Rds

2. • Morning meeting
DR IRFAN ALI
fcps trainee
NURSERY

3. BIODATA
• B/O HUMAIRA
• DOB : 16th July 2016
• TOB :10 30 AM
• DOA : 1st August 2016
• DO L : 16th
• GENDER :FEMALE
• ADDRESS: SHIKARPUR

4. • c/o
Respiratory distress since 1st day of life

5. BIRTH HISTORY
• ANTENATAL HISTORY
23 yrs old mother
primigravida
38 week of gestation.
Booked case.
TT received.
U/S done

6. Multivitamin taken.
No h/o PROM
Prolong labour.
H/o fever 2 days before c-section.

7. • NATAL HISTORY
C-Section at 38 weeks
Hospital delivery,
• POSTNATAL HISTORY
• Cried immediately
• No history of resuscitation at birth
• First urine and stool passed within 24 hours.
• Vitamin k received.
• h/o respiratory distress

8. • FAMILY HISTORY
1st issue of non consanguineous marriage.
No h/o any significant illness in family.
• SOCIOECONOMIC HISTORY
Belongs to a poor class family. father is
unemployed and lives in house of 2 ventilated rooms

9. Examination
• sick looking neonate lying in incubator with visible distress.
H/r : 158 b /min
R/r : 73 br/min
Temp: a/f
Oxygen saturations : 95 % at room air
J-, A-, Cy- ,D- ,E-

10. Anthropometry
Weight 3 kg (50th centile)
Length 49 cm (b/w 75th and 50th centile)
foc 34 cm (b/w 75th and 50th centile)

11. Systemic examination
• Chest :
: tachypnea,
sternal subcostal and intercostal retractions, nasal
flaring,
b/l crepts audible.

12. • CVS : S 1 + S 2 + no added sounds
CRT 2 Sec
• Abdomen : soft NVM present, GS audible
• Genitals : female normal genitalia
• Anus: patent
• SKIN: Normal
• Back : Normal

13. • CNS :
• Fontanelle open and flat
• Moro:
• Sucking :
• Grasp : fair
• Rooting :
• Pupils: bilaterally equal and reactive to light.

14. Head to toe examination
• Normal with no dysmorphic features.

15. Provisional diagnosis
• TERM/ AGA/ NBW
• congenital pneumonia
• PPHN

16. Management
• Admited in nicu
• Incubator care
• Oxygen support via cpap.
• n/g tube passed
• NPO till further orders
• X-ray chest
• echo
• Investigations
• Maintainance fluids
• Iv antibiotics started.

17. Investigations
CBC 18-7-16 20-7-16 22-7-16
Hb
MCV
MCH
MCHC
15.5 g/dl
91 fl
32 pg
33 g/dl
14 g/dl 16.2 g/dl
WBCs 9,700 15,100 13,000
N 70%
(ANC=6790)
77 %
(ANC=11,627)
65 %
(ANC=8450)
L 2O% 15% 28 %
M 08% 5 % 05 %
E 02% 3 % 02%
PLATELETS 163,000 152,000 157,000

18. uce 20-7-16 22-7-16
urea 40 mg/dl 65 mg/dl
Cr 0.6 mg/dl 0.8 mg/dl
Na 135 mEq/L
K 5.12 mEq/L
Cl 102 mEq/L

19. • RBS : 100 mg/ dl at the time of presentation
serial monitoring remained normal
• BBG :B positive
Blood c/s; awaited

20. cxr

21. Hospital course
• Monitoring of vitals and RBS done
• oxygen support continued
• Preductal and postductal spo2 was 95%.
• Antibiotics changed
 Condition gradually improved
 Oxygen tapered kept on headbox support
• Activity improved
• N/G feeding started
• Planned to dmf and step down

22. Repeat labs
4-8-16 8-8-16
CBC
Hb
MVC
MCH
MCHC
13.5 g/dl
82 fl
26 pg
31 g/dl
13 g/dl
85 fl
25 pg
30 g/dl
WBCs 7,500 6,200
N 60 %
(ANC=4500)
64 %
(ANC=3968)
L 36 % 33 %
M 02 % 01 %
E 02 % O2 %
PLATELETS 182,000 2,94,000

23. UCE 04-08-16 08-08-16
Urea 13 26
Cr 0.4 01
Na 140 138
K 5.5 5.6
Cl 101 103

26. FINAL DAIGNOSIS
• TERM/ AGA/ NBW
• Congenital pneumonia

28. • AN APPROACH TO RESPIRATORY DISTRESS IN
NEONATES

29. PLAN
• Introduction
• Causes and
Classification
• Respiratory
Distress Signs
• Evaluation and
Investigation
• General
Management

30. Introduction
Respiratory Distress in Newborn
= Abnormal respiratory signs in neonates

32. Causes and Classification
Respiratory
Distress in
Newborn
Causes
Respiratory
Extrapulmonary
Management
Medical
Surgical

