 1000 g
  4. 4.  In relation to birth weight, most preterm babies are low birth weight or very low birth weight Low birth weight:  born with birth weight between 1,500-2,499 gm  usually be managed safely at home with some extra care and support. Very low birth weight:  born with birth weight less than 1,500 gm  A life-threatening problem in such tiny babies is that suckling, swallowing and breathing are not well coordinated, so they require special attention in order to feed them adequately and safely  difficulty in maintaining their body temperature, so they are at increased risk of hypothermia
  5. 5. premature baby •baby born before 37 completed weeks of pregnancy Preterm baby Very preterm baby •Babies born between the gestational ages of 32-36 weeks of gestation •calculated from the mother’s last normal menstrual period (LNMP date). •can usually be managed safely at home with some extra care and support •born between the gestational ages of 28-31 weeks as calculated from the LNMP date •Like very low birth weight babies •have problems in feeding and maintaining their body temperature
  6. 6. premature baby Preterm baby Very preterm baby Term baby
  7. 7. Birth weight and gestational age Classification Action Weight less than 1,500 gm Very low birth weight Refer URGENTLY to a hospital, making sure to keep the baby warm on the journey Gestational age less than 32 weeks Very preterm Keep the newborn baby warm and refer it soon. Weight 1,500 to 2,500 gm Low birth weight If there is no other problem:counsel on optimal breast feeding, prevention of infection and keeping the baby warm Gestational age 32-36 weeks Preterm As above for low birth weight babies Weight equal to or above 2,500 gm; gestational age equal to or above 37 weeks Normal weight and full term As above for low birth weight and preterm
  8. 8. Associated Factors  Maternal  Low socioeconomic status  Lack of prenatal care  Substance abuse, smoking  Maternal age < 16yrs or > 35yrs  Maternal illness e.g. renal, heart, lung, HPT, DM, etc  Multiple gestation  Prior preterm delivery  Obstetric factors e.g. uterine malformations, cervical incompetence, polyhydramnios, premature rupture of membranes, infection (e.g. chorioamnionitis), placenta praevia, abruptio, etc  Abdominal trauma / surgery  Foetal  Foetal distress, IUGR, etc
  9. 9. BALLARD SCORE Use this score sheet to assess the gestational maturity of your baby. At the end of the examination the total score determines the gestational maturity in weeks. NEUROMUSCULAR MATURITY SCORE SIGN -1 0 1 2 3 4 5 Posture Square Window Arm Recoil Popliteal Angle Scarf Sign Heel To Ear TOTAL NEUROMUSCULAR SCORE SIGN SCORE
  10. 10. PHYSICAL MATURITY SIGN SCORE -1 Skin gelatinous, Sticky, friable, red, transparent translucent superficial cracking, pale parchment, leathery, smooth pink, peeling &/or areas, rare deep cracking, cracked, visible veins rash, few veins veins no vessels wrinkled Lanugo none sparse abundant thinning bald areas mostly bald Plantar Surface heel-toe 40-50mm: -1 <40mm: -2 >50 mm no crease faint red marks anterior transverse crease only creases ant. 2/3 creases over entire sole Breast imperceptable barely perceptable flat areola no bud stippled areola raised areola 1-2 mm bud 3-4 mm bud Eye / Ear lids fused loosely: -1 tightly: -2 lids open pinna flat stays folded sl. curved pinna; soft; slow recoil well-curved formed & firm thick cartilage pinna; soft but instant recoil ear stiff ready recoil Genitals (Male) scrotum flat, smooth scrotum empty, faint rugae testes in upper testes canal, descending, rare rugae few rugae testes down, good rugae testes pendulous, deep rugae Genitals (Female) clitoris prominent & labia flat prominent clitoris & small labia minora prominent clitoris & enlarging minora majora large, minora small majora cover clitoris & minora 0 1 2 majora & minora equally prominent 3 4 5 full areola 5-10 mm bud TOTAL PHYSICAL MATURITY SCORE SIGN SCORE
  11. 11. MATURITY RATING TOTAL SCORE (NEUROMUSCULAR + PHYSICAL) WEEKS -10 20 -5 22 0 24 5 26 10 28 15 30 20 32 25 34 30 36 35 38 40 40 45 42 50
