Nonatology:Neonatal Respiratory Distress

Lecture Points

• Neonatal pulmonary function

• Clinical Manifestation

• The main causes

• Main types of the disease

• Case discussion and presentation

• Summary and conclusion

Pulmonary function of the newborns in particular

• Relative small capacity of the lungs ： limited reserved volume poor compensation, likely to be distressed• Respiratory on abdomen and diaphragmatic movement Distension: likely to be respiratory distressed

• pulmonary surfactant (PS) relative in small amount in preterms and easily to be deficiency

• Diseased lungs trends poor compliance and even ARDS

Neonatal Respiratory Distress

General picture

• commonly occurs during neonatal period caused by various pathogeneses

• breath or 、 irregular, apnea

• With or without retraction at breathing, suprasternal and intercostal

• usually with cyanosis more or less

Causation of neonatal respiratory distress

• Upper respiratory tract ： choana, macrotongue, micrognathia• Larynx/throat and trachea ： intenerate• pulmonary disease ： inflamation 、 abnormality or hypogenesis• others ： congenital heart disease metabolic problems, CNS caused

Pathophysiology in neonatal respiratory distress

hypoxic and /or hypoventilation hypoxemia, PCO2 respiration center peripheral biochemical sensors breath or 、 irregular, apnea

Neonatal Respiratory Distress

• Hyaline Membrane Disease

（ HMD 、 RDS)

• Neonatal infectious Pneumonia

• Meconium Aspiration Syndrome (MAS) for differentiation

Hyaline Membrane Disease （ HMD/RDS ）

Clinical manifestation

• preterms

• normal at birth, respiratory distressed in several hours after birth

• progressively developing and deterioration

• self cured process during the sickness

Clinical manifestation • After birth commonly seen, intrauterine i

nfectious pneumonia relatively less seen • Occurring in neonates with different GAs

and ages• General appearance of infection • Various in severity of respiratory distress• Blood-gas ： PaO2 、 PaCO2

Neonatal infectious Pneumonia

Meconium Aspiration Syndrome (MAS)

Clinical manifestation• Terms and post-terms commonly seen• History of intrauterine distress• amniotic fluid stained by meconium• Lower Apgar’s score• Distress occurs soon after birth• Tachypnea and withdrawal at breathing

• Blood-gas ： PaO2 , PaCO2 and acidosis

CXR:HMD

CXR: pneumonia

CXR:MAS

CXR: MAS

Clinical management for neonatal respiratory distress

Monitoring

• General appearance ： T; response, skin color, feeding tolerance

• respiration （ frequency, pattern and apnea ）

• Other systems: HR, liver, abdomen

• Blood-gas, Pa O2 、SaO2

Clinical management for neonatal respiratory distress

Oxygen therapy• Nasal tube• Mask and tent • Pressed facial mask

Attention! fio2 O2 concentration ROP,CLD/BPD

Clinical management for neonatal respiratory distress

Mechanical ventilation• Target ： early intervention and early withd

raw• Indication ： persistent cyanosis under oxygen therapy

Remarkable SaO2 PaO2 and /or PaCO2 indicated by ABG

Clinical management for neonatal respiratory distress

Mechanical ventilation

• Ventilation modes and parameters

• Continuous positive airway pressure (CPAP) ： 4 - 8 cmH2O;

• Assistant/control (A/C) ： PIP 15-25 cmH2O ； RR 25-35 ； I/E ： 1 ： 1.5-2.5 ； PEEP ： 4 - 12 cmH2O

• Pressure support ventilation ( PSV ) ： 6-10 cmH2O

• High frequency oxillation ventilation: HFOV

Clinical management for neonatal respiratory distress

Medication• antibiotics

penicillin: 10-40 万 u/kg/d

ampicillin: 50-75mg /kg/d

cephalosporin: 25-50mg /kg/d

• PS: 80-120 mg /kg, 1 to 2 dose

Clinical management for neonatal respiratory distress

Keep the baby warm

• Incubator

• Radiator

• Stable room tempereture

Clinical management for neonatal respiratory distress

Clinical nutrition

• Feeding: Breast milk/Formulas

decreasing volume

feeding as needed

• Parenteral nutrition （ T/PPN ）

Thanks for listening

Questions please?