This document discusses respiratory distress syndrome (RDS), also known as hyaline membrane disease. It affects premature infants due to insufficient surfactant production in the lungs. The document covers the epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, and management of RDS. It describes how prematurity is a major risk factor and discusses the role of surfactant deficiency in the development of RDS. Diagnosis involves assessing respiratory distress symptoms, chest x-rays, and blood gases. Management includes prevention strategies like antenatal corticosteroids to promote lung maturation, as well as oxygen supplementation and mechanical ventilation for treatment.
Apnea of prematurity is common in neonates born before 32 weeks gestation or weighing less than 1000g, with rates as high as 54% in infants born at 30-31 weeks and nearly 100% in infants born below 29 weeks or weighing less than 1000g. Apnea can be classified as central, obstructive, or mixed based on whether there is absence of respiratory effort or upper airway obstruction. Common causes include infection, neurological or cardiovascular issues, pulmonary problems, inborn errors of metabolism, metabolic or hematological conditions, gastrointestinal issues, problems with temperature regulation, and drugs. Evaluation may include investigations and treatment involves general measures as well as specific measures and emergency treatment if needed. Methylxanthines are commonly
This document discusses transient tachypnea of the newborn (TTN). TTN is a common condition caused by a delay in clearing fetal lung fluid after birth. It presents with respiratory distress and affects up to 15% of preterm infants. Risk factors include cesarean delivery, prematurity, and gestational diabetes. Diagnosis is based on clinical presentation, physical exam, and chest x-ray findings showing diffuse haziness. Treatment involves respiratory support and monitoring as symptoms typically resolve within 3 days. Medications are not routinely used or recommended for TTN management.
Neonatal jaundice is a condition in newborns marked by high levels of bilirubin in the blood, causing yellowing of the skin and whites of the eyes. Bilirubin levels are often higher in neonates due to increased red blood cell breakdown, liver immaturity, and bacterial colonization. Without treatment, hyperbilirubinemia can cause permanent brain damage known as kernicterus. Proper monitoring and treatment is important to prevent dangerous bilirubin levels in newborns.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
This document provides guidance on managing birth asphyxia through proper newborn resuscitation. Key points discussed include:
1. Preparation for delivery is critical as each birth is an emergency, ensuring proper equipment and staff readiness.
2. Initial resuscitation steps are providing warmth, clearing the airway, drying and stimulating the newborn. Positive pressure ventilation may be needed if breathing does not improve.
3. If the heart rate remains low despite adequate ventilation, chest compressions and medications like epinephrine may be administered to support circulation. Intubation should only be considered in specific situations.
4. Post resuscitation care focuses on monitoring vital signs and providing support until stabilization is achieved.
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
Respiratory Distress Syndrome (RDS) is a condition seen primarily in premature infants caused by a lack of pulmonary surfactant. This deficiency leads to alveolar collapse and respiratory failure. The risk of developing RDS increases the younger the gestational age. Clinical presentation includes tachypnea, retractions, and hypoxemia. Diagnosis is made based on clinical features and chest x-ray showing diffuse lung opacities. Treatment focuses on supportive care including oxygen therapy and mechanical ventilation. Surfactant replacement therapy is also used to reduce mortality from RDS.
Persistent pulmonary hypertension of the newborn (PPHN) is a major problem in neonatal intensive care units that can lead to death or neurological injury in newborns. It occurs when the pulmonary circulation fails to transition from the high resistance fetal state. Causes include meconium aspiration syndrome, idiopathic PPHN, and pulmonary hypoplasia from conditions like congenital diaphragmatic hernia. Treatment involves optimizing oxygenation and cardiac function along with pulmonary vasodilators like inhaled nitric oxide. Future therapies may include phosphodiesterase inhibitors and prostacyclin analogs to further reduce pulmonary hypertension in newborns.
Apnea of prematurity is common in neonates born before 32 weeks gestation or weighing less than 1000g, with rates as high as 54% in infants born at 30-31 weeks and nearly 100% in infants born below 29 weeks or weighing less than 1000g. Apnea can be classified as central, obstructive, or mixed based on whether there is absence of respiratory effort or upper airway obstruction. Common causes include infection, neurological or cardiovascular issues, pulmonary problems, inborn errors of metabolism, metabolic or hematological conditions, gastrointestinal issues, problems with temperature regulation, and drugs. Evaluation may include investigations and treatment involves general measures as well as specific measures and emergency treatment if needed. Methylxanthines are commonly
This document discusses transient tachypnea of the newborn (TTN). TTN is a common condition caused by a delay in clearing fetal lung fluid after birth. It presents with respiratory distress and affects up to 15% of preterm infants. Risk factors include cesarean delivery, prematurity, and gestational diabetes. Diagnosis is based on clinical presentation, physical exam, and chest x-ray findings showing diffuse haziness. Treatment involves respiratory support and monitoring as symptoms typically resolve within 3 days. Medications are not routinely used or recommended for TTN management.
Neonatal jaundice is a condition in newborns marked by high levels of bilirubin in the blood, causing yellowing of the skin and whites of the eyes. Bilirubin levels are often higher in neonates due to increased red blood cell breakdown, liver immaturity, and bacterial colonization. Without treatment, hyperbilirubinemia can cause permanent brain damage known as kernicterus. Proper monitoring and treatment is important to prevent dangerous bilirubin levels in newborns.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
This document provides guidance on managing birth asphyxia through proper newborn resuscitation. Key points discussed include:
1. Preparation for delivery is critical as each birth is an emergency, ensuring proper equipment and staff readiness.
2. Initial resuscitation steps are providing warmth, clearing the airway, drying and stimulating the newborn. Positive pressure ventilation may be needed if breathing does not improve.
3. If the heart rate remains low despite adequate ventilation, chest compressions and medications like epinephrine may be administered to support circulation. Intubation should only be considered in specific situations.
4. Post resuscitation care focuses on monitoring vital signs and providing support until stabilization is achieved.
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
Respiratory Distress Syndrome (RDS) is a condition seen primarily in premature infants caused by a lack of pulmonary surfactant. This deficiency leads to alveolar collapse and respiratory failure. The risk of developing RDS increases the younger the gestational age. Clinical presentation includes tachypnea, retractions, and hypoxemia. Diagnosis is made based on clinical features and chest x-ray showing diffuse lung opacities. Treatment focuses on supportive care including oxygen therapy and mechanical ventilation. Surfactant replacement therapy is also used to reduce mortality from RDS.
