Neonatal Respiratory Distress

Anatomy Of The Respiratory System

 Development Of The Lung

:The pseudoglandular stage:(3-4 m)*1

the conducting airways are being formed-
Tall columnar epithelium cells grow inside-
these airways and form a lining
-Tubular branching continues to develop
throughout this stage
-As early as two months into the
pseudoglandular stage, all of the bronchi
.segments are present
 ……Cont
:The canalicular stage:( 16-24 w)*2
 Layers of epithelium linings grow-
The capillaries form-
.surrounding lung muscles begin to take shape -
bronchioles begin to grow inside the bronchi segments-
bronchioles  contain sacs that will later become the-
.lungs' alveoli
 … Cont
:The saccular stage(24 w-birth)*3
Airway development begins to spread out and form airspaces, -
or saccules
-The bronchiole formations that appeared in the previous
stage begin to grown into alveoli
A fourth developmental stage, called the alveolar period,
occurs after the fetus is born and will continue into the
.fourth year of childhood
 Respiratory Assessment Of Infant

A-Medical History
A Pgar score in 1 minute and 5 minute -1
Gestational age and weight -2
Discussion with medical stuff to have information -3
about
a- stability of condition over last few an hours
b- handling tolerance does infant become rapidly
hypoxia or bradycardia
 .…Cont

c- Feeding when was last feed .?

route of feeding (oral –IV)
d- If infant rested from last session
 ..…Cont
B- Observation
subcostal,intercostal or sternal -1
retraction
nasal flaring -2
grunting -3
movement of the chest -4
colour of baby-5
 Neonatal respiratory Distress
:pulmonary causes-1
A-respiratory distress syndrome
B- Transient Tachypnea
C-aspiration
pneumonia(meconium,secretion or
milk)
 .…Cont
D- Massive pulmonary hemorrhage
E- Congenital lobar emphysema
F- Wilson Mikity syndrome
 .…Cont
:extrapulmonary causes -2
A- Cerebral irritation : asphyxia
B-Hypothermia or hyperthermia
C- Congenital heart disease . myocarditis
D- Persistent fetal circulation : patent ductus
arteriosus and foramen oval RT. To LT shunt
heart hypertension heart failure
 ..…Cont
E- Diaphragmatic hernia : may history of
hydromnios
F- Upper air way obstruction e.g. atresia
G- chest wall disorder : Thoracic dystrophy
Myasthenia gravis
H- Tracheo esophageal fistula
Physiotherapy Techniques

The treatment should be performed -

1 hour after feeding or prior it to

. avoid aspiration of stomach content
:chest percussion *1
Clapping by using 3 fingers or face
mask
.…Cont
:vibration*2
It is useful when infant’s respiratory rate
slow enough to allow time to vibrate
effectively throughout the expiratory
.rate
percussion and vibration can be used *
with baby,both spontaneously breathing
and when intuated
 .…Cont
Precautions for chest percussion and
vibratory
Techniques:
1-liver diseases
2-preterm may develop rickets
3- Preterm with thin skin easily bruised and
damage lead to infection
4- Bronchospasm
 .…Cont
:postural drainage-3
Apical bronchus of upper lobe is commonly
affected in baby
So sitting upright is very effective for these baby
A head-down tip should be avoided in: * •
-children with raised intracranial pressure
Infants with abdominal distension which can -
produce reflux
.…Cont
 ..…Cont
:Breathing exercise*5
Crying is very effective for lung expansion

:Coughing*6
In 18 months of age child can do active cough*
* children of less than 18 months of age, tracheal
compression can be used to stimulate a cough
 ..…Cont

**This technique must be used with care and

only in experienced hands as the infant can
become bradycardic If there is no effective
cough.

7*Airway suction:
Nasopharyngeal suction is often required during
the treatmant to reduce secretion and hypoxia
 …Cont

Done this technique with care to avoid any trauma -

.to the mucus membrane

This technique done with extension of neck-

Done by clear hands (gloves) and object to avoid-

infection

Diameter of Cathlear not more than 50% of air way -

diameter