This document provides an overview of respiratory distress syndrome (RDS) in neonates. RDS, formerly known as hyaline membrane disease, is caused by a deficiency of pulmonary surfactant in an immature lung, especially in preterm infants. It affects about 20,000-30,000 newborn infants each year in the US. The presentation, risk factors, pathophysiology, diagnosis, and treatments of RDS are discussed in detail. Prevention primarily involves antenatal glucocorticoid administration to enhance lung maturation for at-risk pregnancies. Treatment focuses on surfactant therapy, ventilation support, and general supportive care for affected newborns.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
RESPIRATORY DISTRESS SYNDROME, PREVIOUSLY HYALINE MEMBRANE DISEASE IS A COMMON COMPLICATION OF PREMATURITY WITH MORTALITY ALMOST 100% IN THE ABSENCE OF PULMONARY SURFACTANT ADMINISTRATION, ESPECIALLY IN LOW RESOURCE SETTINGS LIKE OURS.
RESPIRATORY DISTRESS SYNDROME, PREVIOUSLY HYALINE MEMBRANE DISEASE IS A COMMON COMPLICATION OF PREMATURITY WITH MORTALITY ALMOST 100% IN THE ABSENCE OF PULMONARY SURFACTANT ADMINISTRATION, ESPECIALLY IN LOW RESOURCE SETTINGS LIKE OURS.
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
A powerpoint presentation on the respiratory illness seen in newborns/neonates.
the diseases mentioned in this presentation are among the most commonly seen in the population.
causes and pathophysiology of obstetric sepsis simplified
Sepsis = ancient greek word ‘sepein’ = ‘to rot’
2016 SCCM definition –
life threatening organ dysfunction caused by a regulated host response to infection.
Sepsis exists on a continuum of severity ranging from infection and bacteremia to sepsis and septic shock, which can lead to MODS and death
Genital tract causes: chorioamnionitis, endometritis, septic abortion, wound infection after vaginal tear, episiotomy, or Caesarean section
Renal causes: lower urinary tract infection, pyelonephritis
Respiratory causes: pneumonia—bacterial, viral; tuberculosis
Intraperitoneal causes: ruptured appendix, acute appendicitis, acute cholecystitis, bowel infarction
Other causes: breast infection, septic pelvic thrombophlebitis, necrotizing fasciitis, malaria, miliary tuberculosis.
Most of what is known concerning sepsis comes from study of endotoxin -lipopolysaccharide-LPS
The lipid A moiety is bound by mononuclear blood cells,becomes internalized and stimulates release of mediators and a series of complex downstream events. Clinical effects manifested by cytokine effects.
Most of the pathogens produce endotoxins e.g klebsiella , some produce exotoxin eg. Clostridium,Staph
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
India Diagnostic Labs Market: Dynamics, Key Players, and Industry Projections...Kumar Satyam
According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
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The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
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3. Objectives
• Define respiratory distress syndrome (RDS).
• Discuss the epidemiology, pathophysiology, and
diagnosis of RDS.
• List a differential diagnosis for respiratory distress in the
neonate.
• Describe the treatments for RDS.
• Discuss ventilation strategies that can be used in the
infant who has RDS.
• Describe long-term complications of RDS and its
treatments.
4. Definition
• Formerly known as hyaline membrane
disease
• Deficiency of pulmonary surfactant in an
immature lung
• Disease of prematurity
5. Epidemiology
• Major cause of morbidity and mortality in preterm infants
• 20,000-30,000 newborn infants each year
• Incidence and severity of RDS are related inversely to
gestational age of newborn infant
• 26-28 weeks' gestation : 50%
• 30-31 weeks' gestation : <30%
• Overall incidence in 501-1500 grams: 42%
• 501-750 grams: 71%
• 751-1000 grams: 54%
• 1001-1250 grams: 36%
• 1251-1500 grams: 22%
18. Surfactant Inactivation
• Meconium and blood can inactivate
surfactant activity (Full-term > Preterm)
• Proteinaceous edema and inflammatory
products increase conversion rate of
surfactant into its inactive vesicular form
• Oxidant and mechanical stress associated
with mechanical ventilation that uses large TV
23. Prevention
• Antenatal glucocorticoids
• Enhances maturational changes in lung architecture
and inducing enzymes
• Stimulate phospholipid synthesis and release of
surfactant
• All pregnant mothers at risk for preterm delivery at or
below 34 weeks gestation should receive ACS
Normal alveolar development occurs in 4 stages.
Embryonic period –
At about 26 days gestation, the embryonic stage begins with the first appearance of the fetal lung, which appears as a protrusion of the foregut. Initial branching of the lung occurs at 33 days gestation forming the prospective main bronchi, which begin to extend into the mesenchyme.
Further branching forms the segmental bronchi as the lung enters the next stage of development.