Persistent pulmonary hypertension of the newborn (PPHN) is a major problem in neonatal intensive care units that can lead to death or neurological injury in newborns. It occurs when the pulmonary circulation fails to transition from the high resistance fetal state. Causes include meconium aspiration syndrome, idiopathic PPHN, and pulmonary hypoplasia from conditions like congenital diaphragmatic hernia. Treatment involves optimizing oxygenation and cardiac function along with pulmonary vasodilators like inhaled nitric oxide. Future therapies may include phosphodiesterase inhibitors and prostacyclin analogs to further reduce pulmonary hypertension in newborns.
Neonatal resuscitation is an intervention performed on babies after birth to help them breathe and for their heart to beat properly. It is needed for about 10% of babies who have trouble transitioning from receiving oxygen from the placenta to breathing on their own. Proper neonatal resuscitation training and equipment can reduce infant mortality from complications during birth by 30%.
Pulmonary hypertension of the newborn (PPHN) is defined as failure of the normal decrease in pulmonary vascular resistance after birth, resulting in right-to-left shunting of blood and hypoxemia. It can occur due to underdevelopment, maldevelopment, or maladaptation of the pulmonary vasculature. Clinically, infants present with respiratory distress and hypoxemia unresponsive to oxygen therapy alone. Diagnosis involves echocardiography demonstrating elevated pulmonary pressures and right-to-left shunting. Management consists of supportive care including ventilation and targeting appropriate oxygen saturations, with vasodilating agents like inhaled nitric oxide or ECMO for severe cases.
This document discusses respiratory distress syndrome (RDS) in newborns, including its definition, incidence, clinical causes, pathophysiology, clinical manifestations, diagnostic evaluations, preventive measures, complications, treatment principles, and nursing care. RDS occurs in preterm infants due to deficient surfactant production and presents as respiratory distress within hours of birth. Diagnosis is based on clinical signs and confirmed with tests like chest x-rays. Treatment involves supportive care in the NICU, surfactant replacement therapy, and careful monitoring to prevent complications.
This document discusses prematurity and its complications. It defines prematurity as a live birth before 37 weeks gestation. The incidence in Pakistan is estimated at 11-13%. Causes of prematurity include maternal, uterine, fetal and other factors such as infections and socioeconomic status. Complications of prematurity can be immediate such as respiratory issues, intraventricular hemorrhage, and infections, or long term such as cerebral palsy and developmental delays. Management involves proper delivery room care, maintaining temperature and fluids, screening for complications, proper feeding and supplementation. Outcomes depend on gestational age and birth weight, with survival rates increasing with advances in neonatal intensive care.
respiratory distress syndrome..... ppt by rahul dhakerRahul Dhaker
Respiratory Distress Syndrome (RDS), also known as neonatal respiratory distress syndrome, is a condition in premature infants caused by a lack of pulmonary surfactant and underdeveloped lungs. This puts premature infants at risk of breathing difficulties. Symptoms include rapid breathing, grunting, and cyanosis. Diagnosis involves blood gas and chest x-ray analysis. Treatment focuses on corticosteroids to aid lung development, surfactant replacement therapy, oxygen supplementation, and ventilation support. While treatment has reduced mortality by 50%, complications can still include sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage.
This set of ppt displays a short description about IVH and Pulmonary hemorrhage its causes, grades, pathophysiology related to it, management and the prognosis in paediatric population.
This document provides information on the clinical presentation and management of respiratory distress in newborns. It discusses the most common causes including transient tachypnea of the newborn, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, it describes the typical symptoms, risk factors, diagnostic findings, and treatment approaches. The differential diagnosis section outlines other less common conditions that can cause respiratory distress in newborns.
A one-month-old baby girl presented with fever and began having seizures two days later. Tests found her sodium levels were low at 115. She screened positive for G6PD deficiency. The document also mentions two other babies, a boy and another girl, but provides no other details about their cases.
Persistent pulmonary hypertension of newborn PPHNChandan Gowda
Persistent pulmonary hypertension of the newborn (PPHN) results from failure of the normal decrease in pulmonary vascular resistance after birth, causing right-to-left shunting of blood and hypoxemia. It can be caused by underdevelopment, maldevelopment, or maladaptation of the pulmonary vasculature. Clinical features include cyanosis and respiratory distress within the first 24 hours of life. Diagnosis involves echocardiography demonstrating elevated pulmonary pressures and responding poorly to oxygen challenges. Treatment aims to reduce PVR through ventilation strategies, medications, and potentially extracorporeal membrane oxygenation.
Neonatal pneumothorax is the accumulation of air in the pleural cavity, which can collapse the lung. It occurs most commonly in preterm infants and those with underlying lung conditions requiring ventilation support. Symptoms range from none in mild cases to respiratory distress and hypotension in severe cases. Diagnosis is confirmed by chest x-ray showing hyperlucent lung fields. Small pneumothoraces may be observed but symptomatic or tension pneumothoraces require needle aspiration or chest tube placement to re-expand the lung. Persistent pneumothoraces lasting over a week sometimes require additional interventions like HFOV. Prognosis depends on the underlying condition but early and effective treatment prevents complications.
This document discusses prematurity and its complications. It defines prematurity as infants born before 37 weeks gestation according to the WHO. Prematurity is classified based on gestational age as extremely, very, or moderate to late preterm. It can also be classified based on birth weight as low, very low, or extremely low. Risk factors include socioeconomic status, previous prematurity, and maternal health conditions. Causes include fetal, uterine, maternal, and iatrogenic factors. Clinical presentation includes weak reflexes and poor muscle tone. Complications involve respiratory, cardiovascular, gastrointestinal, metabolic, central nervous system, renal, and infectious issues. Long term complications may include developmental delays. Care after birth focuses on stabilization, monitoring,
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
This document discusses bronchopulmonary dysplasia (BPD), a chronic lung disease that occurs in premature infants requiring respiratory support. It covers the definition, risk factors, pathogenesis, clinical features, prevention, and treatment of BPD. The definition has evolved over time from relying solely on oxygen need at 28 days to incorporating factors like oxygen need, pressure support, and gestational age. BPD results from lung injury and disrupted lung development due to prematurity and respiratory support. Management aims to protect the lung from injury through gentle ventilation, optimal oxygen levels, and other strategies.
