Neonatal Respiratory Distress

Question 1

Presenting features of respiratory distress

Answer 1

• tachypnoea (> 60/min)
• laboured breathing
  
  • sternal recession
  • subcostal recession
  • nasal flaring
• expiratory grunting
• cyanosis (severe)

Question 2

Treatment for common causes of respiratory distress

Answer 2

• Basic management
  
  • ​neonatal hospital admission
  • CXR
  • ambient oxygen
  • mechanical ventilation
  • circulatory support
• Transient tachypnoea of newborn
  
  • ​CXR- fluid in horizontal fissure
  • ambient O2
  • usually settles within first few days of life
• Meconium aspirate
  
  • ​artificial ventilation
• Pneumonia​
  
  • broad spectrum ABx
• Pneumothorax
  
  • ​chest drain (tension pneumothorax)
  • ventilation at lowest pressures
  • adequate chest movements and blood gases
• Milk aspiration​
• Persistent pulmonary HTN
  
  • ​mechancal ventilation- HF/OV often helpful
  • circulatory support- extracorporeal membrane oxygenation
  • NO inhaled
• Diaphragmatic hernia
  
  • ​vigorous resuscitation risk of pneumothorax in normal lung
  • NG tube- suction to prevent distention of intrathoracic bowel
  • repaired surgically

Question 3

Risk factors for respiratory distress

Answer 3

• C-section -TTN
• High gestational age - MA
• Prolonged ROM, chorioamnionitis, LBW- pneumonia
• Cleft palate/ preterm- milk aspiration

Question 4

Causes of respiratory distress

Answer 4

• Transient tachypnoea of the newborn
  
  • ​commonest cause of RDS
  • delay in resorption of lung liquid
• Meconium aspirate
  
  • ​8-20% babies
  • higher risk with increasing gestational age
  • rarely passed by prematures
  • asphyxiated (by thick meconium) –> gasping, apirate memconium before delivery)
  • mechanical obstruction and chemical pneumonitis
  • predisposes to infection
  • CXR- hyperinflation, consolidation/ collapse
  • High risk of air leak- pnemmothorax/ pneumomediastinum
• Pneumonia
  
  • ​RFs: prolonged ROM, chorioamnionitis, LBW
  • Infection investigation
• Pneumothorax
  
  • ​occurs spontaneously in 2% births
  • or 2” to meconium aspiration, RDS, complicaton of ventilation
• Pesistent pulmonary HTN of newborn
  
  • ​associated w/ asphyxia, meconium aspiration, septicaemia, RDS
  • can be primary disorder
  • high pulmonary vascular resistance
  • right to left shunt in lungs/ atrial/ ductal levels
  • cyanosis shortly after birth
• Milk aspiration
  
  • ​preterm infants, RDS, neurological damage
  • bronchopulmonary dysplasia/ GORD- predisposes to aspiration
  • cleft palate
• Diaphragmatic hernia​
• Other
  
  • tracheo-oesophageal fistula
  • pulmonary hypoplasia
  • airway obstruction (choanal atresia)
  • pulmonary haemorrhage
  • CHD
  • intracranial birth trauma/ encephalopathy
  • severe anaemia
  • metabolic acidosis