Respiratory distress of newborn

Respiratory distress of newborn

1. Respiratory distress of newborn Mrs.Jagadeeswari.J M.Sc (N )

2. definition Respiratory distress syndrome is defined as the persistence of arterial O2 tension <50 mmhg and central cyanosis in room air D.C.DUTTA

3. INCIDENCE It ranges from 75% at around 28 weeks to 52% at 30 weeks of gestation. Use of surfactant has significantly reduced the risk of neonatal death by >10 %

4. CLINICAL CAUSES PULMONARY Hyaline membrane disease Meconium aspiration Pulmonary hypoplasia Broncho pneumonia Airway obstruction

5. CLINICAL CAUSES CARDIOVASCULAR Congenital heart disease Heart failure Pulmonary hypertension

6. CLINICAL CAUSES NON-CARDIOPULMONARY Metabolic acidosis Hypo or hyperthermia Hypoglycemia Asphyxia Birth trauma Drugs Intracranial injury

7. PATHOPHYSIOLOGY Risk factors deficient surfactant production Unequal inflation of alveoli Increased efforts to keep unstable alveoli open Pulmonary vascular resistance increases Hypo perfusion of lungs

8. Hypo perfusion of lungs Right to left shunt Hypoxemia , hypercapnia ,acidosis Hyaline membrane formed Inhibition of gas exchange Decreased lung compliance Respiratory distress syndrome

9. CLINCAL MANIFESTATIONS (4-6 HOURS AFTER BIRTH) Tachycardia Tachypnea Chest retractions Fine crackles Expiratory grunting Nasal flaring Central cyanosis Ventilator failure Extremities puffy or swollen Apnea

10. Diagnostic evaluation 2 or more features if found at examination , more than an hour apart are enough to diagnose RDS Respiratory rate more than 60 breaths/min Nasal flaring Rib retraction Expiratory grunting Central cyanosis

11. Other investigations ABG analysis Shake test Chest x ray –ground glass motting due to extensive atelectasis Assessment of severity of RDS Downe’s score Silverman-Anderson score

12. SHAKE’S TEST It can be done on the gastric aspirate to determine lung maturity. Mix 0.5 ml of gastric aspirate with 0.5 ml of absolute alcohol in a test tube and shake for 15 sec. Formation of bubbles indicate adequate surfactant and less chance of RDS.

13. SLIVERMAN-ANDERSON SCORE

14. Preventive measures Betametehosone-12mg Q24H*2doses-lung maturity before 34 weeks Assessment of lung maturity before premature induction of labour Prevent fetal hypoxia in GDM mothers Avoid hypothermia in the neonate

15. COMPLICATIONS Metabolic disorders Patent ductus arteriosus Low blood pressure Chronic lung diseases Intra cranial haemorrage

16. Treatment principles To prevent hypoxia and acidosis Maintain fluid balance Prevent atelectasis and pulmonary edema Avoid lung injury and infection

17. treatment NICU admission Baby placed in incubator Clear the airway Adequate warmth and humidified oxygen therapy Correction of hypothermia Correction of anemia , electrolyte imbalance Prevention of infection Frequent monitoring of ABG

18. Cont.. Surfactant Prophylactic therapy Preterm infants <28 weeks are administered within 15-20 minutes of life Commercially available surfactant Survanta Curosurf Neosurf

19. Nursing care Providing effective ventilation Providing optimal environment temperature Adequate nutrition by parenteral nutrition Oxygen therapy Minimal handling Position facilitating open airway with head supported by small sheet Encourage bonding Skin care –frequent position change Psychological support to the family

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