Dr . Manahil Ghandour - PowerPoint Presentation

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Dr .

Manahil Ghandour

Respiratory Disorders In Neonates

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Respiratory Disorders In Neonates

ASPHYXIA NEONATORUMRespiratory Distress Syndrome

Transient tachypnea of the newborn

Meconium Aspiration

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ASPHYXIA NEONATORUM

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Asphyxia – Definition:

Inability of the newborn to establish spontaneous Breathing that result in the following biochemical changes:HypoxiaHyper capnia

Acidosis

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WHEN DO YOU ANTICIPATE ASPHYXIA?

High risk pregnancies (maternal, fetal, placental)Complicated labor.

C/S

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How Do You Assess Asphyxia?

2

1

0

SCORE

>100

< 100

Absent

H.Rate

Good Cry

Weak

Absent

R.Rate

N.colour

P.cyanosis

C.cyanosis

Colour

Cough or Sneeze

grimace

No response

Reflexes

Well flexed

Flexion of extremities

flaccid

Muscle Tone

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Hypoxic Ischemic Encephalopathy (HIE)

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( HIE )

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Grade I HIE:

- Alternating periods of lethargy and

irritability

, hyper-alertness and jitteriness.

- Poor feeding.

- Exaggerated and/or a spontaneous Moro reflex.

- Increased heart rate and dilated pupil.

- 

No seizure activity

.

- Symptoms resolved in 24 hours.

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Grade II HIE:

- Lethargy.

- Poor feeding, depressed gag reflex.

- 

Hypotonia

.

- Low heart rate and papillary constriction.

- 50-70% of infants display

seizures

, usually in the first 24 hours after birth.

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Grade III HIE:

- Coma

.

- Flaccidity.

-

 Absent reflexes

.

- Pupils fixed, slightly reactive.

- 

Apnea

,

bradycardia

, hypotension.

-

Seizures are uncommon

.

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Management of Hypoxic Ischemic Encephalopathy:

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Management of Hypoxic Ischemic Encephalopathy:

-

Prevention is the best management.

-

Primary supportive measures.

- Treat seizures.

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Respiratory Distress Syndrome

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RDS

Respiratory distress syndrome (RDS) is the predominant clinical problem encountered in neonatal units. Incidence increases with lower gestational age. It is common in infants of less than 30 weeks gestation 

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RDS

RDS is caused by defective or delayed production of surfactant in structurally immature lungs. Surfactant (a mixture of phospholipids) is secreted into the pulmonary alveoli, reducing the surface tension of lung fluids, and thus contributing to the elasticity of pulmonary tissue , adequate lung expansion and to prevent atelectasis (lung collapse)

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C/F Of RDS

The signs and symptoms of neonatal RDS are Tachypnoea (respiratory rate >60/minute); Nasal flaring Sternal and intercostal

recession

Central cyanosis;

 

Apnoea

;

Expiratory grunt

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Diagnosis

   Diagnosis is by history, blood gases showing impaired respiratory functionX-ray demonstrating the classic reticulogranular or ‘ground glass’ appearance and air

bronchograms

(radiolucent air-filled airways).

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Prevention

prevent preterm delivery Steroids accelerate maturation of foetal lungs by stimulating type II pneumocytes to produce surfactant

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Treatment

Surfactant

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Complications and sequelae

pneumothorax, pulmonary interstitial emphysema, persistent pulmonary hypertension, necrotizing enterocolitis, intraventricular haemorrhage,patent ductus arteriosis

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Transient tachypnea of the newborn (TTN)

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(TTN)

(TTN) is a self-limited disease common in newborn. present within the first few hours of life withtachypnea, increased oxygen requirement, and ABGs that do not reflect carbon dioxide retention..

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(TTN)

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Meconium Aspiration

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(MAS)

Meconium aspiration syndrome (MAS) occurs when a neonate inhales thick meconium. This is usually secondary to fetal hypoxia which causes increased peristalsis, relaxation of anal sphincters and reflex gasping.

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(MAS)

Most meconium deliveries involve some meconium staining of the liquor but the babies are vigorous, needing no further intervention.

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Significant aspiration of thick meconium, however, can induce 4 major pulmonary effects,

viz: Airway obstruction,

Surfactant

dysfunction,

Chemical

pneumonitis

and

Pulmonary hypertension

.

In the majority of cases, these changes begin to resolve after the first six hours of life, with consequent improvement in lung function.

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Presentation of MAS

Obvious presence of meconium or dark green staining of the amniotic fluid.Green or blue staining of the skin at birth.Baby appears limp, with a low Apgar

score.

Breathing is rapid, or absent.

Signs of

postmaturity

(

eg

peeling skin) are present.

Fetal monitor may show

bradycardia

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Investigations

Blood gas analysis showing low blood pH, increased pCO2, decreased pO2.A full blood count may be useful in excluding infectionChest X-ray shows patchy infiltrates, coarse streaking of both lungs, increased AP diameter and flattening of the diaphragm (due to hyperinflation).

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Management

Suction - does not recommend routinely. However If the baby has depressed vital signs, laryngoscopy and suction under direct vision.Oxygen - depending on the degree of respiratory distress,

Antibiotics - these may be useful in ventilated baby.

Steroids - inhaled or systemic

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Complications and prognosis

In mild cases, respiratory distress usually subsides in 2-4 days, although tachypnoea can persist for longer. Rarely, more prolonged respiratory damage can occur Cerebral hypoxia may lead to long-term neurological damage.

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Prevention

More frequent diagnosis of abnormal fetal heart rate patterns Avoidance of post-mature delivery by elective Caesarean section have both been shown to reduce the incidence of meconium aspiration syndrome (MAS).

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