newborn

1. Respiratory distress in
newborn
4th year seminar

2. RDS
• Most common respiratory illness in NICU
• Occur in premature neonate
• Surfactant deficiency
• Risk factors
– Asphyxia and stress
– Male
– Acidosis
– DM mother

3. signs
• tachypnea
• retraction
• grunting
• Nasal flaring
• apneic episode
• cyanosis
• extremities puffy or swollen

4. Chest X-ray
• Ground glass appearance
• Reticulogranular
• With air bronchograms

7. Physiologic abnormalities
• Lung compliance 10-20% of norm
• Atelectasis…areas not ventilated
• Areas not perfused
• Decrease alveolar ventilation
• Reduce lung volume

9. surfactant
• Type 2 pneumocytes lamillar body
22weeks…34-36wks
• Phosphatidylcholine
• Surfactant specific protein
• Recycling and regeneration (including
externally given surfactant)

10. surfactant
• Decrease surface tension at air liquid level
• Equalize tension in alveoli of different size
• Increase in lung compliance.
• Absence of surfactant cause RDS
• Pulmonary hypertension

11. Treatment
• Surfactant Fujiwara…1990s
– Prevention
– rescue
• Supportive
– Thermal
– Fluid and nutrition
– oxygen
• Mechanical ventilation

12. Acid base In RDS
• pH
• PaCO2
• PaO2
• HCO3
• Base deficit

13. complications
• Pneumothorax
• PDA
• Chronic lung disease
• Sepsis
• Line problems

14. Meconium aspiration
• First stool that constitutes the GI epithilium and
secretion during fetal life
• Stress and intra-uterine meconium in term infant
• Gasping cause the aspiration
• Chemical diffuse peumonitis
• Same signes of distrss and PPHN.
• Treatment maily supprtive

16. Congenital pneumonia
• Sepsis risk factors
– PROM
– Preamturity
– Maternal fever, dicharge, abdominal pain,
leukocytosis
– Colonization with GBS
• Same signs of RDS
• X-ray

18. Transient tachypnia of newborn
• Term
• Cesarian delivery
• Usually tachypnia without O2 requirment
• Resolve in 48-72 houres
• Lung fluid
• X-ray