Pseudoglandular stage –
7th to 16th weeks of gestation, 15 to 20 generations of airway branching occur starting from the main segmental bronchi and ending as terminal bronchioles.
end of the pseudoglandular stage, airways are surrounded by a loosely packed mesenchyme, which includes a few blood vessels, and is lined by glycogen-rich and morphologically undifferentiated epithelial cells with a columnar to cuboidal shape.
In general, epithelial differentiation is centrifugal so the most distal tubules are lined with undifferentiated cells with progressive epithelial differentiation of the more proximal airways.
Canalicular stage –
16th and 25 weeks gestation, transition from previable to a potential viable lung occurs as the respiratory bronchioles and alveolar ducts of the gas exchange region of the lung are formed.
The surrounding mesenchyme becomes more vascular and condenses around the airways.
The closer vascular proximity ultimately results in fusion of the capillary and epithelial basement membranes.
After 20 weeks gestation, cuboidal epithelial cells begin to differentiate into alveolar type II cells with formation of cytoplasmic lamellar bodies [2]. The glycogen in these cells is used for surfactant production, which is stored in the lamellar bodies.
Saccular stage –
About 24 weeks gestation, there is potential for viability because gas exchange is possible due to the presence of large and primitive forms of the future alveoli.
In this stage, formation of alveoli (ie, alveolarization) occurs by the outgrowth of septae that subdivide terminal saccules into anatomic alveoli, where air exchange occurs.
The number of alveoli in each lung increases from zero at 32 week gestation to between 50 and 150 million alveoli in term infants and 300 million in adults.
Alveolar growth continues for at least two years after birth at term.
Surfactant components are synthesized from precursors in the endoplasmic reticulum and transported through the Golgi apparatus by multivesicular bodies.
Components are ultimately packaged in lamellar bodies, which are intracellular storage granules for surfactant before its secretion.
After secretion (exocytosis) into the liquid lining of the alveolus, surfactant phospholipids are organized into a complex lattice called tubular myelin. Tubular myelin is believed to generate the phospholipid that provides material for a monolayer at the air-liquid interface in the alveolus, which lowers surface tension.
Surfactant phospholipids and proteins are subsequently taken back into type II cells, in the form of small vesicles, apparently by a specific pathway that involves endosomes, and then are transported for storage into lamellar bodies for recycling.
Alveolar macrophages also take up some surfactant in the liquid layer.
A single transit of the phospholipid components of surfactant through the alveolar lumen normally requires a few hours.
The phospholipid in the lumen is taken back into type II cell and is reused 10 times before being degraded.
Surfactant proteins are synthesized in polyribosomes and extensively modified in the endoplasmic reticulum, Golgi apparatus, and multivesicular bodies.
Surfactant proteins are detected in lamellar bodies or secretory vesicles closely associated with lamellar bodies before they are secreted into the alveolus.
Amniotic fluid L/S ratio increases progressively with gestational age. L/S ratio greater than two signifies maturity of surfactant system of lung
- Surfactant deficiency
- Inflammation and Lung injury
- Pulmonary edema
- Surfactant inactivation
- Pulmonary function and gas exchange
Impaired surfactant synthesis and secretion atelectasis, V/Q inequality, hypoventilation hypoxemia and hypercarbia
Respiratory / metabolic acidosis pulmonary vasoconstriction impaired endothelial and epithelial integrity leakage of proteinaceous exudate and formation of hyaline membranes
Deficiency of surfactant decreases lung compliance and FRC, with increased dead space
Impair surfactant production and/or secretion
Hypoxia, acidosis, hypothermia, hypotension
Oxygen toxicity influx of inflammatory cell exacerbates vascular injury BPD
Antioxidant deficiency and free-radical injury worsen injury
Lungs with HMD require far more pressure than to achieve a given volume of inflation than do lungs obtained from an infant dying of a nonrespiratory cause.
Arrows indicate inspiratory and expiratory limbs of the pressure-volume curves.
Note the decreased lung compliance and increased critical opening and closing pressures, respectively, in the premature infant with HMD
line the alveoli (see the image below) may form within a half hour after birth.
In larger premature infants, the epithelium begins to heal at 36-72 hours after birth, and endogenous surfactant synthesis begins.
The recovery phase is characterized by regeneration of alveolar cells, including type II cells, with a resultant increase in surfactant activity.
low lung volume and the classic diffuse reticulogranular ground-glass appearance with air bronchograms
two doses of betamethasone administered 24 hours apart is currently the recommended steroid for antenatal use
Antenatal steroid administration has been shown to be beneficial if provided fewer than 24 hours before delivery
Furthermore, a reduction in RDS has been seen in infants born up to 7 days after the first dose of antenatal steroids was administered. (1) No benefit is seen in infants who receive the first dose of steroids more than 7 days before birth.
They recommend repeat doses of corticosteroids in women at risk for preterm birth when the first course of steroids was administered more than 7 days previously because of the short-term benefits to the fetal lungs. They do, however, warn about the possibility of decreased birthweight and head circumference at birth, which has been reported.