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
Respiratory distress is a common problem in newborns. This document discusses the epidemiology, clinical features, assessment, causes and management approaches for several major causes of respiratory distress in newborns, including meconium aspiration syndrome, respiratory distress syndrome, and transient tachypnea of newborn. It provides clinical guidance on evaluating and treating newborns presenting with respiratory distress.
1. Respiratory distress syndrome (RDS) is a condition in premature infants caused by a lack of pulmonary surfactant and immature lung structure. This leads to breathing difficulties.
2. Surfactant is a substance produced in the lungs that reduces surface tension and prevents collapse of alveoli during expiration. Premature infants often do not produce enough surfactant.
3. Management of RDS includes improving oxygenation through ventilation support, correcting acidosis, maintaining temperature, adequate nutrition, and administering surfactant via endotracheal tube. Close monitoring of vital signs and symptoms is also important.
This document discusses respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD). RDS is caused by surfactant deficiency in preterm infants and affects lung development and function. Key points include:
- RDS incidence is inversely related to gestational age and birth weight, peaking at 24-48 hours of life.
- Surfactant deficiency leads to atelectasis, decreased lung compliance, increased work of breathing and hypoxemia.
- Surfactant is normally produced by type II alveolar cells starting around 24 weeks gestation and is essential for reducing surface tension in the lungs.
This document discusses several common respiratory diseases that can affect newborns, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), primary pulmonary hypertension of the newborn (PPHN), and apnea of prematurity. It provides details on the causes, clinical presentations, diagnoses and management of each condition. The document is intended to educate medical professionals such as pediatricians on recognizing and treating respiratory issues in newborns.
This document discusses the physiology of transition from fetal to newborn life. It outlines the major changes that occur at birth including the establishment of air breathing and changes in cardiovascular pressures and flows. The fetal circulation operates in parallel while the newborn circulation switches to series. At birth, the umbilical vessels and ducts close, the lungs aerate, and respiratory and cardiac functions are established. Abnormalities in the transition process can occur with preterm birth or C-section and may require assistance.
Bronchopulmonary dysplasia updates_and_prevention dr falakhagfalakha
The document discusses bronchopulmonary dysplasia (BPD) and strategies for prevention. It notes that BPD results from disrupted alveolar development and remodeling of the airways, vasculature, and smooth muscle. Risk factors include prematurity, genetics, chorioamnionitis, and exposures associated with resuscitation and mechanical ventilation. Strategies discussed to prevent BPD include using lower oxygen concentrations during resuscitation, applying continuous positive airway pressure, and avoiding overinflation and atelectrauma through gentle ventilation techniques. Future research is still needed to develop more evidence-based prevention and treatment approaches for BPD.
Critical congenital heart disease (CCHD) can cause cyanosis in newborns. Cyanosis is a bluish discoloration of the skin due to low oxygen levels in the blood. It is an important sign of CCHD that requires prompt evaluation and treatment. Diagnostic tests for newborns with cyanosis include a hyperoxia test, hyperventilation test, physical exam, electrocardiogram, and chest x-ray. These tests help differentiate between cardiac and pulmonary causes of cyanosis and identify those newborns with CCHD who require urgent cardiac intervention. Early diagnosis of CCHD is important because delays can lead to significant morbidity and mortality.
Neonatal resuscitation is an intervention performed on babies after birth to help them breathe and for their heart to beat properly. It is needed for about 10% of babies who have trouble transitioning from receiving oxygen from the placenta to breathing on their own. Proper neonatal resuscitation training and equipment can reduce infant mortality from complications during birth by 30%.
Pulmonary hypertension of the newborn (PPHN) is defined as failure of the normal decrease in pulmonary vascular resistance after birth, resulting in right-to-left shunting of blood and hypoxemia. It can occur due to underdevelopment, maldevelopment, or maladaptation of the pulmonary vasculature. Clinically, infants present with respiratory distress and hypoxemia unresponsive to oxygen therapy alone. Diagnosis involves echocardiography demonstrating elevated pulmonary pressures and right-to-left shunting. Management consists of supportive care including ventilation and targeting appropriate oxygen saturations, with vasodilating agents like inhaled nitric oxide or ECMO for severe cases.
This document discusses respiratory distress syndrome (RDS) in newborns, including its definition, incidence, clinical causes, pathophysiology, clinical manifestations, diagnostic evaluations, preventive measures, complications, treatment principles, and nursing care. RDS occurs in preterm infants due to deficient surfactant production and presents as respiratory distress within hours of birth. Diagnosis is based on clinical signs and confirmed with tests like chest x-rays. Treatment involves supportive care in the NICU, surfactant replacement therapy, and careful monitoring to prevent complications.
This document discusses prematurity and its complications. It defines prematurity as a live birth before 37 weeks gestation. The incidence in Pakistan is estimated at 11-13%. Causes of prematurity include maternal, uterine, fetal and other factors such as infections and socioeconomic status. Complications of prematurity can be immediate such as respiratory issues, intraventricular hemorrhage, and infections, or long term such as cerebral palsy and developmental delays. Management involves proper delivery room care, maintaining temperature and fluids, screening for complications, proper feeding and supplementation. Outcomes depend on gestational age and birth weight, with survival rates increasing with advances in neonatal intensive care.
respiratory distress syndrome..... ppt by rahul dhakerRahul Dhaker
Respiratory Distress Syndrome (RDS), also known as neonatal respiratory distress syndrome, is a condition in premature infants caused by a lack of pulmonary surfactant and underdeveloped lungs. This puts premature infants at risk of breathing difficulties. Symptoms include rapid breathing, grunting, and cyanosis. Diagnosis involves blood gas and chest x-ray analysis. Treatment focuses on corticosteroids to aid lung development, surfactant replacement therapy, oxygen supplementation, and ventilation support. While treatment has reduced mortality by 50%, complications can still include sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage.
This set of ppt displays a short description about IVH and Pulmonary hemorrhage its causes, grades, pathophysiology related to it, management and the prognosis in paediatric population.
