Signs of respiratory distress

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pediatrics respiratory emergency

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Signs of respiratory distress

  1. 1. Signs of respiratory distress & Common respiratory problems Dr.Osama Arafa Abd EL Hameed M. B.,B.CH - M.Sc Pediatrics - Ph. D. Consultant Pediatrician & Neonatologist Head of Pediatrics Department - Port-Fouad Hospital By
  2. 2. Pulmonary diseases in the newborn period 1/13have breathing problems at birth 1/6with breathing problems have infections GA< 31 : 1/2 have infections Boys 9.3%, Girls 5.9% Mortality 0.4% (5% < 36 weeks GA(
  3. 3. Infants at Risk for Developing Respiratory Distress Preterm Infants Infants with birth asphyxia Infants of Diabetic Mothers Infants born by Cesarean Section Infants born to mothers with fever, Prolonged ROM, foul-smelling amniotic fluid. Meconium in amniotic fluid. Other problems
  4. 4. Pediatric Respiratory System Large head, small mandible, small neck Large, posteriorly-placed tongue High glottic opening Small airways Presence of tonsils, adenoids
  5. 5. Pediatric Respiratory System Poor accessory muscle development Less rigid thoracic cage Horizontal ribs, primarily diaphragm breathers Increased metabolic rate, increased O2 consumption
  6. 6. Pediatric Respiratory System Decrease respiratory reserve + Increased O2 demand = Increased respiratory failure risk
  7. 7. Pulmonary diseases in the newborn period Symptoms and signs Tachypne (frequency > 60 per min( Cyanosis in room air Flare of the nostrils Chest retractions Grunting
  8. 8. Respiratory Distress
  9. 9. When is it abnormal to show signs of respiratory distress? When tachypnea, retractions, flaring, or grunting persist beyond one hour after birth. When there is worsening tachypnea, retractions, flaring or grunting at any time. Any time there is central cyanosis Acrocynosis: blue color of the hands and feet with pink color of the rest of the body, common in delivery room and is usually NORMAL
  10. 10. Causes of Neonatal Respiratory Distress Obstructive/restrictive - mucous, choanal atresia, pneumothorax, diaphragmatic hernia. Primary lung problem - Respiratory Distress Syndrome (RDS(, meconium aspiration, bacterial pneumonia, transient (TTN(. Non-pulmonary -hypovolemia/hypotension, congenital heart disease, hypoxia, acidosis, cold stress, anemia,
  11. 11. Pulmonary diseases in the newborn period Respiratory Distress Syndrome(RDS( Transient Tachypnoe of newborn(TTN(. Pneumonia/Infection Meconium Aspiration Air Leaks Pulmonary hypertension Chronic Lung Disease (CLD(
  12. 12. Pulmonary causes Common Rare RDS Lung hypoplasia Trans tachypne Obstr upper airways Meconium asp Tumours Pneumonia Pulm hemorrhage Pneumothorax Malformations Cong diaprhagmatic hernia
  13. 13. Extra-pulmonary causes Common Rare Persist Fetal Circulat Cerebral edema Cong Cord Malfor Drugs Cerebral Hemorrhage Neuromuscular Polycythemia Asph, spinal cord Hypoglycemia Metabolic Diseases Hypothermia Acidosis
  14. 14. Evaluation of Respiratory Distress Administer Oxygen and other necessary emergency treatment Vital sign assessment Determine cause-- physical exam, Chest x-ray, ABG, Screening tests: Hematocrit, blood glucose, CBC Sepsis work-up
  15. 15. Principles of Therapy Improve oxygen delivery to lungs-- supplemental oxygen, CPAP, assisted ventilation, surfactant Improve blood flow to lungs-- volume expanders, blood transfusion, partial exchange transfusion for high hematocrit, correct acidosis (metabolic/respiratory( Minimize oxygen consumption-- neutral thermal environment, warming/humidifying oxygen, withhold oral feedings, minimal handling
  16. 16. Respiratory Distress Syndrome Also called as hyaline membrane disease Most common cause of respiratory distress in premature infants, correlating with structural & functional lung immaturity. 1/3infants born between 28 to 34 weeks, but less than 5% of those born after 34 weeks. Pathophysiology- surfactant deficiency- increase in alveolar surface tension- decrease in compliance.
  17. 17. CLINICAL FEATURES OF RDS Tachypnea/Apnea Dyspnea Grunting/Flaring Hypoxemia Radiographic Features Pulmonary Function Abnormalities
  18. 18. Early RDS
  19. 19. Progressive RDS
  20. 20. Late RDS
  21. 21. THERAPY FOR RDS Oxygen - maintain PaO2 > 50 torr Nasal CPAP Intermittent Mandatory Ventilation Surfactant Replacement High Frequency Ventilation Intercurrent Therapies
  22. 22. PIE
  23. 23. PIE Pathology
  24. 24. Pneumothorax/PIE
  25. 25. Pneumothorax
  26. 26. Pneumopericardium
  27. 27. TRANSIENT TACHYPNEA OF THE NEWBORN 40%cases Delayed Fluid Resorption Hard to differentiate early on from RDS both clinicaly and radiographicaly especially in the premature infant Initial therapy similar to RDS, but hospital course is quite different
  28. 28. Wet Lung
  29. 29. Meconium Aspiration Syndrome Incidence- 1.5- 2 % in term or post term infants. Meconium is locally irritative, obstructive & medium for for bacterial culture Meconium aspiration causes significant respiratory distress. Hypoxia occurs because aspiration occurs in utero. CXR- Patchy atelectasis or consolidation.
  30. 30. Meconium Aspiration
  31. 31. MAS
  32. 32. PERSISTENT PULMONARY HYPERTENSION Usually secondary to primary pulmonary disease state Pulmonary Vascular Lability Treat the underlying problem Maintain normo-oxygenation Selective Pulmonary Vasodilators Pray for good luck
  33. 33. PPHN
  34. 34. CONGENITAL PNEUMONIA Infectious; primarily GBS Amniotic Fluid aspiration Viral etiology Surfactant inactivation
  35. 35. GBS Pneumonia
  36. 36. Pneumonia
  37. 37. CONGENITAL MALFORMATIONS Choanal Atresia Tracheal Atresia/stenosis Chest Mass Diaphragmatic hernia Sequestration Lobar emphysema
  38. 38. Lobar Emphysema
  39. 39. Diaphragmatic Hernia
  40. 40. Chylothorax
  41. 41. Phrenic Nerve Paralysis
  42. 42. ACQUIRED DISEASES Infections Bronchopulmonary Dysplasia Sub-glottic stenosis Apnea of Prematurity
  43. 43. Early BPD
  44. 44. Progressive BPD
  45. 45. Late BPD
  46. 46. APNEA Definition: cessation of breathing for longer than a 15 second period or for a shorter time if there is bradycardia or cyanosis
  47. 47. Babies at Risk for Apnea Preterm Respiratory Distress Metabolic Disorders Infections Cold-stressed babies who are being warmed CNS disorders Low Blood volume or low Hematocrit Perinatal Compromise Maternal drugs in labor
  48. 48. Anticipation and Detection Place at-risk infants on cardio- respiratory monitor Low heart rate limit (80-100( Respiratory alarm (15-20 seconds(
  49. 49. Treatment Determine cause: x-ray blood sugar body and environmental temperature hematocrit sepsis work up electrolytes cardiac work up
  50. 50. Treatment CPAP Theophylline/Caffeine therapy Mechanical ventilation Apnea monitor

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