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    Respiratory Distress in The Newborn

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    Ferawati
    This document discusses respiratory distress in newborns. It covers the epidemiology, risk factors, signs, pathogenesis, and differential diagnosis of various conditions that can cause respiratory distress. These include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, the summary discusses risk factors, presentation, findings on chest x-ray, management considerations, and potential complications.

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    Respiratory Distress in The Newborn

    Uploaded by

    Ferawati
    34 views6 pages
    This document discusses respiratory distress in newborns. It covers the epidemiology, risk factors, signs, pathogenesis, and differential diagnosis of various conditions that can cause respiratory distress. These include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, the summary discusses risk factors, presentation, findings on chest x-ray, management considerations, and potential complications.

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    Respiratory Distress in the Newborn

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    This document discusses respiratory distress in newborns. It covers the epidemiology, risk factors, signs, pathogenesis, and differential diagnosis of various conditions that can cause respiratory distress. These include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, the summary discusses risk factors, presentation, findings on chest x-ray, management considerations, and potential complications.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views6 pages

    Respiratory Distress in The Newborn

    Uploaded by

    Ferawati
    This document discusses respiratory distress in newborns. It covers the epidemiology, risk factors, signs, pathogenesis, and differential diagnosis of various conditions that can cause respiratory distress. These include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome, and meconium aspiration syndrome. For each condition, the summary discusses risk factors, presentation, findings on chest x-ray, management considerations, and potential complications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 6

    Respiratory Distress in the Newborn

    RESPIRATORY DISTRESS IN THE NEWBORN 1

    EPIDEMIOLOGY 1
    RISK FACTORS FOR RESPIRATORY DISTRESS 2
    SIGNS OF RESPIRATORY DISTRESS 2
    PATHOGENESIS 2
    O EARLY GESTATION 2
    O LATE GESTATION 2
    O POST-NATAL 2
    DIFFERENTIAL DIAGNOSIS OF RESPIRATORY DISTRESS 3
    AIRWAY CAUSES 3
    PULMONARY CAUSES 3
    CARDIOVASCULAR CAUSES 3
    THORACIC CAUSES 3
    NEUROMUSCULAR CAUSES 3
    MISCELLANEOUS 3
    TRANSIENT TACHYPNEA OF THE NEWBORN 3
    O RISK FACTORS 3
    O PRESENTATION 3
    O CXR 4
    O MANAGEMENT 4
    NEONATAL PNEUMONIA 4
    O RISK FACTORS 4
    O PRESENTATION 4
    O CXR 4
    O MANAGEMENT 4
    O COMPLICATION 4
    RESPIRATORY DISTRESS SYNDROME 5
    O RISK FACTORS 5
    O PRESENTATION 5
    O MANAGEMENT 5
    MECONIUM ASPIRATION SYNDROME 5
    O RISK FACTORS 5
    O MANAGEMENT 6
    O COMPLICATION 6

    Epidemiology
    o 15% in term infants
    o 29% in late preterm

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review
    Risk Factors for Respiratory Distress
    o Prematurity
    o Meconium-stained amniotic fluid
    o C/S Delivery
    o Gestational Diabetes
    o Maternal Chorioamnionitis
    o Prenatal ultrasonographic findings: oligohydramnios or structural lung abnormalities

    Signs of Respiratory Distress: one or more signs of increased work of breathing


    Tachypnea o Respiratory rate of more than 60
    o Compensatory mechanism: hypercarbia, hypoxemia, or acidosis
    Nasal Flaring o Increases upper airway diameter
    o Reduces resistance and work of breathing
    Chest Retractions o Shown by using accessory muscles
    o Occur when lung compliance is poor, or airway resistance is high
    Noisy Breathing Stertor ▪ Snoring
    ▪ Indicates: nasopharyngeal obstruction

    Stridor ▪ High-pitched, monophonic


    ▪ Indicates: obstruction at the larynx, glottis, or subglottic area

    Wheezing ▪ High-pitched, polyphonic


    ▪ Indicates: tracheobronchial (lower airway) obstruction

    Grunting ▪ Low- or mid-pitched


    ▪ Expiratory sound cause by sudden close of the glottis
    ▪ Compensatory symptom for poor pulmonary compliance

    Pathogenesis
    o The type of disease depends on the stage of development it occurred at & if it is pre or post-
    natal
    o Early Gestation (0 to 16 weeks):
    ▪ Tracheoesophageal Fistula
    ▪ Bronchopulmonary sequestration: abnormal mass of pulmonary tissue not connected to
    the tracheobronchial tree
    ▪ Bronchogenic cysts: abnormal branching of the tracheobronchial tree
    o Late Gestation (17 to 36 weeks): parenchymal lung malformations
    ▪ Congenital cystic adenomatoid malformation
    ▪ Pulmonary hypoplasia from congenital diaphragmatic hernia or severe oligohydramnios,
    o Post-Natal:
    ▪ Transient Tachypnea of the Newborn (TTN)
    ▪ Respiratory Distress Syndrome (RDS)
    ▪ Neonatal Pneumonia
    ▪ Meconium Aspiration Syndrome (MAS)