This document provides information on the clinical presentation and management of respiratory distress in newborns. It discusses the most common causes including transient tachypnea of the newborn, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, it describes the typical symptoms, risk factors, diagnostic findings, and treatment approaches. The differential diagnosis section outlines other less common conditions that can cause respiratory distress in newborns.
A one-month-old baby girl presented with fever and began having seizures two days later. Tests found her sodium levels were low at 115. She screened positive for G6PD deficiency. The document also mentions two other babies, a boy and another girl, but provides no other details about their cases.
Persistent pulmonary hypertension of newborn PPHNChandan Gowda
Persistent pulmonary hypertension of the newborn (PPHN) results from failure of the normal decrease in pulmonary vascular resistance after birth, causing right-to-left shunting of blood and hypoxemia. It can be caused by underdevelopment, maldevelopment, or maladaptation of the pulmonary vasculature. Clinical features include cyanosis and respiratory distress within the first 24 hours of life. Diagnosis involves echocardiography demonstrating elevated pulmonary pressures and responding poorly to oxygen challenges. Treatment aims to reduce PVR through ventilation strategies, medications, and potentially extracorporeal membrane oxygenation.
Neonatal pneumothorax is the accumulation of air in the pleural cavity, which can collapse the lung. It occurs most commonly in preterm infants and those with underlying lung conditions requiring ventilation support. Symptoms range from none in mild cases to respiratory distress and hypotension in severe cases. Diagnosis is confirmed by chest x-ray showing hyperlucent lung fields. Small pneumothoraces may be observed but symptomatic or tension pneumothoraces require needle aspiration or chest tube placement to re-expand the lung. Persistent pneumothoraces lasting over a week sometimes require additional interventions like HFOV. Prognosis depends on the underlying condition but early and effective treatment prevents complications.
This document discusses prematurity and its complications. It defines prematurity as infants born before 37 weeks gestation according to the WHO. Prematurity is classified based on gestational age as extremely, very, or moderate to late preterm. It can also be classified based on birth weight as low, very low, or extremely low. Risk factors include socioeconomic status, previous prematurity, and maternal health conditions. Causes include fetal, uterine, maternal, and iatrogenic factors. Clinical presentation includes weak reflexes and poor muscle tone. Complications involve respiratory, cardiovascular, gastrointestinal, metabolic, central nervous system, renal, and infectious issues. Long term complications may include developmental delays. Care after birth focuses on stabilization, monitoring,
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
This document discusses bronchopulmonary dysplasia (BPD), a chronic lung disease that occurs in premature infants requiring respiratory support. It covers the definition, risk factors, pathogenesis, clinical features, prevention, and treatment of BPD. The definition has evolved over time from relying solely on oxygen need at 28 days to incorporating factors like oxygen need, pressure support, and gestational age. BPD results from lung injury and disrupted lung development due to prematurity and respiratory support. Management aims to protect the lung from injury through gentle ventilation, optimal oxygen levels, and other strategies.
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
Respiratory distress is a common problem in newborns. This document discusses the epidemiology, clinical features, assessment, causes and management approaches for several major causes of respiratory distress in newborns, including meconium aspiration syndrome, respiratory distress syndrome, and transient tachypnea of newborn. It provides clinical guidance on evaluating and treating newborns presenting with respiratory distress.
1. Respiratory distress syndrome (RDS) is a condition in premature infants caused by a lack of pulmonary surfactant and immature lung structure. This leads to breathing difficulties.
2. Surfactant is a substance produced in the lungs that reduces surface tension and prevents collapse of alveoli during expiration. Premature infants often do not produce enough surfactant.
3. Management of RDS includes improving oxygenation through ventilation support, correcting acidosis, maintaining temperature, adequate nutrition, and administering surfactant via endotracheal tube. Close monitoring of vital signs and symptoms is also important.
This document discusses respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD). RDS is caused by surfactant deficiency in preterm infants and affects lung development and function. Key points include:
- RDS incidence is inversely related to gestational age and birth weight, peaking at 24-48 hours of life.
- Surfactant deficiency leads to atelectasis, decreased lung compliance, increased work of breathing and hypoxemia.
- Surfactant is normally produced by type II alveolar cells starting around 24 weeks gestation and is essential for reducing surface tension in the lungs.
This document discusses several common respiratory diseases that can affect newborns, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), primary pulmonary hypertension of the newborn (PPHN), and apnea of prematurity. It provides details on the causes, clinical presentations, diagnoses and management of each condition. The document is intended to educate medical professionals such as pediatricians on recognizing and treating respiratory issues in newborns.
This document discusses the physiology of transition from fetal to newborn life. It outlines the major changes that occur at birth including the establishment of air breathing and changes in cardiovascular pressures and flows. The fetal circulation operates in parallel while the newborn circulation switches to series. At birth, the umbilical vessels and ducts close, the lungs aerate, and respiratory and cardiac functions are established. Abnormalities in the transition process can occur with preterm birth or C-section and may require assistance.
Bronchopulmonary dysplasia updates_and_prevention dr falakhagfalakha
The document discusses bronchopulmonary dysplasia (BPD) and strategies for prevention. It notes that BPD results from disrupted alveolar development and remodeling of the airways, vasculature, and smooth muscle. Risk factors include prematurity, genetics, chorioamnionitis, and exposures associated with resuscitation and mechanical ventilation. Strategies discussed to prevent BPD include using lower oxygen concentrations during resuscitation, applying continuous positive airway pressure, and avoiding overinflation and atelectrauma through gentle ventilation techniques. Future research is still needed to develop more evidence-based prevention and treatment approaches for BPD.
Critical congenital heart disease (CCHD) can cause cyanosis in newborns. Cyanosis is a bluish discoloration of the skin due to low oxygen levels in the blood. It is an important sign of CCHD that requires prompt evaluation and treatment. Diagnostic tests for newborns with cyanosis include a hyperoxia test, hyperventilation test, physical exam, electrocardiogram, and chest x-ray. These tests help differentiate between cardiac and pulmonary causes of cyanosis and identify those newborns with CCHD who require urgent cardiac intervention. Early diagnosis of CCHD is important because delays can lead to significant morbidity and mortality.
