pediatrics respiratory emergency

1. Signs of respiratory distress
&
Common respiratory problems
Dr.Osama Arafa Abd EL Hameed
M. B.,B.CH - M.Sc Pediatrics - Ph. D.
Consultant
Pediatrician & Neonatologist
Head of Pediatrics Department - Port-Fouad Hospital
By

2. Pulmonary diseases in the newborn
period
1/13have breathing problems at birth
1/6with breathing problems have infections
GA< 31 : 1/2 have infections
Boys 9.3%, Girls 5.9%
Mortality 0.4% (5% < 36 weeks GA(

3. Infants at Risk for Developing
Respiratory Distress
Preterm Infants
Infants with birth asphyxia
Infants of Diabetic Mothers
Infants born by Cesarean Section
Infants born to mothers with fever, Prolonged
ROM, foul-smelling amniotic fluid.
Meconium in amniotic fluid.
Other problems

4. Pediatric Respiratory System
Large head, small
mandible, small neck
Large, posteriorly-placed
tongue
High glottic opening
Small airways
Presence of tonsils,
adenoids

5. Pediatric Respiratory System
Poor accessory muscle development
Less rigid thoracic cage
Horizontal ribs, primarily diaphragm
breathers
Increased metabolic rate, increased O2
consumption

6. Pediatric Respiratory System
Decrease respiratory reserve +
Increased O2 demand =
Increased respiratory failure risk

7. Pulmonary diseases in the newborn
period
Symptoms and signs
Tachypne (frequency > 60 per min(
Cyanosis in room air
Flare of the nostrils
Chest retractions
Grunting

8. Respiratory Distress

9. When is it abnormal to show
signs of respiratory distress?
When tachypnea, retractions, flaring, or grunting
persist beyond one hour after birth.
When there is worsening tachypnea, retractions,
flaring or grunting at any time.
Any time there is central cyanosis
Acrocynosis: blue color of the hands and feet with
pink color of the rest of the body, common in
delivery room and is usually NORMAL

10. Causes of Neonatal Respiratory
Distress
Obstructive/restrictive - mucous, choanal atresia,
pneumothorax, diaphragmatic hernia.
Primary lung problem - Respiratory Distress
Syndrome (RDS(, meconium aspiration, bacterial
pneumonia, transient (TTN(.
Non-pulmonary -hypovolemia/hypotension,
congenital heart disease, hypoxia,
acidosis, cold stress, anemia,

11. Pulmonary diseases in the newborn
period
Respiratory Distress Syndrome(RDS(
Transient Tachypnoe of newborn(TTN(.
Pneumonia/Infection
Meconium Aspiration
Air Leaks
Pulmonary hypertension
Chronic Lung Disease (CLD(

12. Pulmonary causes
Common Rare
RDS Lung hypoplasia
Trans tachypne Obstr upper airways
Meconium asp Tumours
Pneumonia Pulm hemorrhage
Pneumothorax Malformations
Cong diaprhagmatic hernia

13. Extra-pulmonary causes
Common Rare
Persist Fetal Circulat Cerebral edema
Cong Cord Malfor Drugs
Cerebral Hemorrhage Neuromuscular
Polycythemia Asph, spinal cord
Hypoglycemia Metabolic Diseases
Hypothermia
Acidosis

14. Evaluation of Respiratory
Distress
Administer Oxygen and other necessary
emergency treatment
Vital sign assessment
Determine cause-- physical exam, Chest
x-ray, ABG, Screening tests: Hematocrit,
blood glucose, CBC
Sepsis work-up

15. Principles of Therapy
Improve oxygen delivery to lungs-- supplemental
oxygen, CPAP, assisted ventilation, surfactant
Improve blood flow to lungs-- volume expanders,
blood transfusion, partial exchange transfusion
for high hematocrit, correct acidosis
(metabolic/respiratory(
Minimize oxygen consumption-- neutral thermal
environment, warming/humidifying oxygen,
withhold oral feedings, minimal handling

17. Respiratory Distress Syndrome
Also called as hyaline membrane disease
Most common cause of respiratory distress in
premature infants, correlating with structural &
functional lung immaturity.
1/3infants born between 28 to 34 weeks, but less
than 5% of those born after 34 weeks.
Pathophysiology- surfactant deficiency- increase in
alveolar surface tension- decrease in compliance.

18. CLINICAL FEATURES OF RDS
Tachypnea/Apnea
Dyspnea
Grunting/Flaring
Hypoxemia
Radiographic Features
Pulmonary Function Abnormalities

19. Early RDS

20. Progressive RDS

21. Late RDS

22. THERAPY FOR RDS
Oxygen - maintain PaO2 > 50 torr
Nasal CPAP
Intermittent Mandatory Ventilation
Surfactant Replacement
High Frequency Ventilation
Intercurrent Therapies

23. PIE

24. PIE Pathology

25. Pneumothorax/PIE

26. Pneumothorax

27. Pneumopericardium

28. TRANSIENT TACHYPNEA OF
THE NEWBORN
40%cases
Delayed Fluid Resorption
Hard to differentiate early on from RDS both
clinicaly and radiographicaly especially in
the premature infant
Initial therapy similar to RDS, but hospital
course is quite different

29. Wet Lung

30. Meconium Aspiration Syndrome
Incidence- 1.5- 2 % in term or post term infants.
Meconium is locally irritative, obstructive & medium
for for bacterial culture
Meconium aspiration causes significant respiratory
distress. Hypoxia occurs because aspiration
occurs in utero.
CXR- Patchy atelectasis or consolidation.

31. Meconium Aspiration

32. MAS

33. PERSISTENT PULMONARY
HYPERTENSION
Usually secondary to primary pulmonary disease state
Pulmonary Vascular Lability
Treat the underlying problem
Maintain normo-oxygenation
Selective Pulmonary Vasodilators
Pray for good luck

34. PPHN

35. CONGENITAL PNEUMONIA
Infectious; primarily GBS
Amniotic Fluid aspiration
Viral etiology
Surfactant inactivation

36. GBS Pneumonia

37. Pneumonia

38. CONGENITAL MALFORMATIONS
Choanal Atresia
Tracheal Atresia/stenosis
Chest Mass
Diaphragmatic hernia
Sequestration
Lobar emphysema

39. Lobar Emphysema

40. Diaphragmatic Hernia

41. Chylothorax

42. Phrenic Nerve Paralysis

43. ACQUIRED DISEASES
Infections
Bronchopulmonary Dysplasia
Sub-glottic stenosis
Apnea of Prematurity

44. Early BPD

45. Progressive BPD

46. Late BPD

47. APNEA
Definition:
cessation of breathing for longer than a
15 second period or for a shorter time if
there is bradycardia or cyanosis

48. Babies at Risk for Apnea
Preterm
Respiratory Distress
Metabolic Disorders
Infections
Cold-stressed babies who are being warmed
CNS disorders
Low Blood volume or low Hematocrit
Perinatal Compromise
Maternal drugs in labor

49. Anticipation and Detection
Place at-risk infants on cardio-
respiratory monitor
Low heart rate limit (80-100(
Respiratory alarm (15-20 seconds(

50. Treatment
Determine cause:
x-ray
blood sugar
body and environmental temperature
hematocrit
sepsis work up
electrolytes
cardiac work up

51. Treatment
CPAP
Theophylline/Caffeine therapy
Mechanical ventilation
Apnea monitor