Respiratory disorder in neonate

1. Prepared by
Dr Abdirahman mumin
RESPIRATORY DISORDERS

2. RESPIRATORY DISORDERS

3. Respiratory Distress in the Newborn
Clinical Features
 tachypnea: RR >60/min
 tachycardia: HR >160/min
 grunting, subcostal/intercostal indrawing, nasal
flaring
 duskiness, central cyanosis
 decreased air entry, crackles on auscultation

4. Differential Diagnosis of Respiratory
Distress

5. Respiratory distress syndrome (RDS)
Case
Shortly after birth, a 33-week gestation infant
develops tachypnea, nasal flaring, and grunting
and requires intubation. Chest radiograph shows
a hazy, ground-glass appearance of the lungs.

6. Etiology and pathophysiology RDS
 Surfactant deficiency -poor lung compliance due
to high alveolar surface tension _ atelectasis -
decreased surface area for gas exchange _
hypoxia + acidosis _ respiratory distress “Hyaline
membrane disease”
 Usually occur preterm.

7. Risk Factors:
 Maternal DM
 Preterm delivery
 Male sex
 LBW
 Acidosis
 sepsis
 Hypothermia
 Second born twin

8. Clinical Features:
 Respiratory distress within first few hours of life
 worsens over next 24-72 h
 Hypoxia
 Cyanosis
 Primary initial pulmonary hallmark is hypoxemia.
Then, hypercarbia and respiratory acidosis
ensue.

9. Diagnosis:
 Best initial diagnostic test—chest radiograph
which show:
 ground-glass appearance
 Atelectasis
 air bronchograms
 Most accurate diagnostic test—L/S ratio (part of
complete lung profile; lecithin-tosphingomyelin
ratio)

10. Primary prevention :
 Avoid prematurity (tocolytics)
 Antenatal betamethasone
Treatment :
 Resuscitation
 Oxygen and Ventilation
 Surfactant (decreases alveolar surface tension,
improves lung compliance, and maintains
functional residual capacity)
 Most effective treatment—intubation and
exogenous surfactant administration

11. Complications : In severe prematurity and/or
prolonged ventilation increased risk of
bronchopulmonary dysplasia
Prognosis :Dependent on GA at birth and severity
of underlying lung disease; long-term risks of
chronic lung diseas

12. Transient tachypnea of the newborn
(TTN)
Etiologic and pathophysiology
 Delayed resorption of fetal lung fluid
_accumulation of fluid in peribronchial lymphatic's
and vascular spaces _tachypnea “Wet lung
syndrome”
 Slow absorption of fetal lung fluid → decreased
pulmonary compliance and tidal volume with
increased dead space.
 Tachypnea after birth
 Generally minimal oxygen requirement
 Usually term and late preterm Term

13. Risk Factors:
 Maternal DM
 Maternal asthma
 Male sex
 Macrosomia (>4500 g)
 Elective Cesarean section
 short labour
 Late preterm delivery

14. Clinical Features:
 Tachypnea within the first few hours of life
 ± retractions
 Grunting
 nasal flaring
 Often NO hypoxia or cyanosis

15. Diagnosis :
 Common in term infant delivered by Cesarean
section or rapid second stage of labor
 Chest x-ray (best test) show:
i. air-trapping
ii. fluid in fissures
iii. perihilar streaking

16. Prevention: Where possible, avoidance of elective
Cesarean delivery, particularly before 38 wk GA.
Treatment:
 Supportive
 Oxygen if hypoxic
 Ventilator support (e.g. CPAP)
 IV fluids and NG tube feeds if too tachypneic to
feed orally
 Rapid improvement generally within hours to a
few days

17. Complication:
 Hypoxemia
 Hypercapnia
 Acidosis
 PPHN(Persistent pulmonary hypertension of
the newborn )

18. Meconium aspiration syndrome
Etiology and pathophysiolgy:
 Meconium is sterile but causes airway
obstruction, chemical inflammation, and
surfactant inactivation leading to chemical
pneumonitis
 Meconium passed as a result of hypoxia and
fetal distress; may be aspirated in utero or with
the first postnatal breath → airway obstruction
and pneumonitis → failure and pulmonary
hypertension
 Usually term and postterm

19. Risk Factors: Meconium-stained amniotic fluid
Post-term deliver.
Clinical Features:
 Respiratory distress within hours of birth Small
 airway obstruction
 chemical pneumonitis tachypnea
 barrel chest with audible crackles Hypoxia

20. Diagnosis: Chest x-ray (best test) which show
 patchy infiltrates
 increased AP diameter
 flattening of diaphragm
 Hyperinflation

21. Prevention:
 If infant is depressed at birth, intubate and suction
below vocal cords
 Avoidance of factors associated with in utero
passage of meconium (e.g. post-term delivery

22. Treatment:
 Resuscitation
 Oxygen and Ventilatory support
 Surfactant
 Inhaled nitric oxide
 Extracorporeal membrane oxygenation for
PPHN

23. Complications:
 Hypoxemia
 Hypercapnia
 Acidosis
 PPHN
 air leak (pneumothorax, pneumomediastinum)
 Chemical pneumonitis
 Secondary surfactant inhibition
 Respiratory failure

24. Diaphragmatic hernia
Etiology and pathophysiology :Failure of the
diaphragm to close → abdominal contents enter
into chest, causing pulmonary hypoplasia
Clinical Features:
 Born with respiratory distress and scaphoid
abdomen
 Bowel sounds may be heard in chest
Diagnosis:prenatal ultrasound; postnatal x-ray
(best test) reveals bowel in chest
Best initial treatment: immediate intubation in
delivery room for known or suspected CDH,
followed by surgical correction when stable
(usually days)

25. THE END