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Newborn
Down score
Etiologies
Systemic
Pulmonary
Metabolic (e.g.,
hypoglycemia, hypothermia
or hyperthermia)
Transient
tachypnea of the
newborn (TTN)
metabolic acidosis
Respiratory
distress
syndrome (RDS)
Pneumonia
Meconium
aspiration
syndrome (MAS)
Air leak
syndromes
Pulmonary
hemorrhage
anemia, polycythemia
Cardiac
Congenital heart disease;
cyanotic or acyanotic
Congestive heart failure
Persistent pulmonary
hypertension of the newborn
(PPHN)
Neurological (e.g., prenatal
asphyxia, meningitis)
Anatomic
Upper airway
obstruction
Airway
malformation
Rib cage
anomalies
Diaphragmatic
disorders
(e.g., congenital
diaphragmatic
hernia,
diaphragmatic
paralysis)
Pulmonary
1- Transient tachypnea of newborn
2- Hyaline membrane disease
3- Meconium aspiration syndrome
(MAS)
4- Pneumonia
5- Air Leak Syndromes
Transient Tachypnea of
Newborn
TTN (known as wet lung) is a relatively
Transient Tachypnea of
Newborn
Risk factors:
Maternal asthma
C- section
Macrosomia, maternal diabetes
Prolonged labor, Excessive maternal sedation
Fluid overload to the mother,Delayed
Transient Tachypnea of
Newborn
Usually near-term or term
Transient Tachypnea of
Newborn
Chest x-ray :
diaphragm
Fluid in
the
fissure
General Management of
Respiratory Distress
Supplemental oxygen or MV, if needed.
Continuously monitor with pulse oximeter.
Obtain a chest radiograph.
Correct metabolic abnormalities
(acidosis,hypoglycemia).
Obtain a blood culture & begin an
General Management
Provide an adequate nutrion. Infants with
Pulmonary
1- Transient tachypnea of newborn
2- Hyaline membrane disease
3- Meconium aspiration syndrome
(MAS)
4- Pneumonia
5- Air Leak Syndromes
Physiologic abnormalities
Surfactant deficiency- increase in
of normal
Surfactant Function
Normal Expiration
With Surfactant
Abnormal Respiration
Without Surfactant
Compliance
Maximalvolume
Volume
Pressure
Openingpressures
17
Risk factors
Prematurity
Maternal diabetes
Multiple births
Elective cesarean section
without labor
Perinatal asphyxia
Cold stress
Genetic disorders
Decreased risk
Chronic intrauterine stress
Prolonged rupture of
membranes
Antenatal steroid prophylaxis
Clinical Manifestations
Appear within minutes of birth may not be recognized for
may be heard
Progressive worsening of cyanosis & dyspnea. BP may fall;
Chest x-ray:
Findings can be graded according to the severity:
become visible
Grade 1
Grade 2
Grade 3
Grade 4
Management
Prevention:
Lung maturity testing: lecithin/sphingomyelin (L/S) ratio
Tocolytics to inhibit premature labor.
Antenatal corticosteroid therapy:
Prevention
Antenatal corticosteroid therapy consists of either :
Betamethasone 12 mg/dose IM for 2 doses, 24 hrs apart, or
Dexamethasone 6 mg/dose IM for 4 doses, 12 hrs apart
room.
Treatment
Administer oxygen
Initiate CPAP as early as possible in infants
Types of Surfactant
Natural Surfactants: contain appoproteins SPB & SP-C
Curosurf (extract of pig lung mince)
Survanta (extract of cow lung mince)
Infasurf (extract of calf lung)
Mode of administration of
Surfactant
Dosing may
be divided
into 2
alliquots and
adminitered
via a 5-Fr
catheter
passed in
the ET
Insure technique
Intubation surfactant extubation to CPAP
Pulmonary
1- Transient tachypnea of newborn
2- Hyaline membrane disease
3- Meconium aspiration syndrome
(MAS)
4- Pneumonia
5- Air Leak Syndromes
Meconium Aspiration
Syndrome
Risk Factors:
Post-term pregnancy
Pre-eclampsia, eclampsia, maternal
hypertension,
Maternal diabetes mellitus
IUGR
Evidences of fetal distress (e.g.,abnormal
biophysical profile)
Clinical Manifestations
Meconium staining amniotic fluid (meconium
oliguria)
Pathophysiology
Management
In the DR or OR:
Visualization of the vocal cords & tracheal
In the NICU:
Empty stomach contents to avoid further aspiration.
Suction frequently & perform chest physiotherapy.
Management
Consider CPAP, if FiO2 requirements >0.4; however
myocardial dysfunction).
continue todeteriorate.
Pulmonary
1- Transient tachypnea of newborn
2- Hyaline membrane disease
3- Meconium aspiration syndrome
(MAS)
4- Pneumonia
5- Air Leak Syndromes
Pneumonia
Common organisms:
GBS
gramve organisms (e.g. E.Coli,
Klebsiella,Pseudomonas)
, Staph. aureus, Staph. epidermidis
Candida.
acquired viral infections (e.g., HSV,
CMV).
Clinical Manifestations
Early manifestations may be nonspecific (e.g., poor
44
Management
Initiate ampicillin and
Pulmonary
1- Transient tachypnea of newborn
2- Hyaline membrane disease
3- Meconium aspiration syndrome
(MAS)
4- Pneumonia
5- Air Leak Syndromes
Clinical Manifestations
Spontaneous pneumothorax may be
Tension pneumothorax
(a life-
threatening
condition)
cardiac
output and
obstructive
shock; urgent
drainage
prior to a
radiograph is
mandatory.
Others
Pneumomediastinum
It can occur with aggressive ETT insertion, Ryle's
feeding tube
insertion, lung disease, MV, or chest surgery (e.g.,
TEF).
Pneumopericardium
Pneumoperitoneum
Subcutaneous emphysema
Systemic air embolism
Massive Pneumoperitoneum in MV
neonate
Severe bilateral PIE affecting the right more than the left lung;
there is gross cardiac compression. A chest drain is in situin
the right hemithorax.
Management
Conservative therapy: close observation of the
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