This document discusses restrictive versus liberal transfusion thresholds in preterm neonates. It summarizes evidence from several clinical trials showing that a restrictive transfusion strategy (lower Hb/Hct thresholds) results in fewer transfusions without increasing mortality or morbidity risks compared to a liberal strategy. The evidence supports using respiratory support level and Hct triggers to guide transfusions. Delaying cord clamping, minimizing phlebotomy losses, and erythropoietin administration can further reduce transfusion needs in preterm neonates.
The document provides an overview of patent ductus arteriosus (PDA). Some key points:
1. PDA is more common in preterm infants, occurring in up to 80% of infants weighing less than 1000g. It refers to the failure of the ductus arteriosus to close after birth.
2. Diagnosis is typically made using echocardiography. Symptoms can include respiratory issues, apnea, heart murmur, and increased work of breathing.
3. Treatment involves supportive care initially and drug therapy with indomethacin or ibuprofen to close the ductus. Surgery may be needed for larger PDAs or those that do not close with medication
This document discusses respiratory distress in newborns. It begins by defining respiratory distress and listing its common causes such as respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and pneumonia/sepsis. It then discusses the incidence of respiratory distress and these conditions. For example, it notes that RDS occurs in about 50% of extremely low birth weight infants. The document proceeds to describe the pathophysiology, clinical signs, diagnosis, and management of RDS in more depth. It emphasizes the importance of antenatal steroids in preventing RDS and discusses the use of surfactant replacement therapy for treatment.
This document provides an outline on pulmonary hypertension (PH) in children. It begins with an introduction to PH and differences from adults. The anatomy of the pulmonary circulation is described along with classifications of PH. Pathophysiology involves abnormalities in pulmonary artery endothelial and smooth muscle cells. Survival rates have improved with newer treatments but are still worse than adults for some groups. Clinical presentation is often subtle in children. Evaluation includes echocardiography, chest imaging and right heart catheterization. Pharmacological therapies are discussed along with other treatment methods.
This document discusses diabetic retinopathy, which is a complication of diabetes that affects the eyes. It begins by defining diabetes mellitus and its two main types. It then discusses the various stages of diabetic retinopathy from mild non-proliferative diabetic retinopathy to proliferative diabetic retinopathy. Risk factors like duration of diabetes, blood sugar control, hypertension, and pregnancy are covered. Diagnosis, symptoms, and treatment recommendations are provided. The goal is to educate about this chronic eye condition caused by diabetes and its potential to cause vision loss if not properly managed.
Acute Respiratory Distress Syndrome. ppt 2023 Siva P Sivakumar.pptxTamilaruviMuniraj
This document provides an overview of acute respiratory distress syndrome (ARDS). It defines ARDS, describes its risk factors and pathophysiology. Key points include: ARDS involves fluid buildup in the lungs leading to hypoxemia; risk factors include sepsis, pneumonia and trauma; pathophysiology involves damage to the alveolar-capillary barrier allowing fluid influx; mortality has decreased to 30-40% with improved care but remains higher with greater illness severity or older age; complications can include barotrauma from mechanical ventilation.
The document discusses three case studies of neonates presenting with various medical conditions. For each case, clinical details are provided about the neonate's condition, vital signs, lab results, and treatments administered. The reader is then prompted to indicate the next appropriate action or intervention in each case. The document also reviews various methods for monitoring hemodynamics and end-organ perfusion in neonates.
The document discusses pediatric radiology and presents six clinical cases. It begins with an overview of pediatric imaging statistics in the US and evolving guidelines for radiation doses. Six cases are then presented and diagnosed: aortic coarctation, craniosynostosis, cystic fibrosis, osteogenesis imperfecta, tetralogy of Fallot, and Aicardi syndrome. For each case, the presenter provides the diagnosis and key details about the condition.
Right use of Pulse Oximetry must be Used as a Screening Test for Early Detect...crimsonpublishersOJCHD
Preventive medicine is the ideal way in dealing with frequent and fatal diseases. Congenital heart disease (CHD) are responsible for the largest proportion of mortality caused by birth defects, in the first year of life. Actual numbers and mortality from CHD is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries the resources are minimal. Prevention/early detection, is urgently needed to tackle the increasing needs. Aim: To justify why pulse oximetry (pox) is the best available, early detecting postnatal screening test currently. Conclusion: Although CHD's are both frequent and carry a high morbidity and mortality, we still lack a single, easy to apply, non-invasive and low-cost screening test, worldwide. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, the combination of clinical assessment with pox.
Right use of Pulse Oximetry must be Used as a Screening Test for Early Detect...crimsonpublishersOJCHD
Preventive medicine is the ideal way in dealing with frequent and fatal diseases. Congenital heart disease (CHD) are responsible for the largest proportion of mortality caused by birth defects, in the first year of life. Actual numbers and mortality from CHD is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries the resources are minimal. Prevention/early detection, is urgently needed to tackle the increasing needs. Aim: To justify why pulse oximetry (pox) is the best available, early detecting postnatal screening test currently. Conclusion: Although CHD's are both frequent and carry a high morbidity and mortality, we still lack a single, easy to apply, non-invasive and low-cost screening test, worldwide. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, the combination of clinical assessment with pox.
1. Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. It involves necrosis of the intestinal tissue.
2. The greatest risk factor is prematurity, with risk inversely related to birth weight and gestational age. Other risk factors include genetic factors, indomethacin exposure, maternal cocaine use, G6PD deficiency, H2 blockers, antibiotics like co-amoxiclav, and conditions that decrease mesenteric blood flow.
3. While the exact cause is unknown, factors that may contribute to pathogenesis include genetic susceptibility, ischemic injury from hypotension, and dysregulated intestinal immune response to bacterial colonization in premature infants.
Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. The main risk factors are prematurity, genetic factors, maternal health conditions like cocaine use, medications like indomethacin and dexamethasone, and certain enteral feeding practices. The pathogenesis involves an initial hypoxic-ischemic insult to the intestine combined with microbial factors and an excessive inflammatory response that can lead to necrosis of the intestinal tissue. Timely diagnosis and management are important for improving outcomes.
Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity, is a chronic lung condition that can affect premature infants. It occurs as a result of lung injury from mechanical ventilation and oxygen therapy needed to treat respiratory distress syndrome. The incidence of BPD has increased with improved survival of very low birth weight infants. Risk factors include prematurity, infection, oxygen therapy, mechanical ventilation, and a patent ductus arteriosus. The pathogenesis involves oxidative stress, lung inflammation, and arrested alveolar development. Treatment focuses on preventing lung injury through gentle ventilation strategies, permissive hypercapnia/hypoxemia, nutrition support, and in some cases postnatal corticosteroids.
Retinopathy of prematurity (ROP) is an eye disease affecting premature infants receiving oxygen therapy in the ICU. Exposure to high levels of oxygen can cause abnormal blood vessel growth in the retina, which may lead to scarring and retinal detachment. Screening guidelines recommend examining infants born before 32 weeks gestation or weighing less than 1500g, between 4-6 weeks of age or 31-33 weeks post-conceptional age, to monitor for ROP and determine if treatment is needed. Maintaining oxygen saturation between 70-96% in the first postnatal week and avoiding peaks above 94-99% can help reduce the risk and severity of ROP.
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Similar to RDS (neonate respiratory distress syndrome) (20)
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3. Introduction
Neonatal respiratory distress syndrome (NRDS), also called
hyaline membrane disease; the commonest respiratory disorder
among preterm neonates.
It is a syndrome caused in premature neonates by
developmental insufficiency of ‘surfactant’ production and
structural immaturity in the lungs.
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4. Definition
“It is defined as an acute lung disease of the newborn (especially the
premature newborn), lungs cannot expand because of a wetting
agent is lacking, characterized by rapid shallow breathing and
cyanosis and the formation of a glassy hyaline membrane over the
alveoli.”
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4
Medical dictionary 2015
5. Epidemiology:
RDS affects 40,000 infants each year in the US and accounts
for approximately 20% of neonatal deaths.
RDS affects 50,000 infants each year in the India and accounts
for approximately 28.5% of neonatal deaths.
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Kumar A et al. indian J pediatr.1996
6. Epidemiology Cont…
RDS typically affects infants <35 weeks gestational age (GA)
but may affect older infants who have delayed lung maturation.
Approximately 50% of the neonates born at 26-28 weeks of
gestation develop RDS
<30% of premature neonates born at 30-31 weeks develop
RDS.
Fanaroff and Martin’s Neonatal-Perinatal medicine,2013
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8. Etiology Contd…
There are many factor involve in developing NRDS:
1. Prematurity
2. Low birth weight
3. Genetic factor
4. Contributing factors
5. Secondary surfactant deficiency
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9. Etiology Contd….
24-25 weeks gestation 95-100% get RDS
26-27 weeks gestation 50-70% get RDS
28-30 weeks gestation 20-40% will get RDS
31-36 weeks gestation
10-20% will get RDS
Term neonates < 1%
1. Prematurity or Young gestational age
Canberra Hospital Neonatal Intensive Care1/6/2021
9
Incidence of RDS α 1 .
gestational ageType
equation here.
10. Etiology Contd…
2. low birth weight :
71% incidence in infants of 500g -750g
54% incidence in infants of 750g –1000g
36% incidence in infants of 1000g-1250g
22% incidence in infants of 1250g -1500g
Fanaroff M et al, Neonatal-Perinatal medicine. 20131/6/2021
10
Incidence of RDS α 1 .
Low birth weight
11. Etiology Contd…
3. Genetic factor
Genetic
factor
White race
History of
RDS in
sibling
Male
gender
Surfactant
production
disorder
Mutation
of gene
Anadkat j S et al.2014
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12. Increased risk for respiratory distress among white, male, late
preterm and term infants
In this study white race and sex in infants with (GA) 34 to 42
weeks, (n=286 454) within 12 hospitals in the California.
Conclusion: Male sex and White race independently increase risk
for RDS in late preterm and term infants.
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Anadkat J S et al. Journal of Perinatology.2012
18. Pulmonary Surfactant
Structure of lung surfactant
Protein 10% of lung surfactant
Consists of small proteins
Hydrophobic protein
SP-B and SP-C
Hydrophilic proteins
SP-A and SP-D
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19. Pulmonary Surfactant Contd…
SP-B
Required for normal pulmonary function
Abnormal expression of SP-B Can cause severe lung disease that is
lethal in perinatal period
SP-C
Promotes formation of phospholipid film
SP-C deficiency do not cause respiratory distress at birth
Hydrophilic SP-A and SP-D
They are host defense of the lung
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20. Pulmonary surfactant
The timing of lung surfactant or (Lecithin) production
At 32-34 weeks fetal cortisol increase
Stimulate Type II pneumocyte cells
By 34-36 weeks sufficient amount of Lecithin secreted into
alveolar lumen
Excreted into the amniotic fluids
Lecithin concentration in amniotic fluid indicate lung maturity
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21. Function of surfactant
Decrease the surface tension.
To promote lung expansion
during inspiration.
To prevent alveolar collapse
and loss of lung volume at the
end of expiration.
Facilitates recruitment of
collapsed alveoli.
www.medscape.com 20:10,18.08.2015 1/6/2021
21
22. The Laplace Relationship
Explains the relationship between intra-alveolar pressure (P)needed
to counteract the tendency of the alveoli to collapse under the force
of surface (wall) tension (ST) and the radius (r ).
The pressure (P)needed to stabilize the respiratory system from
within is directly proportional to twice the surface tension (ST)and
inversely proportional to the radius (r)of the structure
H2O molecules
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D Henry et al 2003
P = 2 x ST
r
28. Clinical manifestations
C = Cyanosis
H = Hypoxia
I = Intercostal retractions/ subcostal retraction
L = low body temperature ( Hypothermia)
D= Difficulty breathing (birth) progressively worse
I = Immature neonates (apnea)
N = Nasal flaring
T = Tachypnea
E = Expiratory grunting ( partial closure of glottis)
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NNF manual 2003
We can make a
mnemonic
“CHILD IN TroubleE”
30. Diagnosis of RDS
Good history
Assess by assessment scales
Clinical presentation
CXR
ABG
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31. Prenatal Diagnosis Contd….