33. Causes
Respiratory
Extrapulmonary
Upper Airway
Obstruction
Choanal
Atresia
Pierre Robin
Sequence
Laryngeal
pathology
Lower Airway
TTN
RDS/HMD
MAS
Congenital
Pneumonia
Air Leak
Syndrome
Milk
Aspiration
Rib cage
anomalies
Congenital
Diaphragmatic
Hernia
Neuromuscular
diseases
PPHN
Congenital
Heart Diseases
Shock Anaemia Polycythaemia
Hypoglycaemia Hypothermia
Metabolic
acidosis
Intracranial
Birth Trauma/
Encephalopathy

34. Management
Medical
• TTN
• MAS
• RDS/HMD
• Pneumonia
• Milk Aspiration
• CHD
• Shock
• Anaemia
• Polycythaemia
• Hypoglycaemia
• Hypothermia
• Metabolic Acidosis
Surgical
• Choanal atresia
• Pierre Robin Sequence
• Air Leak Syndrome
• Rib cage anomalies
• Congenital Diaphragmatic Hernia
• Air Leak Syndrome
• Intracranial Birth Trauma/
Encephalopathy

35. Respiratory Distress Signs
Respiratory
Distress in
Newborn
Tachypnoea
Retractions
Grunting
Nasal
Flaring
Cyanosis

36. Tachypnoea
Respiratory Rate:
up to 2 months:
60 or more
2 to 12 months:
50 or more
12 months to 5 years:
40 or more

37. Retractions
• Due to negative intrapleural
pressure generated
between the contraction of
diaphragm, respiratory
muscles and the mechanical
properties of lung and chest
wall
– Suprasternal Retraction
SSR
– Intercostal Retraction
ICR
– Subcostal Retraction SCR

38. Suprasternal Retraction SSR

39. Subcostal Retraction SCR

40. Intercostal Retraction ICR

42. • Expiration through partially
closed vocal cords to
increase airway pressure
and lung volume resulting in
improved ventilation-
perfusion (V/P) ratio
• Low pitched expiratory
sound.
Grunting

43. Evaluation and Investigation
History Examination Investigation

44. History Examination Investigation
Antenatal US Finding
Amniotic Fluid Index
Renal Agenesis?
Pulmonary Hypoplasia?
Liquor
Oligohydramnio
?Pulmonary
Hypoplasia
Polyhydramnios
?Cong Diaphr
Hernia
?Oesoph
atresia/TEF
MSAF
MAS ? PPHN
Gestation/Delivery
Term LSCS
?TTN
Preterm
?RDS
Postdate
?MAS

45. History Examination Investigation
Risk Factors
IDM
?Hypoglycaemia
GBS+ve Mother
Sepsis/Congenital
Pneumonia
Condition at birth
Distress
?Met
acidosis
Not vigorous
?Asphyxial Lung
Ds
Require resus at
birth
?Air Leak
Syndrome
Leaking Liquor
>18hrs
?Presumed
Sepsis
PPROM/PROM
Maternal UTI
?Presumed
Sepsis

46. Term Baby
• TTN
• MAS
• Congenital
Pneumonia
• Dev Anomalies
Preterm Baby
• RDS
• Congenital
Pneumonia
• TTN
at birth
Respiratory
Distress
later after
a period of
normal
function
Possible causes
• Acquired/Nosocomial
Pneumonia
• Dev anomalies
• CHD
• IEM
• Metabolic (Met acidosis/
electrolytes)

47. • T – hypo/hyperthermic
• RR – tachy/apnoea
• HR – tach/bradycardia
• SPO2 – desaturate?
Vitals
• Pallor
• Plethoric
• SGA/LGA
• Macrosomic/hydroptic
General
Condition
• Cleft palate
• Excessive oral secretion
Oral Cavity
• Pierre Robin
• Potter face
Congenital
anomalies
History Examination Investigation

48. •Dextrocardi,murmurs
•In-drawing sternum
•Air entry
CVS/Lung
•Scaphoid abdomen
Abdomen
•Meconium stained
Umbilical
cord/
Nails
•Hypotonia
•Poor sucking reflex
•Incomplete Moro
Tone/
Reflexes

49. Look for:
• O2 Saturation
• Metabolic/ respiratory
acidosis/ alkalosis
• Blood counts
(Hb/TWC/Plt/Ht)
• Glucose level
• Sepsis causative agent
• Collapse/Air Leak/CDH/
Cardiomegaly
DXT Blood
C+S/LP
CXR
Portable
SPO2
monitoring
VBG/ ABG FBC

50. GENERAL MANAGEMENT
Respiratory
Support
Supportive Care
Definitive/Specific
Therapy
• O2 Delivery
• PEEP/ Mechanical ventilation
(CPAP/SiPAP)
• Intubation and suction
• HR monitoring
• Continuous SPO2
monitoring
• Temp/DXT monitoring
• I/O charting
• Feeding (PO/TPN)
• Cot/Incubator nursing
According to
diagnosis