An approach to respiratory distress

1. Approach to Respiratory
Distress in infants
Presented by:Dr. PRATIK MUKHERJEE
MODERATOR : Dr. ASIM MULLICK

2. WHAT IS RESPIRATORY DISTRESS
• Respiratory distress refers to increased work on breathing,
Characterized by grunting, chest retractions, apnea, with reduced
air entry and cyanosis
• It is one of the most Common causes of mortality in an infant, with
Fifteen percent of term infants and 29% of late preterm infants
admitted to the intensive care unit develop significant respiratory
morbidity. ( ref Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the
term newborn infant. Paediatr Respir Rev. 2013;14(1):29–36 :National Library of
Medicine
• Thus it is absolutely imperative to have a Consolidated overview
and identify the etiology and manage accordingly

3. Flow chart: Respiratory Distress in a infant
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Respiratory Distress
Grunting, RF>60 per min, retraction,cynoasis
Respiratory Non Respiratory
Pulmonary Extra Pulmonary
•Pneunomia
•Pilmonary hemorrhage
•Congential lung disease
•Pneumothorax
•Upper airway problems
•Lower airway problem
•Rib cage abnormalities
•Diaphgrama Pathologies
•Mediastinal masses
•Cardiac
•NeuroMuscular
•Metabolic
•Hematologic

4. Flow chart: Infant with acute Respiratory Distress
based on investigation

5. symptoms of Respiratory distress
Any Respiratory distress starts with increased breathing, With respiratory
rates on the higher sides (>60 in <2 months while >50 in > 2months to
1year) with the following:
• Nasal flaring
• Sub costal retraction, tracheal tug
• Irritability
• Signs of severe distress : Added breath sounds like cyanosis, grunting,
wheezing
• Poor feeding
• Decreased consciousness (if severe distress)

6. Reason for Respiratory Distress
• Maternal Factors: Maternal health, including infections during pregnancy, smoking, and
inadequate prenatal care, can affect infant respiratory health.
• Prematurity: Preterm babies often have underdeveloped lungs, leading to respiratory
difficulties.
• Infections: Respiratory infections like pneumonia, bronchiolitis, and influenza can cause
distress in infants, especially in areas with limited access to healthcare and vaccination.
• Environmental Factors: Pollution, indoor air quality, and exposure to smoke from
cooking fires can contribute to respiratory issues.
• Congenital Abnormalities: Conditions such as congenital heart defects or structural
abnormalities in the airways can lead to respiratory distress.
• Low Birth Weight: Infants born with low birth weight may experience respiratory
complications due to underdeveloped organs.

7. Detailed Observations-1
• General Appearance
• Respiratory Rate:
• Nasal Flaring:
• Fever:
• Grunting:
• Cyanosis:

8. Detailed Observations -2
• Oxygen Saturation (SpO2):
• Use of Accessory Muscles:
• Breath Sounds:
• Feeding and Fluid Intake:
• History and Context

9. Pulse oximetry
• Non Invasive saturation monitoring by pulse oximetry helps in
accessing the severity
• Saturation level<95% indicates the need for interventions
• Saturation target for a sick infant on respiratory support is 90-95%

10. Blood gas Analysis
• Arterial or Capillary Blood Gas Analysis helps in accessing the severity
of RD and guiding the management
• Normal range of Blood gas analysis in neonates are:
pH 7.35 – 7.45
PaCo2 35-45 mm Hg
PaO 45-85 mmHg
Bicarbonate 20-24 mEq/L
Base Deficit 3-7 mEq/L

11. Other Differentials

12. Assesment of Severity

13. Flow chart: Approach to respiratory distress

14. Flow Chart of Treatment
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Patient with Respirative Distress
comes to ER
General Appearence
Admission
Oxygen Therapy
Monitoring of Vitals
Saturation
Blood investigation
Low strenth Antibiotics
( If patient has cough and presence
of added bacterial infections
Urgent Admission
Sign
of
Severe
Distress
No
Yes
Oxygen Therapy + ABG
Analysis
If sign of shock
If no Sign of
shock
NIU
Invasive ventilatioin
+
High strength Antibiotics
+
Regular monitoring of vitals

15. THANKS