Respiratory Distress in Newborn: Causes, Diagnosis, and Management
Respiratory distress in newborns is a critical condition that requires prompt identification and treatment. It can be caused by various factors such as pulmonary and non-pulmonary issues. Early recognition is vital to improve outcomes in newborns with respiratory distress. This article provides insights on the causes, diagnosis, and management of respiratory distress in newborns.
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Respiratory Distress in Newborn DR. SAURABH PIPARSANIA MBBS, DNB, MNAMS ASSOCIATE PROFESSOR IMCHRC
What is respiratory distress Causes of RD Case based discussion: RDS MAS TTNB Cardiac causes Surgical Causes
Respiratory Distress It is suspected in newborn when : RR > 60/min in a resting quiet baby . Subcostal/intercostal retraction Nasal flaring Grunting Dull,lethargic Cyanosed Inability to maintain Spo2 Respiratory distress in the newborn is the commonest problem causing mortality & morbidity. Early recognition & prompt t/t is essential to improve the outcome .
Pulmonary Causes Cause RDS (HMD ) MAS Time of onset First 6 hr.of life First few hrs. Remark Preterm Preterm,Term, Post- term, IUGR PVL>24 hrs, PVB, PROM, maternal fever, chorionamnionitis Untimely LSCS, Cyanosis, distress, h/o PPV TEF , Diaphragmatic hernia, CCAM Pneumonia Any age TTNB PPHN Pneumothorax Congenital malform. Few hrs of age Any age Any age At birth
Non Pulmonary Causes Cardiac Metabolic CHD , CCF Hypothermia metabolic dehydration , asphyxia) Asphyxia , IVH , cerebral edema Thoracic dystrophy , hypoglycemia ( , , acidosis sepsis CNS causes Chest wall problems :
Case 1 A primi mother give birth to 32 weeks preterm vaginally by vertex presentation with birth weight 1.5 kg. Apgar score was 5 and 9. Baby developed respiratory distress 4 hrs after birth. X-ray 6 hrs after birth
What is the most probable diagnosis: RDS MAS TTNB Congenital Pneumonia Congenital diaphragmatic hernia Pneumothorax 1. 2. 3. 4. 5. 6.
Respiratory Distress Syndrome (HMD) RDS is common in Preterm babies < 34 wks. Of gestation . It is the commonest cause of RD in preterm neonate . Apart from Prematurity other causes are : Asphyxia Acidosis Maternal Diabetes C-Section
Etiopathogenesis Surfactant deficiency Surfactant is a Lipoprotein It is produced by Type 2 Alveolar cells of Lungs . Surfactant Therefore neonates production starts around born < 35 wks. Develop RDS. 20 wks. & peaks at 35-36 wks. Surfactant helps reduce surface tension in the alveoli ( from outside ) If SURFACTANT is less or to collapse during absent , surface tension and alveoli tend expiration .
Pathology ctd. more negative pressure is needed in inspiration to keep the alveoli patent Inadequate oxygenation & work of breathing :There is hypoxemia & acidosis Pulmonary vasoconstriction & Rt . Lt. Shunt across Foramen Ovale worsens hypoxemia & respiratory failure sets in . This Causes ischemic damage to alveoli . So proteins transudate into the alveoli. This gives a hyaline membrane appearance .
Clinical Features of RDS Onset of RDS is within 6 hrs. Of life . Tachypnea , intercostal & subcostal retractions, grunting , cyanosis & air entry . Respiratory failure may occur.
Diagnosis of RDS Prenatal diagnosis : L/S ratio in amniotic fluid ; if > 2 it indicates lung maturity . Shake Test : Gastric or amniotic fluid + Alcohol shake for 15 sec . Allow to settle Bubbles are formed if if surfactant is adequate .
Investigations Septic screen, Calcium X-ray chest electrolytes. diagnosis is clinical X-Ray : Reticulogranular pattern , ground glass opacity, whiteout lung .
Treatment of RDS Supportive :to maintain : Temperature: thermoneutral enviroment Airway: OP/NP suction Breathing : Oxygenation, Ventilation Circulation Electrolytes Avoid Sepsis Supply energy ( calories ) . Specific Surfactant replacement therapy Prophylactic Selective and early rescue INSURE
Complications of RDS During recovery CCF may occur . 1. 2. IV Hge. causes apneic attacks . 3. DIC Bleeding inside the Brain or Lungs . 4. Prolonged ventilation causes air leaks , ROP , Brochopulmonary dysplasia .