History of premature delivery( perinatal )
Concentration of lecithin in amniotic fluids
Ratio of lecithin/sphingomyelin
Lecithin indicate lung maturity
Sphingomyelin remains constant during pregnancy
L/S ratio 2:1 indicate lung maturity
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32. Prenatal Diagnosis Contd….
Blood gases ( PCo2, Po2 )
Pulse Oximetry (Spo2<87%)
Complete blood count
Electrolytes, glucose, renal and liver function
Blood Culture to rule out sepsis
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33. Prenatal Diagnosis Contd….
Assessment of severity of the respiratory Distress in two methods
A. Downe’score
Parameter 0 1 2
RR(per min) <60 60-80 >80
Cynosis Absent In room air In 40%O2
Grunt Absent Audible with a
Stethoscope
Audible with a
nacked ear
Retraction Absent Mild Moderate –
sever
Air entry Good Diminished Barely Audible
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NNF NNP data base 2003
A score of >6 indicates impending respiratory
failure and warrants mechanical ventilation
34. B. Silverman –Anderson score
A score of >6 indicates impending respiratory failure and warrants mechanical
ventilation 1/6/2021
34
NNF NNP data base 2003
A score of >6 indicates impending respiratory
failure and warrants mechanical ventilation
36. Respiratory Disorders in the Newborn:
Identification and Diagnosis
Radiographically in HMD lungs demonstrate the typical
“ground glass” appearance that represents diffuse atelectasis
and “air bronchograms” bronchograms”that reflect the
contrast of the relatively airless parenchyma against the air-
filled bronchi.
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Aly H, Article of neonatology, 2004
37. Prenatal Diagnosis Contd….
Pulmonary Function
Compliance decrease
Functional residual capacity is reduced
Hypoxemia secondary to mismatch of ventilation,
Alveolar ventilation is decreased
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38. Management of RDS
1. Prevention
2. Medical management
3. Nursing management
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39. Management of RDS Cont…
1.Prevention of RDS
A. Prevent premature delivery
• Adequate bed rest
• Administer tocolytic agent as prescribe by physician
B. Determine lung maturity to plan delivery by
• Biochemical tests
• Biophysical tests
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40. Management of RDS Cont…
Biochemical tests to determine lung maturity:
• Lecithin/sphingomyelin (L/S) ratio: Ratio >2 indicates low risk
for RDS.
• Phosphatidylglycerol
• Fluorescence polarization test
Biophysical test to determine lung maturity :
• Foam stability index
• Lamellar body count
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41. Management of RDS Cont…
C. Antenatal Corticosteroids(ACS) Use
Leads to improvement in neonatal lung function by:
• Enhancing maturation changes in lung architecture.
• Induction of lung enzymes leading to biochemical maturation.
Types of ACS Used:
• Betamethasone 12mg IM q 24hrs X 2 doses
• Dexamethasone 6mg IM q 6hrs X 4 doses.
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F Brownfoot et al.2013
42. Management of RDS Cont…
ACS should be given to all women at high risk for preterm
delivery at < 34 weeks unless impending delivery is anticipated.
Benefits accrue within few hours of administration.
Multiple course of ACS is not encouraged, however rescue
therapy may be considered if several wks have elapsed since
initial course and GA is still <28-30 wks.
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43. Management of RDS Cont…
• Multiple weekly dosing is not encouraged.
• ACS is recommended despite presence of prolonged ROM at
GA 24-32 wks when there is no evidence of chorioamnionitis.
• ACS is not recommended before 24 wks or after 34 wks GA.
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44. Management of RDS Cont…
Benefits of ACS
For GA 24 -34 wks, ACS result in:
Reduction in severity of RDS
Reduction incidence of intraventricular haemorrhage
Reduction in mortality
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45. Stimulation of fetal lung maturation with
dexamethasone in unexpected premature labour.
This study include 150 pregnant women which delivered before 37
week of gestation.
CONCLUSION
Dexamethasone accelerates maturation of fetal lungs, decrease
number of neonates with respiratory distress syndrome and
improves survival in preterm delivered neonates. Optimal
gestational age for use of dexamethasone therapy is 31 to 34 weeks
of gestation.
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Grgic G et all. Article in Bosnian 2013
46. Antenatal corticosteroids promote survival of extremely
preterm infants born at 22 to 23 weeks of gestation
Conclusions:-ACS exposure improved survival of extremely
preterm infants. ACS treatment considered for threatened preterm
birth at 22 to 23 weeks of gestation.
Rintaro M. Article of neonatology, 2011
1/6/2021
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48. Cont…
B. Respiratory support
Supplemental oxygen provide by
Nasal Cannula
Nasal CPAP by prongs or mask
• Bubble CPAP
• Ventilator CPAP
Endotracheal intubation to keep O2 saturations above 87 % on
pulse Oximetry.
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49. Cont…
Indication of CPAP
In delivery room for babies at risk of RDS
Babies on low flow oxygen with respiratory distress
Mechanical ventilation
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CJ morley et al med. 2008
52. Continuous Positive Airway Pressure in Preterm Neonates: An Update of
Current Evidence and Implications for Developing Countries
Conclusions: CPAP, if used early and judiciously, is an effective
intervention and need immediate scaling-up in resource-limited
settings.
Kumar P et al, indian paediatrics,2015
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53. Assisted ventilation for hyaline membrane
disease
Results: Survival on assisted ventilation improved from initial
22.2% in 1989 to 77.8% in 1993. Of 19 babies weighing
between 750-1000g, 8 survived. 12 of 27 babies with a gestation
of less than 28 weeks survived. Survival rates in babies with
gestation of more than 33 weeks was 94%.
Singh M et al, IJP 1995
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54. Cont…
C. Surfactant through ET
Prophylactic surfactant is given within 20 minutes of delivery
( GA < 30-32 Weeks ).
Reduces incidence of
i. Pneumothorax
ii. Mortality in those <30 wks
Early surfactant is given within 2 hrs of delivery.
1/6/2021
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55. Available in market
.
Medicine
(Brand)
Volume
Conc.
