Neonatal Respiratory distress

Question 1

Definition of neonatal respiratory distress

Answer 1

The presence of >2 of these symptoms for >4hours suggests respiratory distress

i. Tachypnea RR >60BPM
ii. Cyanosis or hypoxia
iii. Expiratory grunt
iv. WOB with chest retraction/recession
v. Nasal flare

Question 2

Causes

Answer 2

a. Congenital
i. CCAM
ii. CLE
iii. Diaphragmatic hernia
iv. Diaphragmatic eventration
v. Bronchogenic cyst
vi. Bronchopulmonary sequestration
b. Pulmonary
i. TTN (due to retained fetal lung fluid)
ii. RDS (due to surfactant deficiency) + BPD
iii. Pneumonia
iv. Pneumothorax, pneumomediastinum, pulmonary interstitial emphysema
v. Meconium aspiration
vi. Pulmonary hypoplasia (E.g. part of Potter’s sequence with oligohydramnios)
c. ENT
i. Choanal atresia
ii. Pierre Robin
iii. TOF
d. Cardiac = congenital cardiac disease, PPHTN
e. CNS = birth asphyxia
f. Other = Haematological (anaemia, polycythemia), sepsis, metabolic disease

Question 3

History and examination features

Answer 3

a. History = gestational age, poly/oligohydramnios, antenatal US, RF sepsis, passage of meconium, APGARS/resus
b. Examination = cardiorespiratory
i. Chest transillumination if suspect pneumothorax
ii. Passage of nasogastric catheters if choanal atresia or TOF suspected
iii. Hyperoxia test if cardiac cause suspected
c. CXR + FBE, UEC, CRP, blood cultures +/- full septic screen

Question 4

Management

Answer 4

a. Monitoring – oximetry, HR, temperature, consider pO2/CO2 monitoring with arterial line
b. Fluid balance and IVF (10% dextrose)
c. Oxygen = NP humidified, CPAP, mechanical ventilation
d. Goals
i. Oxygen saturations
1. Term – 92-95%
2. Preterm 33-36/40 – 88-92%
3. Preterm <32/40 / <1500g – 85-90%
ii. PaO2
1. Term – 60-90mmHg
2. Preterm – 60-75mmHg

Question 5

Indications for mechanical ventilation

Answer 5

i. Apnea of increasing severity
ii. FiO2 >0.6 to maintain pO2 >60mmHg
iii. Rising pCO2 >60mmHg particularly if there is falling pH