Prevention of RDS Suppress labor Betamethasone I/M 12mg 24 hrs. Interval Dexamethasone I/M 6 mg 12 hrs. premature is labor . 1. 2. If unavoidable ( 24-34 wks ) : given 2 doses at OR 4 doses every
Case 2 A fullterm baby born to a primi mother with MSL. Baby cried after resuscitaion . Birth weight was 3.2 kg. Kept in NICU for observation. Respiratory distress increases and worsens in next 24 hours.
What is the most probable diagnosis: RDS MAS TTNB Congenital Pneumonia Congenital diaphragmatic hernia Pneumothorax 1. 2. 3. 4. 5. 6.
Meconium Aspiration Syndrome Thin meconium causes pneumonitis & thick meconium causes blockage & respiratory failure . MAS is common in Post term & IUGR and term neonates with fetal distress. Babies develop RD in first few hrs. of life Deteriorates in 24 hrs .
C/f OF MAS R. R (>60/mt) , cyanosis , intercostal/subcostal retractions, grunting , laboured breathing . Inability to maintain SpO2, apneic spells , electrolyte imbalance . Staining of the umbilical cord X Ray chest areas of hyperexpansion Air leaks resp. Failure . Bil. Heterogenous opacities Atelectasis
T/t of MAS Delivery room management: intubation & PPV in non vigorous babies Temperature regulation: Therapeutic hypothermia. I/V fluids Oxygen: hood/ Nasal Prongs. Ventilatory support. Antibiotics Treatment of PPHN. Inotropes for shock: dopamine/ dobutamine Treatment of seizures Cautious feeding
Case 3 A full term baby born to a primi mother by LSCS with birth weight of 2.8 kg. Baby cried immidiately after birth. Apgar score was 6 and 9. Baby developed respiratory distress after 2 hours of birth. X-ray after 6 hours of birth:
What is the most probable diagnosis: RDS MAS TTNB Congenital Pneumonia Pneumothorax Congenital diaphragmatic hernia 1. 2. 3. 4. 5. 6.
Transient Tachypnea of Newborn Benign self limiting disorder . Occurs usually in Term/near term newborn . LSCS without precipitous labor Poorly timed CS It is due to delayed clearance of lung fluid Change in feto-maternal hormonal milieu Treatment: Thermoregulation. IVF O2 therapy: hood/nasal prongs/ CPAP/ Ventilator . Recovery is usually complete in 24-72 hrs and sometimes takes more time .
Case 4 A full term baby born to a primi mother by LSCS with birth weight of 2.8 kg. Baby cried immidiately after birth. Apgar score was 6 and 9. h/o PVL> 24 hrs with fever and foul smelling liqor. Baby developed respiratory distress after birth. X-ray :
What is the most probable diagnosis: RDS MAS TTNB Congenital Pneumonia Pneumothorax Congenital diaphragmatic hernia 1. 2. 3. 4. 5. 6.
Congenital Pneumonia H/o Leaking , Fever in mother . Respiratory distress with grunting , cyanosis , s/o sepsis . X-Ray shows patchy pneumonitis . Septic screen including CRP positive . T/t is Oxygen I/V fluids Antibiotics like 3 rd generation cephalosporins, or Piperacillin + Tazobactum . Antibiotics according to culture sensitivity
Cardiac causes CHD: Duct dependent lesions PDA is the common cause of CCF & resp. distress . PPHN T/t : Palliative: O2,/Inotropes/ PGE1/ treatment of CCF Ibuprofen/ Indomethacin for PDA Definitive: corrective surgeries
Surgical causes T.O Fistula , Diaphragmatic Hernia , Choanal atresia, CCAM, Pneumothorax etc. Treatment: surgical management .
Case 5 A full term baby born to a primi mother by LSCS with birth weight of 2.8 kg. Baby did not cry after birth. Required Bag and Mask ventilation. Apgar score was 3 and 9. Baby developed respiratory distress after birth. Air entry was decreased on right side with signs of poor perfusion.X-ray :
What is the most probable diagnosis: RDS MAS TTNB Congenital Pneumonia Pneumothorax Congenital diaphragmatic hernia 1. 2. 3. 4. 5. 6.
A full term baby born to a primi mother by LSCS with birth weight of 2.8 kg. Baby had respiratory distress at birth. o/e : abdomen was scaphoid, heart sounds were heard on the left side and auscultation of chest revealed gurgling sound with signs of poor perfusion .X-ray :
