it 28 - respiratory distress - jul

7/21/2019 IT 28 - Respiratory Distress - JUL

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Visual 1

Respiratory Distress

Julniar M Tasli

Herman Bermawi



Objective

• To know the defnition o respiratory

distress• Must be able to obtain a complete

maternal and newborn history

•

Can perorm a through physicalexamination

• Recognie the common respiratorydisorders

• Can identiy those that are lie!treateningand rever them to the hospitals that havea "#C$ subdivison



%efniton

R% in the newborn is characteried by one ormore o the

ollowing &

! "asal 'aring

! Chest restriction & suprasternalsubcostal

intercostal

! Tachypnea! (runting



Evaluation

Is it a life threatening

event or illness?

Visual 4



#nitial )ssesment The aim o initial assesment o the inant in R% to identiy

lietreatening conditions that re*uire prompt support

+alarming or

R%, &

a- Obstructive airway& ! gasping

! choking

! stridor

b- #nsu.cient breathing & ! apnea

! poor respiratory e/ort

c- Circulatory collaps & ! bradycaria ! hipotension

! poor perusion

d- 0oor oxygenation & ! cyanosis



Evaluation of RespiratoryDistress Using Down’s

Score

1earning Objective 2 Visual 6

Audible with earAudible by

stethoscope

No gruntingGrunting

No air entryMild decrease in air

entry

Good bilateral air

entry

Air Entry

Cyanosis on O2Cyanosis relieed by

O2

No cyanosisCyanosis

!eere retractionsMild retractionsNo retraction"etractions

# $%&'in6% ( $%&'in) 6%&'in"espiratory "ate

21%



Evaluation of Respiratory

Distress Using Down’sScoreScore < 4 No respiratory distress

Score 4 ! Respiratory distress

Score " ! I#pending

respiratory failure $%loodgases should &e o&tained'

1earning Objective 2 Visual *



%e (repared

• Resuscitation e)uip#ent and*orsupplies

•

Involve others $tea# approach'• +ave sta, trained

• -%.

–

-irway – %reathing

– .irculation

Visual $



0hysical examination

#nspection & ! alarming sign urgent attention

! inspiratory stridor upper airway obstruction

! asymetric chest 3 severe distress tension

pneumothorax

! scaphoid abdomen & congenitaldiaphragmatic hernia

)uscultation & ! the symmetry and ade*uacy o airexchange

! abnormal breath sound

Transilumination o the chest



.onditions -ssociated with

Respiratory Distress4istory & Maternal

Obstertrical

5ymptom

Visual 1%



Visual 11



Differential diagnosis of respiratory distress



Investigations

• .hest /ray

• -rterial &lood gas

•

.%. $ane#ia0 polycythe#ia0sepsis'

• 1lucose chec2 $hypoglyce#ia'

•

%lood culture $sepsis0pneu#onia'

Visual 1+



3reat#ent

• -fter sta&iliation0 treat thecause of RD

• Use .(-(

• -void unnecessary e5posure too5ygen

•

-nti&iotics until sepsis is ruledout

Visual 14



.o##on .auses of RD.o##on .auses of RD

• 3ransient tachypnea of thenew&orn $33N'

• +yaline #e#&rane disease $+6D'

• 6econiu# aspiration syndro#e$6-S'

• -ir lea2 syndro#e

• (neu#onia

• .ongenital heart diseases

Visual 1,



3ransient 3achypnea of the3ransient 3achypnea of the

Neonate $33N'Neonate $33N'

De7nition

- &enign disease of nearter# orter# neonates who haverespiratory distress shortly afterdelivery that resolves within 89days:




(athogenesis of 33N(athogenesis of 33N

• +ow is lung ;uid for#ed?

• hat is the function of lung;uids?

• hat happens to lung ;uidsduring la&or?

•

Does it #atter the type of la&or?

Visual 1*




Neonate $33N' $cont'Neonate $33N' $cont'

Ris2 factors

•

.esarean section without la&or• 6acroso#ia

• 6ale se5

•

(rolonged la&or• E5cessive #aternal sedation

• =ow -pgar score $< ! at > #inute'

1earning Objective 6 Visual 1$





.linical (resentation of 33N

3he neonate is usually nearter# or

ter#0 and shortly after delivery hastachypnea $"@ &reaths*#inute': 3he

neonate #ay also have grunting0

nasal ;aring0 ri& retractions0 and

cyanosis: 3he disease usually does

not last longer than !A hours:

1earning Objective 6 Visual 1-



Visual 2%





–

.hest /rayB(erihilar strea2ing0 #ildcardio#egaly0 increased lungvolu#e0 ;uid in the #inor

7ssure0 and perhaps ;uid in thepleural space are co##on7ndings:




3ransient 3achypnea of3ransient 3achypnea of

the Neonate $33N' $cont'the Neonate $33N' $cont'6anage#ent of 33N

•

Cudicious use of o5ygen• luid restriction• eeding as tachypnea i#proves .on7r# the diagnosis &y e5cluding

other causes of tachypnea e:g:pneu#onia0 congenital heart disease0hyaline #e#&rane disease0 andcere&ral hyperventilation:






utco#e and (rognosis of 33N

3he disease is selfli#ited and thereis no ris2 of recurrence or furtherpul#onary dysfunction: Respiratory

sy#pto#s i#prove asintrapul#onary ;uid is #o&ilied0and this is usually associated withdiuresis:

1earning Objective 6 Visual 2+

+ li 6 & Di+ li 6 & Di



+yaline 6e#&rane Disease+yaline 6e#&rane Disease

$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e'

De7nition

+yaline #e#&rane disease $+6D' isalso called respiratory distresssyndro#e $RDS': 3his condition

usually occurs in a preter# neonate:(re#ature lungs are surfactantde7cient:





$Respiratory Distress$Respiratory Distress

Syndro#e'Syndro#e' $cont'$cont'

Respiratory diFculties e5hi&itedincludeB

• Increasing tachypnea $" G@*#in'

• .hest retractions

• .yanosis on roo# air that persists or

progresses over the 7rst A44 hoursof life:

• Decreased air entry• 1runting

1earning Objective 7 Visual 2,




$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont'

Incidence

+6D occurs in a&out A9H ofneonates &orn at 8A wee2sgestation: 3he incidence

increases with increasingpre#aturity:




+yaline 6e#&rane Disease

$Respiratory DistressSyndro#e' $cont'

Ris2 actors of

+6D

• Increased Ris2

– (re#aturity

– 6ale se5

– Neonate of dia&etic#other

1earning Objective 7 Visual 2*



+yaline 6e#&rane Disease

$Respiratory DistressSyndro#e' $cont'

Ris2 actors of +6D

• Decreased Ris2

– .hronic intrauterine stress• (rolonged rupture of #e#&ranes• 6aternal hypertension• Narcotic use• Intrauterine 1rowth Retardation

$IU1R' or S#all for 1estational -ge$S1-'

– .orticosteroids (renatal

1earning Objective 7 Visual 2$





Investigations for +6D $RDS'

•

=a&oratory StudiesB – %lood gasesB hypo5ia0 hypercar&ia0 acidosis:

– .%. and &lood culture are re)uired to rule out

infection:

– Seru# glucose levels are usually low:

• .hest /ray StudyB

– Reveals ground glass appearance with air

bronchograms-

1earning Objective 7 Visual 2-



Visual +%




$Respiratory Distress$Respiratory Distress

Syndro#e'Syndro#e' $cont'$cont'

6anage#ent of +6D $RDS'

•

1eneral – 3her#al regulation

– (arenteral ;uid

– -nti&iotics

– .ontinuous #onitoring

1earning Objective 7 Visual +1




$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont' – .ontinuous positive airway

pressure $.(-(' is tried:

– If under .(-(• (+ < !:A

• r (A < 4@##+g iA " G@H

• r (.A " G@##+

•

%ase de7cit " >@Endotracheal intu&ation and#echanical ventilation:

.onsider surfactant therapy1earning Objective 7 Visual +2





–.autionB every >@ days on

the ventilator is associatedwith A@H increased ris2 forcere&ral palsy

1earning Objective 7 Visual ++





• Speci7c 3reat#ent

– Surfactant replace#ent therapy iftracheal intu&ation is re)uired

• utco#e

– RDS accounts for A@H of all neonataldeaths

– .hronic lung diseases occurs in AJHin K=% infants




Visual +,



6econiu# -spiration6econiu# -spiration

Syndro#e $6-S'Syndro#e $6-S'

De7nition

3he respiratory distresssecondary to #econiu#aspiration &y the fetus in uteroor &y the neonate during la&orand delivery:




6econiu# -spiration6econiu# -spiration

Syndro#e $6-S' $cont'Syndro#e $6-S' $cont'(athogenesisB aspiration of#econiu# can causeB

• -irway o&struction $&all and valve'

• Severe in;a##ation

• (ul#onary hypertension

• (latelet activation

1earning Objective 8 Visual +*



Meconium )spiration5yndrome +M)5, +cont,

Risk 9actors o M)5

• 0ost!term pregnancy

• Maternalhypertension

• )bnormal etal heartrate

• :iophysical profle ≤ ;

•

0re!eclampsia• Maternal diabetes

mellitus

• 5()

• Chorioamnionitis

1earning Objective 8 Visual +$




Clinical presentation o M)5

• Meconium staining o amniotic 'uid beorebirth-

• Meconium staining o neonate ater birth-

• Respiratory distress leading to increased

anteroposterior diameter o the chest-• 0ersistent pulmonary hypertension o the

newborn +004",-

1earning Objective 8 Visual +-




#nvestigations or M)5

• 1aboratory studies

– :lood gas analysis

– :lood culture and C:C

1earning Objective 8 Visual 4%




#nvestigations or M)5

• Radiologic studies

– Chest <!ray& fndings include patchyinfltrates= coarse streaking o both

lung felds= hyperin'ation o the lungand 'attening o the diaphragm-




Visual 42

Meconium )spiration




Management o M)5

0renatal management&• #dentifcation o high!risk pregnancy-

• Monitoring o etal heart rate duringlabor-

• )mnioinusion +>,

1earning Objective 8 Visual 4+

Meconium )spiration



Meconium )spiration5yndrome +M)5, cont,

Management o M)5

%elivery room management& +iamniotic 'uid is

meconium stained,• Obstetrical& 5uction o the oropharynx by

obstetrician beore delivery o shoulders-

• 0ediatric& ?isualiation o vocal cords andtracheal suction i inant is not breathing-


