Respiratory Distress Syndrome Among Neonates

rds amoung neonates

1. Case presentation DR. SARFARAZ WALI POST GRADUATE TRAINEE PAEDS MEDICINE GMCH SUKKUR Dr Imam Baksh M cps PGR peads GMMMC Sukkhur

2. HISTORY A new born baby preterm 31 weeks, 6 hours of life D/O Rab Nawaz , weight 1.4kg resident of Sukkur born via LSCS at private hospital , admitted through E.R with complaint of Difficulty in breathing + cyanosis since birth

3. HOPC A/C to statement of my patient’ father, baby was delivered via LSCS at private hospital. H/O of delayed cry at birth was present for that suctioning was done, oxygen inhalation with nasal prongs was given, baby cried after 5 minutes than sent to tertiary care hospital.

4. ANTE NATAL HISTORY 20 years old mother G2 P1+1 Pregnancy induced hypertension Pregnancy was planned Vaccination for tetanus not done Booked case , 4 antenatal visits, USG done 4 times in 4 th , 6 th , 7 th and 8 th months

5. NATAL HISTORY Gestational age: 31 week MOD: LSCS POD: Hospital COMPLICATIONS: Nil, no h/o prom, oligohydramnios or polyhydramnios

6. POST NATATL HISTORY CRY: Delayed cry HISTORY OF RESUSCITATION : Suctioning and oxygen inhalation with nasal prongs FEEDING: not started WEIGHT: 1.4kg

7. PAST OBSTETRIC HISTORY G2 P1+1 1 st baby: miscarriage at 8 th month of gestation due to HTN 2 nd baby: 6 hours old, preterm, delivered via LSCS at hospital

8. FAMILY HISTORY Consanguineous marriage Mother 20 years old, father 24 years old No history of neonatal death . No history of acute or chronic illness in family

9. SOCIOECONOMIC HISTORY Belongs to non affording family Father only source of income Parents uneducated Lives in village, home consist of 2 rooms, well ventilated, sanitation not satisfactory

10. EXAMINATION

11. GENERAL PHYSICAL EXAMINATION 6 hours old female baby lying in incubator having cannula on left hand, n.g placed in right nostril and having oxygen inhalation with nasal prongs at 1 l/min having following vitals VITALS: PULSE: 155/MIN R/R: 73/MN TEMP: 98.6 F BSR: 81 MG/DL ANTHROPOMETRIC MEASURES: FOC: 32 cm HT: 48cm WT: 1.4kgs

12. HEAD TO TOE EXAMINATION No dysmorphic features Fontanelles flat and opened No evidence of cephal hematoma, caput or craniotabes No bruise or edema of face Shape and size of nose normal, nostrils patent Ears placed normally on position No evidence of cleft lip and palate No congenital anomaly of upper and lower limbs No deformity of chest or abdomen, anal patent Female genitals, no evidence of ambiguous genitalia

13. SYSTEMIC EXAMINATION RESPIRATORY SYSTEM: ON INSPECTION: Respiration abdomino thorasic , chest indrawing, no any scar mark, bulging or veins visible, r/r was 72/min, tachypnic , substernal recessions were observed PALPATION AND PERCUSSION: Not significant ON AUSCULTATION: Normal vesicular breath, air entry equal b/l, b/l crackles audible.

14. ABDOMINAL & CVS EXAMINATION Abdominal shape was normal Umbilical cord normal No visible veins, mass observed Liver Spleen, kidney, bladder not palpable Bowel sounds audible Chest normal shaped, no bulging scar mark No pulsations observed Apex beat at 4 th intercoastal space No heave, thrill S1+ S2 audible No murmur

15. CNS EXAMINATION Tone normal Pupils BERL Fontanelles normal flat and opened SUKING: Weak MORO: Weak ROOTING: Weak

16. DIFFERENTIAL DIAGNOSIS

17. INVESTIGATIONS CBC HB 14 TLC 8500 NEUTROPHILS 38% LYMPHOCYTES 55% MONOCYTES 14% EOSINOPHILS 8% PLATELETS COUNT 110000 UREA ELECTROLYTES UREA 23MG/DL ELECTROLYTES NA 125 K 3.6 CL 93

18. CHEST X RAY

19. DIAGNOSIS RESPIRATORY DISTRESS SYNDROME

20. DEFINITION Also known as Hyaline Membrane Disease (HMD) Commonest cause of preterm neonatal mortality Defined as: It’s a clinical diagnosis in a preterm new born with Respiratory difficulty including tachypnea(>60 breaths/min) Chest retractions Cyanosis CXR film( ground glass appearance ,white washout)

21. RDS Primarily occurs in premature infants. Its incidence is inversely related to gestational age and birthweight Gestational age Percentages Less than 28 weeks 60%-80% 32 – 36 weeks 15%-30% 37%-39% 5% Term Rare

22. CAUSES Lung disorder due to aspiration Intrauterine pneumonia• Meconium aspiration• Milk aspiration Delay in clearance of lung liquid Transient tachypnea of newborn Disorder due to lung immaturity Idiopathic RDS (hyaline membrane disease) Bronchopulmonary dysplasia• Pulmonary hemorrhage Apneic attacks Air leaks like pneumothorax

23. RISK FACTORS

24. INCIDENCE

25. Incidence of RDS The risk of developing RDS increases with Maternal diabetes Multiple Births C section Perinatal Asphyxia Previous history

26. PATHOPHYSIOLOGY

27. SURFACTANT

28. CLINICAL PRESENTATION

29. DIAGNOSIS CHEST RADIOGRAPH : Grades of RDS

30. MANAGEMENT

31. Initial dose 2.5ml/kg/birth wt If needed 2 nd dose then give 1.5 ml/kg/birth wt. 2 nd dose repeat after 6-12 hrs There is no role of administering after 48 or maximum 72 hrs of life

32. Methods of surfactant Therapy IN - Sur- E technique (Intubate- surfactant- extubate ) LISA technique(less invasive surfactant technique) Nebulized surfactant therapy

33. COMPLICATIONS of SURFACTANT THERAPY:

34. COMPLICATIONS OF RDS:

35. Prevention with steriods Corticosteriods is recommended for all women in preterm labour (24 – 34 week gestation) who are likely to deliver fetus within 1 week Betamethasone 12 mg IM q 24 hours for 2 doses Repeated weekly doses pf betamethasone until 32 weeks Dexamethasone 6mg IM q 12 hour for 4 doses

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