(per ml)
Dosage
(recom)
Inter
b/w
Max.
doses
MRP
Neosurf
(CIPLA)
5ml &
3 ml
1ml=27mg
135 mg
per kg
12 hrs. 2
5 ml=8000
3 ml=4900
Survanta
(ABBOT)
8 ml &
4 ml
1ml=25mg
100mg
per kg
6 hrs. 2
8ml=12000
4 ml=7260
Curosurf
(NICHOLAS)
1.5 ml 1ml=80mg
200mg per
kg (first)
100mg per
kg (repeat)
12 hrs. 2 1.5ml=10,680
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S Ashwini et al.2009
56. Administration
Dosage:
Precautions:
Check ETT position
Close monitoring
Do not shake vial
Opened vials can be kept in refrigerator for up to 12 hours
[Do not freeze! Keep at 2-8oC]
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57. Administration
Techniques: Rapid bolus administration
i) Through 5 Fr feeding catheter inserted into ETT:
A. Give as 4 equal aliquots, remove catheter and ventilate
0.5-2 min between doses
B. 2-4 postural changes recommended
a. Head up 10o, head to right, then left; followed by Head
down 10o, head to right then left
b. Right or left side dependent (Earlier Preferred)
European J. Perinat..2007 1/6/2021
57
58. Administration
Immediately after administration, watch for:
o Acute airway obstruction (ETT may get occluded):
bradycardia, cyanosis, hypotension
o Rapid improvement in oxygenation and ventilation
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59. Surfactant therapy in preterm infants with respiratory distress
syndrome and in near-term or term newborn with acute RDS
Conclusion :-Comparative trials with poractant alfa at a higher
initial dose of 200 mg/kg appear to decreased mortality in infants
<32 weeks gestation when compared with beractant. Early rescue
(<30 min of age) surfactant therapy is an effective method to
minimize over treatment of some preterm infants who may not
develop RDS.
surfactant therapy has been shown to be 70% effective in
improving
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Ramanathan R Journal of Perinatology.2006
61. Nursing management
1. Assessment
The most essential nursing function is to observe and assess the
infants response to therapy.
Continuous close monitoring of the infant is mandatory as the
infants condition can change rapidly.
Continuous pulse oximetry readings are required to determine
the FiO2 required. ABG monitoring is also necessary to decide
ventilator settings.
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62. Nursing diagnosis Expected outcome interventions
Risk of Ineffective
breathing pattern
related to
pulmonary
immaturity
Child will maintain
Normal breathing
pattern
- Assess the general condition of the
child
- Monitor the vital signs and oxygen
saturation every hourly
- Monitor the breathing pattern every
hourly.
- Provide a neutral thermal
environment.
- Instill normal saline nasal drops
every two hourly and keep nose
patent
- Make sure that there is proper
delivery of oxygen through oxygen
hood
Cont….
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63. Nursing diagnosis Expected outcome interventions
Ineffective
thermoregulation
related to immature
temperature control
and decreased
subcutaneous fat
Child maintains
normal body
temperature
-Assess the general condition of
child
-Monitor the temperature of the
child every hourly
-Maintain the temperature of the
incubator
-Provide additional dress like
sweaters, cap, nappy and soaks.
-Do not open the incubator door
frequently or for a long time.
Cont…
1/6/2021
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64. Nursing diagnosis Expected outcome Interventions
Risk for Infection
related to deficient
immunological
defences, exposure to
environmental
pathogens and invasive
procedures
Child remains
protected from the
risk of infection
-Monitor the vital signs every hourly
-Maintain strict aseptic precautions for
every invasive procedure.
-Provide a neutral thermal environment.
-Administer antibiotics as per order.
-Maintain hygiene of the baby
-Inspect the umbilicus for any signs of
infection
-Maintain the cleanliness of the
incubator
-Advise the mother to maintain hand
hygiene before touching the infant
Cont…
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65. Nursing diagnosis Expected
outcome
Interventions
Risk for Imbalanced
nutrition less than
body requirement
related to inability
to ingest nutrients
Child
maintains
normal
nutritional
status
-Assess the nutritional status and hydration
status of the child.
-Assess the abdomen for any abdominal
distension and monitor the abdominal girth
every 6 hourly.
-Check the stools for colour, consistency,
and presence of any streaks of blood.
-Encourage breast feeding on demand and
every 2 hrs
-Nurse the baby in prone position or side
lying position after giving feeds.
Cont…
1/6/2021
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66. References
1. Farrell P, Zachman R: In Quilligan EJ, Kretchmer N. Fetal and Maternal Medicine. New
York, John Wiley; 1980.
2. Fanaroff , Martin’s Neonatal-Perinatal medicine, Diseases of the fetus and Infant, 8th
edition,1097-1107, 2006.
3. Polin, Yoder, Burg Practical Neonatology, 3rd edition, 155-180, 2001
4. www.UpToDate.com. Overview of neonatal respiratory distress Disorder of transition.
2015.
5. Steinberg KP, Hudson LD, Goodman RB, et al, an efficacy and safety of corticosteroids
for persistent acute respiratory distress syndrome. N Engl J Med 2006, 354:1671-1684
6. Michael A. kahn, DDS/Lynn W.Solomon DDS.
7. Bernard GR, Luce JM, Sprung CL,et al. a high-dose corticosteroids in patients with the
adult respiratory distress syndrome. N Engl J Med 1987, 317:1565-1570.
8. Anne Greenough and et al; Neonatal Respiratory Disorders: 2nd Edition; 247-64
1/6/2021
66
67. Cont…
9. Kliengman and et al; Nelson Textbook of Pediatrics; 18th edition; vol.2; 731-41
10. Kumar and et al; Robbins Basic Pathology; 8th edition; 257-59.
11. Donna L Wong; Essentials of Pediatric Nursing; 5th edition;:259-63
12. Hockenberry and et al. Wong’sNursing Care of Infants and Children.7th edition.Mosby.2003;
379-88
13. Accessed from www.google.com (respiratory distress syndrome, hyaline membrane disease).
14. MV murali, Ray D, Paul VK, et al. continuous positive airway pressure with a face mask in infants
with hyaline membrane disease. Indian Pediatric 1988, 25: 627-31.
15. MT stahlman, Young WC, Payne G. Studies of ventilatory aids in hyaline membrane disease. Am J
Dis Child 1962,104: 526-32.
1/6/2021
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68. Cont…
16. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials.
Am J Obstet Gynecol 1995; 173: 322–335.
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