Respiratory distress is a symptom complex

•Tachypnea

•Grunting

•Retractions

•cynosis
 causes of for neonatal respiratory distress

Causes affecting respiration at alveolar level: HMD,

Pneumonia, Meconium Aspiration Syndrome, Pneumothorax,
pulmonary hemorrhage, PPHN, TTN

 Structural anomalies of respiratory tract: Choanal Atresia,

Tracheo-esophageal fistula, Congenital Diaphragmatic hernia,
Congenital Lobar Emphysema

Extrapulmonary causes:.Bone defects of the chest wall,

Congenital heart disease, Metabolic acidosis
 DOWNE’s SCORING
  0   1  2
 Cyanosis  None  In room air  In 40% FIO2

 Retractions None  Mild  Severe

 Audible with  Audible without

 Grunting  None
stethoscope stethoscope

 Air entry Clear  Decreased or delayed  Barely audible

 Respiratory
 Under 60   60-80  Over 80 or apnea
rate

 Score: 
> 4 = Clinical respiratory distress; monitor arterial blood gases
> 8 = Impending respiratory failure
Silvermann’s Scoring system
Neonatal respiratory distress syndrome (RDS) is a
condition of increasing respiratory distress,
commencing at, or shortly after, birth and increasing in
severity until progressive resolution occurs among the
survivors, usually between the 2nd to 4th day

Incidence and severity is inversely proportional to gestational age

50% of the neonates born at 26-28 weeks of gestation

<30% of premature neonates born at 30-31 weeks
 CONTRIBUTING FACTORS

•Neonates younger than 33-38 weeks

•Weight less than 2500g
•Maternal diabetes
•Cesarean delivery without preceding labor
•Precipitous labor
•Fetal asphyxia
•Second of twins
•Cold stress
•Previous history of RDS in sibling
•Males
•whites
 DECREASED RISK

•Use of antenatal steroids

•Pregnancy-induced or chronic maternal hypertension

•Prolonged rupture of membranes

•Maternal narcotic addiction

•Chronic intrautrine stress

•IUGR or SGA

•Thyroid hormones

•Tocolytic agents
EITIOLOGY
 PATHOPHYSIOLOGY
Pulmonary Surfactant decreases surface
tension
Structure of lung surfactant
Pulmonary surfactant deficiency
Inflammation and respiratory epithelial injury
Decrease fluid absorption and lung edema
Accumulation of neutrophils in the lung
Atelectasis causes lung inflammation
 PRENATAL assessment of FLM

Lecithin –sphingomyelin ratio

Surfactant albumin ratio

Lamellar body counts

 DIAGNOSIS

Is a Clinical diagnosis
 Tachypnea
 Hypoxia
 Cyanosis
 Expiratory grunting (from partial
closure of glottis)
 Subcostal and intercostal
retractions
 Nasal flaring
 apnea
 hypothermia
Chest radiograph

Blood gases

 Pulse Oximetry

 Full blood count

 Electrolytes, glucose, renal and liver function

 Echocardiogram: diagnosing PDA, determine

the direction and degree of shunting, making
the diagnosis of pulmonary hypertension and
excluding structural heart disease

 Cultures to rule out sepsis

Pulmonary Function
Compliance decrease
Functional residual capacity is reduced
Hypoxemia secondary to mismatch of
ventilation,
PDA and foramen ovale plays rule in
hypoxemia
due to R-L shunting
Alveolar ventilation is decreased
Minute ventilation is increased
 Treatment of RDS

Oxygen

 Surfactant

CPAP

Mechanical ventilation
Oxygen :

Spo2 88-95% /85-92%

Warmed, humidified
 SURFACTANT

Natural
Bovine (Survanta®, Infasurf®, Alveofact®)
Porcine (Curosurf®)

Synthetic
Without proteins (Exosurf®)
With proteins (KL4®, Venticute®)
Surfactant Laboratory Container Concentration Recommended dose

Curosurf Farmalab-Chiesi 1.5 & 3 ml 80 mg/ml 100 to 200 mg/kg

Survanta Abbott 4ml & 8 ml 25 mg/ml 100 mg/kg

Alveofact Boeringer 1.2 ml 40 mg/ml 100 mg/kg

Exosurf Wellcome 13.5 mg/ml(DPPC) 5 ml/kg

 Timing

 Administration

 complications
 CPAP
WHEN

HOW
 Adequacy –
comfortable
 absence of
grunt,retractions,cynosis
 CRT<3secs
 spo2-90-93%

COMPLICATIONS

WEANING
 MECHANICAL VENTILATION

Indications - severe apnea

pH< 7.25
pco2>55
po2 <50 with fio2>50
shock
Mode –SIMV
Fio2-0.5/PEEP-4-6/PIP-20-25/ti-0.2

Maintainence and detoriation

Weaning PIP
Fio2
PEEP
Rates
(rr-20/fio2-.3/pip-18)
 Supportive treatment

 Temperature regulation

 Fluids, metabolism, and nutrition

Circulation and anemia

Antibiotics: start antibiotics in all infants who

present with
respiratory distress at birth after obtaining blood
cultures.

Support of parents and family

 Prevention of RDS

Delaying premature birth. Tocolytics

ANTENATAL steroids

 Good control of maternal diabetes

Prophylactic surfactant therapy

 Avoid hypothermia in the neonate

COMLICATIONS
 Transient Tachypnea of the Newborn

Results from slow absorption of

lung fluid

Term born by LSCS/IDM /maternal

asthma

Mild respiratory distress

Peaks at about 36 hours of life

Resolve spontaneously
 CONGENITAL PNEUMONIA
Pneumonia & Sepsis have various manifestations
including typical signs of distress as well as
temperature instability

Common pathogen- Group B Streptococcus,

Staph aureus, Streptococcus aureus,
Streptococcus Pneumoniae,Gm neg rods

Risk factors- prolonged rupture of membranes,

prematurity,& maternal fever

CXR- bilateral infiltrates suggesting in utero

infection.
 MECONIUM ASPIRATION SYNDROME

 Incidence- 1.5- 2 % in term or post

term infants.
 Meconium is locally irritative,
obstructive & medium for for
bacterial culture
 Meconium aspiration causes
significant respiratory distress.
Hypoxia occurs because aspiration
occurs in utero.
 CXR- Patchy atelectasis or
consolidation.
 Apnea of prematurity

> 50% of infants <1500g require

intervention for apnea
Treatments
• Stimulation
• CPAP
• Intubation
• Medication:
Caffeine
Methylxanthines
Theophylline
Doxapram
• Oxygen
 pneumothorax

Spontaneous -1-2%

MAS ,hypoplastic
lung,aggressive
resuscitation,CPAP,ventilation

Tension pneumothorax-
immidiate drainage