Respiratory distress Flashcards
Signs of respiratory distress in the newborn
- Central cyanosis
- Tachypnoea
- Subcostal/sternal recession
- expiratory grunting
- nasal flaring
why does expiratory grunting occur in resp. distress
keeps alveoli from collapsing entirely and occurs as vocal cords are partially closed
What are the 6 main causes of respiratory distress in the newborn
- respiratory distress syndrome
- congenital pneumonia
- transient tachypnoea (TTN)
- Meconium aspiration syndrome
- air leak (pneumothorax)
- Upper airway obstruction
aetiology of respiratory distress syndrome
surfactant deficiency and immaturity in the lungs, can also be a consequence of neonatal infection
What is surfactant
Produced by type 2 pneumocytes and coats alveoli to prevent collapse throughout inhalation and exhalation. The surfactant reduces surface tension in the alveolar air space so preventing collapse on exhalation and allows re-opening with a lower amount of force
Diagnosis of RDS
Pre-term infant with signs of increased work of breathing and CXR signs
CXR signs
homogenous lung fields and heart (gram-blast appearance) with air bronchograms
treatment of RDS
establish lung volume and nasal CPAP
exogenous surfactant therapy
what is congenital pneumonia associated with
PROM (>18-24h) and septicaemia with group B strep
Presentation of congenital pneumonia
delayed onset after birth (24-48h)
- may present with shock sepsis
- Patchy areas of consolidation bilaterally on CXR
Treatment of congenital pneumonia
prevent group B strep transmission with intrapartum abx esp. for high risk groups
- broad spectrum abx e.g. penicillin and co-amox
Incidence of TTN
1-2% of all newborns, usually in term infants
Why does TTN occur
due to delayed clearanc of lung fluid
presentation of TTN
c-section baby with onset of respiratory distress 1-3hours after birth
* any increased work of breathing in term infant*
CXR findings of TTN
coarse streaking and fluid in interlobar fissures ‘wet lung’
Mx of TTN
Treat infection if present and respiratory support (stop feeds, oxygen and nasal CPAP)
presentation of meconium aspiration
passage of meconium in utero
- fetal/neonatal gasping
- aspiration
- fetal hypoxia/distress
consequences of mec. aspiration
mechanical airway obstruction, chemical pneumonitis, surfactant inactivation
CXR findings in mec. aspiration
coarse streaking and patchy consolidation
- may have pneumothorax, pneumomediastinum or pneumonia
aetiology of air leak (pneumothorax)
- spontaneous
- complication of respiratory illness (RDS, mec aspiration, pneumonia)
- complication of treatment (PPV or CPAP)
diagnosis of pneumothorax
transillumination
or typical CXR changes (same as adult)
Tx of pneumothorax
use butterfly needle with syringe to drain air away and allow lung to re-inflate
causes of inspiratory stridor
- Laryngomalacia- epiglottis folds over and soft larynx
- mechanical obstruction; haemangioma, granuloma from trauma (ET suction), sub-glottic stenosis (ET tube)
- vocal cord palsy