  12. 12. Factor Score 0 Score 1 Score 2 Heart rate No heart rate Below 100 beats/min Above 100 beats/min Breathing No breathing Slow and irregular Good Some flexing of arms and legs Actively moving Muscle tone Limp and loose Reflexes Vigorously cries when No reflex responses Grimaces or frowns when reflexes are reflexes are stimulated stimulated Colour Blue and pale Body is pink but hands and feet are blue Entire body is pink
  13. 13. Skin •may be reddened. The skin may be thin so blood vessels are easily seen. Lanugo •there is a lot of fine hair all over the baby’s body. Limbs Head size Chest Sucking ability •the limbs are thin and may be poorly flexed or floppy due to poor muscle tone. •appears large in proportion to the body. The fontanelles (open spaces where skull bones join) are smooth and flat. •no breast tissue before 34 weeks of pregnancy. •weak or absent. Genitals •in boys the testes may not be descended and the scrotum may be small; in girls the clitoris and labia minora may be large. Soles of feet •creases are located only in the anterior (front) of the sole, not all over, as in the term baby
  14. 14. Respiratory distress is a symptom complex arising from disease processes that cause failure to maintain adequate gaseous exchange •Tachypnea (>60bpm) •Grunting, Flaring, Retractions/ recessions (GFR) •Cynosis •Reduced air entry
  15. 15.  >> premature infants, correlating with structural and functional lung immaturity  >> infants born at fewer than 28 weeks’ gestation 1/3 of infants born at 28 to 34 weeks’ gestation  < 5 % of those born after 34 weeks’ gestation. The condition is more common in boys, and the incidence is approximately six times higher in infants whose mothers have diabetes, because of delayed pulmonary maturity despite macrosomia1.
  16. 16. CAUSES OF RESPIRATORY DISTRESS Obstruction of the airway 123- Choanal atresia Congenital stridor Tracheal or bronchial stenosis Lung parenchymal disease 1234- Meconium aspiration Respiratory distress syndrome Pneumonia Transient tachypnea of the newborn (retained lung fluid) 5- Pneumothorax 6- Atelectasis 7- Congenital lobar emphysema Non-pulmonary causes 123- Heart failure Intracranial lesions Metabolic acidosis Miscellaneous 1- Disorders of the diaphragm e.g. (diaphragmatic hernia) 2- Pulmonary haemorrhage 3- Pulmonary hypoplasia
  17. 17. In Silverman-Anderson score, inspection or auscultation of the upper and lower chest and nares are scored on a scale of 0, 1 or 2 using this system are: A score greater than 7 indicates that the baby is in respiratory failure.
  18. 18. DOWNE’s SCORING OF RESPIRATORY DISTRESS 0 Cyanosis None 1 2 In room air In 40% FIO2 Mild Severe Grunting None Audible with stethoscope Audible without stethoscope Air entry Clear Decreased or delayed Barely audible Retractions None Respiratory Under 60 rate 60-80 Over 80 or apnea Score: > 4 = Clinical respiratory distress; monitor arterial blood gases > 8 = Impending respiratory failure
  19. 19. RISK FACTORS •Neonates younger than 33-38 weeks •Weight less than 2500g •Maternal diabetes •Cesarean delivery without preceding labor •Precipitous labor •Fetal asphyxia •Second of twins •Cold stress •Previous history of RDS in sibling •Males •whites
  20. 20.  Surfactant deficiency is the 1O cause of RDS.  Low levels of surfactant cause high surface tension  High surface tension makes it hard to expand the alveoli.  Tendency of affected lungs to become atelectatic at end- expiration when alveolar pressures are too low to maintain alveoli in expansion  Leads to failure to attain an adequate lung inflation and therefore reduced gaseous exchange
  21. 21. PATHOPHYSIOLOGY Pulmonary Surfactant decreases surface tension
  22. 22. Homogenous opaque infiltrates and air bronchograms, in dicating contrast in airless lung tissue seen against air-filled bronchi, decrease d lung volumes also can be detected
  23. 23.     Oxygenation with blow-by oxygen, nasal cannula, or mechanical ventilation (CPAP). Corticosteroid therapy accelerates fetal lung maturation by increasing formation and release of surfactant. Surfactant replacement therapies Nutrition
  24. 24. THANK YOU