This document discusses several respiratory disorders that can affect newborns, including respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, and diaphragmatic hernia. It provides details on the etiology, risk factors, clinical features, diagnosis, treatment and complications of each condition. A case example is given of a 33-week infant with symptoms of respiratory distress syndrome including tachypnea, nasal flaring and grunting, and chest x-ray findings consistent with RDS. Overall treatments discussed include oxygen, ventilation, surfactant administration and surgery depending on the specific condition.

1. Prepared by
Dr Abdirahman mumin
RESPIRATORY DISORDERS

2. RESPIRATORY DISORDERS

3. Respiratory Distress in the Newborn
Clinical Features
 tachypnea: RR >60/min
 tachycardia: HR >160/min
 grunting, subcostal/intercostal indrawing, nasal
flaring
 duskiness, central cyanosis
 decreased air entry, crackles on auscultation

4. Differential Diagnosis of Respiratory
Distress

5. Respiratory distress syndrome (RDS)
Case
Shortly after birth, a 33-week gestation infant
develops tachypnea, nasal flaring, and grunting
and requires intubation. Chest radiograph shows
a hazy, ground-glass appearance of the lungs.

6. Etiology and pathophysiology RDS
 Surfactant deficiency -poor lung compliance due
to high alveolar surface tension _ atelectasis -
decreased surface area for gas exchange _
hypoxia + acidosis _ respiratory distress “Hyaline
membrane disease”
 Usually occur preterm.

7. Risk Factors:
 Maternal DM
 Preterm delivery
 Male sex
 LBW
 Acidosis
 sepsis
 Hypothermia
 Second born twin

8. Clinical Features:
 Respiratory distress within first few hours of life
 worsens over next 24-72 h
 Hypoxia
 Cyanosis
 Primary initial pulmonary hallmark is hypoxemia.
Then, hypercarbia and respiratory acidosis
ensue.

9. Diagnosis:
 Best initial diagnostic test—chest radiograph
which show:
 ground-glass appearance
 Atelectasis
 air bronchograms
 Most accurate diagnostic test—L/S ratio (part of
complete lung profile; lecithin-tosphingomyelin
ratio)

10. Primary prevention :
 Avoid prematurity (tocolytics)
 Antenatal betamethasone
Treatment :
 Resuscitation
 Oxygen and Ventilation
 Surfactant (decreases alveolar surface tension,
improves lung compliance, and maintains
functional residual capacity)
 Most effective treatment—intubation and
exogenous surfactant administration

11. Complications : In severe prematurity and/or
prolonged ventilation increased risk of
bronchopulmonary dysplasia
Prognosis :Dependent on GA at birth and severity
of underlying lung disease; long-term risks of
chronic lung diseas

12. Transient tachypnea of the newborn
(TTN)
Etiologic and pathophysiology
 Delayed resorption of fetal lung fluid
_accumulation of fluid in peribronchial lymphatic's
and vascular spaces _tachypnea “Wet lung
syndrome”
 Slow absorption of fetal lung fluid → decreased
pulmonary compliance and tidal volume with
increased dead space.
 Tachypnea after birth
 Generally minimal oxygen requirement
 Usually term and late preterm Term

13. Risk Factors:
 Maternal DM
 Maternal asthma
 Male sex
 Macrosomia (>4500 g)
 Elective Cesarean section
 short labour
 Late preterm delivery

14. Clinical Features:
 Tachypnea within the first few hours of life
 ± retractions
 Grunting
 nasal flaring
 Often NO hypoxia or cyanosis

15. Diagnosis :
 Common in term infant delivered by Cesarean
section or rapid second stage of labor
 Chest x-ray (best test) show:
i. air-trapping
ii. fluid in fissures
iii. perihilar streaking

16. Prevention: Where possible, avoidance of elective
Cesarean delivery, particularly before 38 wk GA.
Treatment:
 Supportive
 Oxygen if hypoxic
 Ventilator support (e.g. CPAP)
 IV fluids and NG tube feeds if too tachypneic to
feed orally
 Rapid improvement generally within hours to a
few days

17. Complication:
 Hypoxemia
 Hypercapnia
 Acidosis
 PPHN(Persistent pulmonary hypertension of
the newborn )

18. Meconium aspiration syndrome
Etiology and pathophysiolgy:
 Meconium is sterile but causes airway
obstruction, chemical inflammation, and
surfactant inactivation leading to chemical
pneumonitis
 Meconium passed as a result of hypoxia and
fetal distress; may be aspirated in utero or with
the first postnatal breath → airway obstruction
and pneumonitis → failure and pulmonary
hypertension
 Usually term and postterm

19. Risk Factors: Meconium-stained amniotic fluid
Post-term deliver.
Clinical Features:
 Respiratory distress within hours of birth Small
 airway obstruction
 chemical pneumonitis tachypnea
 barrel chest with audible crackles Hypoxia

20. Diagnosis: Chest x-ray (best test) which show
 patchy infiltrates
 increased AP diameter
 flattening of diaphragm
 Hyperinflation

21. Prevention:
 If infant is depressed at birth, intubate and suction
below vocal cords
 Avoidance of factors associated with in utero
passage of meconium (e.g. post-term delivery

22. Treatment:
 Resuscitation
 Oxygen and Ventilatory support
 Surfactant
 Inhaled nitric oxide
 Extracorporeal membrane oxygenation for
PPHN

23. Complications:
 Hypoxemia
 Hypercapnia
 Acidosis
 PPHN
 air leak (pneumothorax, pneumomediastinum)
 Chemical pneumonitis
 Secondary surfactant inhibition
 Respiratory failure

24. Diaphragmatic hernia
Etiology and pathophysiology :Failure of the
diaphragm to close → abdominal contents enter
into chest, causing pulmonary hypoplasia
Clinical Features:
 Born with respiratory distress and scaphoid
abdomen
 Bowel sounds may be heard in chest
Diagnosis:prenatal ultrasound; postnatal x-ray
(best test) reveals bowel in chest
Best initial treatment: immediate intubation in
delivery room for known or suspected CDH,
followed by surgical correction when stable
(usually days)

25. THE END