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review
    ▪ Persistent pulmonary hypertension of the newborn

    Differential Diagnosis of Respiratory Distress


    Airway Causes Pulmonary Causes Cardiovascular Causes
    Nasal Obstruction RDS Congenital Heart Disease
    Choanal Atresia TTN Neonatal Cardiomyopathy
    Micrognathia MAS Cardiac Tamponade
    Congenital Airway Obstruction Syndrome Neonatal Pneumonia Pericardial Effusion
    Pulmonary Hypoplasia Fetal Arrythmia
    Surfactant Protein Deficiency High Output Cardiac Failure
    Pulmonary Hemorrhage

    Thoracic Causes Neuromuscular Causes Miscellaneous


    Pneumomediastinum CNS Injury Sepsis
    Chest Wall Deformities Cerebral Malformations Hypoglycemia
    Skeletal Dysplasia Congenital TORCH Infections Metabolic acidosis
    Diaphragmatic Hernia or Paralysis Hydrocephalus Hypothermia or hyperthermia
    Seizures Hydrops fetalis
    Neonatal Myasthenia Gravis Inborn error of metabolism
    Hypermagnesemia
    Hyponatremia or hypernatremia
    Severe Hemolytic Disease
    Anemia
    Polycythemia

    Transient Tachypnea of the Newborn


    o TTN is a benign self-limited respiratory distress syndrome of term and late preterm infants
    related to delayed clearance of lung liquid
    o Risk Factors:
    ▪ C-Section
    ▪ Late preterm or early term
    ▪ Maternal sedation or medication
    ▪ Fetal distress
    ▪ Gestational Diabetes
    o Presentation: tachypnea and increased work of breathing

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review
    o Persists for 24 - 72 hours
    o CXR:
    ▪ excess diffuse parenchymal
    infiltrates due to fluid in the
    interstitial
    ▪ Fluid in the inter-lobar fissure,
    ▪ ± Pleural effusions

    o Management: Supportive
    ▪ Supplement oxygen ± CPAP
    ▪ Blood Gas: mild respiratory acidosis & hypoxemia
    o Self-limiting course of disease

    Neonatal Pneumonia
    o MC form: Perinatal pneumonia
    ▪ Acquired at birth
    o MC Organism: Group B Streptococcus
    o Risk Factors:
    ▪ Prolonged Rupture of Membranes (PROM)
    ▪ Chorioamnionitis / Maternal Infection
    ▪ Prematurity
    o Presentation: increased work of breathing + oxygen requirement
    o CXR:
    ▪ Diffuse parenchymal infiltrates with
    air bronchograms
    ▪ Lobar consolidation

    o Management: Ampicillin + Aminoglycoside


    ▪ ± Vancomycin (if the pt has been in the NICU for longer than 4 days)
    ▪ Supportive management as needed
    o Complication: PPHN

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review
    Respiratory Distress Syndrome
    o Hyaline Membrane disease
    o Cause: a deficiency of alveolar surfactant, which increases surface tension in alveoli, resulting in
    micro-atelectasis and low lung volumes
    ▪ Excess lung fluid due to epithelial injury results in pulmonary edema
    o Risk Factors:
    ▪ Prematurity
    ▪ Gestational Diabetes
    ▪ Male Infant
    ▪ Multiple Gestation
    o CXR: diffuse granular infiltrates

    o Presentation: tachypnea, nasal flaring, grunting + retractions


    ▪Cyanosis requiring supplemental oxygen
    o Management:
    ▪ Prevention: Antenatal Corticosteroids
    ▪ Respiratory Support: CPAP, HFNC or Intubation
    ▪ Severe cases → intubation + administration of surfactant into the lungs
    ▪ There is no universal guideline for surfactant administration

    Meconium Aspiration Syndrome


    o Occurs when the fetus passes meconium before birth (4-5%)
    o Risk Factors:
    ▪ Post-term Gestation
    ▪ Fetal Distress
    ▪ African American Ethnicity
    o Meconium causes inflammation & epithelial injury
    ▪ Results in ventilation-perfusion mismatch

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review
    o CXR:
    ▪ streaky with diffuse
    parenchymal infiltrates
    ▪ hyperinflated with patchy areas
    of atelectasis

    o Management:
    ▪ Supplemental oxygen + CPAP ± HFOV
    ▪ Replacement with exogenous surfactant
    o Complication: pneumomediastinum, pneumothorax, and PPHN

    Done by: Norah AlRohaimi (Pediatric Resident - NGHA)


    Source: UptoDate + Pediatrics in Review

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