2. • B/O Nancy, baby boy born via SVD at 38 weeks with birth weight 3kg
• Mother is 39 year old, para 4, with anemia in pregnancy
• She presented with contraction pain and fever 1 day before the delivery, her UFEME
showed leucocyte 2+, nitrate negative and she was started on cephalexin for 3 days (TWC
6.51, plt 305), Mother’s HVS no growth
• Subsequently progress into labor and baby born vigorous with good AS (9/10/10)
• However baby was tachypnea with labile saturation (Spo2 88-90% under room air) at
nursery and started on nasal prong at around 2 hours of life and worsening respiratory
distress with tachypnea, retractions, and grunting at 4 hours of life and was intubated.
Case scenario
3. • Presumed sepsis
• Congenital pneumonia
• Transient tachypnea of newborn (TTN)
• Persistent pulmonary hypertension of newborn (PPHN) – primary or secondary
• RDS/ hyaline membrane
• Congenital heart disease
• Congenital diaphragmatic of hernia
Differential diagnosis of respiratory
distress in newborn?
4. • On examination, patient was intubated, tachypnea with recession, good
perfusion, other neonatal examinations are normal
• Lungs clear, equal a/e, CVS DRNM, PA soft
• BP stable, SPO 100% under low ventilator settings (Pr 18/6, FiO2 30%)
• FBC normal (TWC 24 (NEU 69.6 %/Lym 15 %)/ HB 20.6/PLT 198/HCT 66.4)
• ABG : ph. 7.32/Pco2 38/PO2 99 /HCO3 19.6/BE -6.0
• CRP : 2.2
• Bedside ECHO: TR jet , balanced chamber size, good contractibility
Case scenario
5. Case scenario
ETT
Ryle tube
9 – ribs Lungs
expansion
Bilateral lung
infiltrates with
consolidation mainly
in the middle and
right lower lobe
Left Costophrenic
angles - clears
1
2
3
4
5
6
7
8
9
Right costophrenic
angles - blunt
1
2
3
4
5
6
7
8
9
6. Differential
Differential Point support Point against
Congenital pneumonia Mother has fever and UTI
Respiratory distress
CXR
Presumed sepsis Mother has fever and UTI
Respiratory distress
CXR – no obvious consolidation
Transient tachypnea of newborn Respiratory distress Respiratory distress at 4 hours of life
TTN usually right after birth
More commonly seen in LSCS
CXR not characteristic for TTN
Persistent pulmonary
hypertension of newborn
Respiratory distress
Labile Saturation
Stable under low ventilator setting
ECHO – normal
Congenital heart disease Respiratory distress
Labile Saturation
ECHO normal
Congenital diaphragmatic of
hernia
Respiratory distress CXR- no evidence of CDH
7. • Treated as congenital pneumonia
• Treatment
- Ventilated for 3 days and successfully extubated to nasal prong
- Not require inotropes throughout the admission
- Completed IV ampicillin and gentamicin for 5 days, blood culture NG
- Started feeding at day 1 of life and achieved full feeding
Progress
9. Objectives
• Recognize newborn with respiratory distress
• Understand the differential diagnosis of RDS
• Learn the pathophysiology, presentation diagnosis and
management for the most common causes
10. You have called to labour room to review a term baby who is
tachypnoea soon after delivery
14. TTN
• Most common aetiology
• Impaired clearance of fetal fluid from
lungs at birth
• Infant born via caesarean section
• Typically present right after birth
• Treatment: Respiratory support
• Resolved 48-72 hours (6 hours)
18. RDS
• Most commonly seen in premature
baby
• Surfactant deficiency in immature lung
(Surfactant decrease alveolar surface
tension which helps with alveolar
expansion and decrease risk of
atelectasis.
• Risk: Extreme premature,
no/incomplete antenatal steroid
20. Meconium aspiration syndrome
• Risk factor: Post date, sepsis, stress (any
cause of fetal hypoxia)
• Aspiration of meconium into the lungs
Obstruction of airways air
trapping alveolar rupture
• Deactivation and decrease synthesis of
surfactant
• Risk of develop PPHN
26. Summary
• Identify the high risk group (Prem delivery, MMSL/TMSL, maternal risk of sepsis etc)
• Recognize signs and symptoms of respiratory distress
• NRP
• Always call for help
• Early Respiratory support
• Other treatment will depend on the respective pathologies
27. REFERENCES
1. Nelson Textbook Of Paediatrics
2. https://emedicine.medscape.com/article/976914-overview#a7
3. Ncbi: Respiratory Distress of Newborn
4. American Academy of Family Physicians: Respiratory Distress in the
Newborn
5. Michael D. Nissen, Congenital and neonatal pneumonia, Paediatric
Respiratory Reviews, Volume 8, Issue 3, 2007, Pages 195-203, ISSN 1526-0542,
https://doi.org/10.1016/j.prrv.2007.07.001.
6. Pediatric Protocol
7. OPENPediatrics
Editor's Notes
Ask the floor to name at least 7 of the differential
Quite obvious for this case
The baby has congenital pneumonia
With the history of mother having fever and UTI
Let’s look at other differential diagnosis
Basically all will present with respiratory distress
With that
Im going to talk about the RDS in newborn
While on your way to labour room, you should have some differential in your mind as you are dealing with a newborn with respiratory distress
What’s the differential in your mind?
Describe what can see from this video
Describe what can see from this video
Describe what can see from this video
CXR as mentioned earlier
Surfactant decrease alveolar surface tension
Helps with alveolar expansion
And decrease risk of atestasis.
Surfactant decrease alveolar surface tension
Helps with alveolar expansion
And decrease risk of atestasis.
Surfactant decrease alveolar surface tension
Helps with alveolar expansion
And decrease risk of atestasis.
Surfactant decrease alveolar surface tension
Helps with alveolar expansion
And decrease risk of atestasis.
SVD 38 week
EFW 3kg
ANC – fever, tachycardic high TWX, cover with triple antibiotic , 3doses and progress into labour
HVS – GBS
Liquor clear
AS 9/9 , CTG normal prior to deliver
Try to appreciate this sound and interpret the sound
Surfactant decrease alveolar surface tension
Helps with alveolar expansion
And decrease risk of atestasis.