i i i




• (eneral Management o "eonate withM)5

– @mpty the stomach contents to avoidurther aspiration-

– Correction o metabolic abnormalities e-g-hypoxia= acidosis= hypoglycemia=

hypocalcemia and hypothermia-

– 5urveillance or end organ hypoxicAischemicdamage +brain= kidney= heart and liver,-

1earning Objective 8 Visual 4,

M i ) i i




• Respiratory Management o "eonatewith M)5

– 9re*uent suction and chest vibration-

– 0ulmonary toilet to remove residualmeconium i intubated-

– )ntibiotic coverage +ampicillin andgentamicin,-

– $se C0)0-




)ir 1eak 5yndromes%efnition

The air leaks syndromes+pneumomediastinum= pneumothorax=pulmonary interstitial emphysema andpneumopericardium, comprise a spectrumo diseases with the same underlyingpathophysiology- Overdistension oalveolar sacs or terminal airways leads to

disruption o airway integrity= resulting indissection o air into surrounding spaces-

1earning Objective ; Visual 4$



)ir 1eak 5yndromes +cont,

#ncidence

Most commonly seen in neonates withlung disease who are on ventilatorysupport but can also occurspontaneously- The more severe the

lung disease= the higher the incidenceo pulmonary air leak-

1earning Objective ; Visual 4-



Visual ,2





Clinical 0resentation o "eonates with)ir 1eak

5yndromes

• Respiratory distress or sudden deteriorationo clinical course with alteration o vital

signs and worsening o blood gases-• )symmetry o thorax is present in unilateral

cases-

1earning Objective ; Visual ,+




#nvestigations or )ir 1eak5yndromes

• The defnitive diagnosis o all air leaksyndromes is made radiographically by

an )!0 chest <!ray flm and a lateralflm-

1earning Objective ; Visual ,4




Management o )ir 1eak 5yndromes

• (eneral – )void ventilators

– Careul use o manual bag ventilation• 5pecifc

–

%ecompression o air leak according tothe type-

– %o not needle the chest

1earning Objective ; Visual ,6



)pnea +cont,

Risk 9actors o "eonatal )pnea

• (athological apnea

– 4ypothermia

– 4ypoglycemia

– )nemia

– 4ypovolemia

– )spiration – "@C A %istension

1earning Objective E Visual ,$

Cardiac disease .ung disease

Gastro intestinal re/lu0

Airway obstruction

n/ection 'eningitis

Neurological disorders



)pnea +cont,

#nvestigations• Monitoring at!risk neonates less than 6D

weeks gestational age-

• @valuate or a possible underlying cause-

• 1aboratory studies should include a C:C=blood gas analysis= serum glucose=electrolyte= and calcium levels-

• Radiologic studies i chest disease issuspected

1earning Objective E Visual ,-



)pnea +cont,

Management o )pnea• (eneral Therapy

– 0erorm tactile stimulation-

–

C0)0 in recurrent and prolongedapnea-

– 0harmacological therapy +ca/eine ortheophylline, may be re*uired-

• Monitor levels-

1earning Objective E Visual 6%



)pnea +cont,

Management o )pnea

• 5pecifc Therapy

– Treatment o the cause= i identifed= eg-treatment o sepsis= hypoglycemia=anemia= and electrolyte abnormalities-

1earning Objective E Visual 61



)pnea +cont,

Outcome and 0rognosis

• #n most neonates apnea resolveswithout the occurrence o long!termdefciencies-

1earning Objective E Visual 62



5ummary& 1earning

Objectives2- @valuate the severity o respiratorydistress using the %ownFs 5core-

D- #dentiy common neonatal

respiratory disorders= including& – Transient Tachypnea o the "ewborn +TT",

– Respiratory %istress 5yndrome +R%5,

– Meconium )spiration 5yndrome +M)5,

–

)ir leak syndromes – )pnea

– 0neumonia

1earning Objectives Visual 6+



5ummary& 1earning

Objectives +cont,8- #dentiy the risk actors= clinical

presentation= re*uired laboratory

and radiological investigations=management o M)5-

;- #dentiy the incidence= risk actors=

clinical presentations= re*uiredradiological investigations= andmanagement o air leak syndromes-

1earning Objectives Visual 6,



5ummary& 1earning

Objectives +cont,E- #dentiy the incidence= risk

actors= causes= re*uired

investigations= and managemento apnea-

G- #dentiy the etiology= clinical

presentation= re*uiredinvestigations= and managemento pneumonia-

it 28 - respiratory distress - jul

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