approach to respiratory distress in newborn.pptx

approach to respiratory distress in newborn

1. APPROACH TO RESPIRATORY DISTRESS IN NEWBORN Presenter : ASYraf ifraheim

2. RESPIRATORY DISTRESS Term that often used to indicate signs and symptoms of abnormal respiratory pattern. It is a clinical impression Respiratory distress is tachypnoea (respiratory rate) > 60 bpm with intercostal and subcostal indrawing, sternal recession, nasal flaring and the use of accessory muscles. An arterial oxygen tension (Pao2 ) 50 mm Hg, or a requirement for supplemental oxygen to maintain a pulse oximeter saturation over 85%

3. RESPIRATORY DISTRESS Cause of significant morbidity and mortality Incidence 4 to 6% of live births Many are preventable Early recognition, timely referral, appropriate treatment esential

4. Causes of Respiratory Distress Pulmonary Cardiac - congenital heart disease Central nervous system - asphyxia, intracranial bleeding Metabolic - hypoglycemia, acidosis

5. Approach to Respiratory Distress Clinically significant in newborns who have signs of respiratory distress or increased work of breathing – tachypnea/rapid breathing, nasal flaring, chest retractions, grunting, cyanosis Onset of distress Progression – improving or deteriorating

6. History taking Prenatal U/S scan: polyhydramnios, or oligohydramnios Anomalies on ultrasound Maternal illness - GDM, PIH Predisposing factors - PROM, fever Maternal medication - antenatal steroids Meconium-stained amniotic fluid Gestational age – preterm/term/post term

7. Examination Severity of respiratory distress Tachypnea RR>60 Nasal flaring Abnormal chest wall movement Retractions at intercostal, subcostal and sternal Usage of assessory muscles Cyanosis Neurological status Blood pressure, CRT Cyanosis Features of sepsis Look for malformations

8. Chest Examination Air entry Mediastinal shift Adventitious sounds Hyperinflation Heart sounds

9. Grading of Distress Severity

10. Possible etiology

11. Investigation Bood investigation FBC CRP Blood C&S Blood gas analysis CXR

12. Management Clearing of airway, ensuring adequate breathing and circulationand continuous pulse oximeter monitoring. Warm, humidified oxygen is given with a head box, preferably with a FiO 2  meter and pulse oximeter monitoring to determine the amount of oxygen required. Maintenance of correct temperature is essential. HMD and PPHN are aggravated by hypothermia. Fluid and electrolyte management: Electrolyte balance, fluids, calcium and glucose homeostasis are all equally important. Fluids are usually started at a minimum of 60ml/kg/day of D10%

13. Management cont’d Maintenance of adequate haemoglobin : Any neonate with respiratory distress should have a packed cell volume (PCV) above 40% (but less than 75%). All preterm babies with respiratory distress should be started on broad spectrum antibiotics. In term babies, decision to start antibiotics would depend on the clinical situation, but the threshold should be low.

14. References Nelson Textbook of Paediatrics 21st Edition Management of Respiratory Distress in the Newborn, Med J Armed Forces India.  2007 Jul; 63(3): 269–272. National neonatology forum

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