43CHAPTER 4DISCUSSION & DUMMARY1.1. DiscussionThe most
common etiology of neonatal respiratory distress is
transienttachypnea of the newborn; this is triggered by excessive
lung fluid, and symptomsusually resolve spontaneously. Respiratory
distress syndrome can occur in prematureinfants as a result of
surfactant deficiency and underdeveloped lung anatomy.Intervention
with oxygenation, ventilation, and surfactant replacement is
oftennecessary. Prenatal administrationof corticosteroids
between2and!wee"s#gestation reduces the ris" of respiratory
distress syndrome of the newborn when theris" of preterm delivery
is high. $econium aspiration syndrome is thought to occurin utero
as a result of fetal distress by hypoxia. The incidence is not
reduced by
useofamnioinfusionbeforedeliverynorbysuctioningoftheinfant
duringdelivery.Treatment options are resuscitation, oxygenation,
surfactant replacement,
andventilation.Respiratorydistresssyndrome%R&'(,
previouslycalledhyalinemembranedisease,is acommon cause
ofmorbidityand mortalityassociated with prematuredelivery. R&'
is a developmental disorder rather than a disease process per se,
and itis usually associated with premature birth.In premature
infants, respiratory distresssyndrome develops because of impaired
surfactant synthesis and secretion leading toatelectasis,
ventilation)perfusion %*+,( ine-uality, and hypoventilation with
resultanthypoxemia and hypercarbia. .lood gases show respiratory
and metabolicacidosis that cause pulmonary vasoconstriction,
resulting in impaired endothelial andepithelial integrity with
lea"age of proteinaceous exudate and formation of
hyalinemembranes./de-uacyofventilationandoxyegenationmust
beestablishedassoonaspossible to avoid pulmonary vasoconstriction,
further ventilation)perfusionabnormalities, andatelectasis.
$ildormoderateR&'canbemanagedby0P/Pappliedbymas", nasal
cannula, nasal prongs, orendotracheal ornasopharyngealtubes.
0areful attention to the mechanical details of application of 0P/P
ormechanical respirators is re-uired. $andatory ventilation should
be instituted well in44advance of respiratory failure and severe
respiratory acidosis to avoid severehypoxemia and atelectasis.
*entilation is maintained through an endotracheal tube,which can be
placed nasally or orally, for delivery of oxygen and positive
pressure.Pressure)cycled ventilators are most fre-uently used in
the neonatal intensive careunit %1I02( and are controlled by
setting positive inspiratory pressure, rate,inspiratory)expiratory
times, and positive end)expiratory pressure %P33P(.1.2. Summary/
male newborn, named &1$, was admitted to the neonatal unit at
4eneral5ospital 5a6i /dam $ali" $edan %R'2P 5/$( on 7une 8, 29:;
with shortness ofbreath as the chief complaint. The neonate was
born on the same day, about one hourbefore admission to the
hospital with gestational age < !9)!2 wee"s. This complainthad
been experienced since delivery with no history of bluishness. =hen
admitted,the newborn had wea" cry, less of activity, and wea"
suc"le. Dianosis !Respiratory distress ec. 5yaline $embrane
&isease'uspect of neonatal sepsis>ow birth weight
%>.=(Preterm newborn) appropriate for gestational age
%/4/(Tr"a#m"n# !) 0P/P with ?i@2 < 2;A, P33P < B, @2 ?low
< C>+min, 'p@2 < 8!)8; A) Total fluid re-uisite < C9
cc+"g.=+day < :C.C cc+day, consisting ofDo Parenteral < C9
cc+"g.=+day < :C.C cc+day I*?& &:9A E 0a. 4luconas :9 cc
F B cc+ houro 3nteral < diet is ceased for a while) *it. G
in6ection : mg %I$() 0efotaxime in6ection 89mg+:2 hrs
%I*()4entamycine in6ection 8mg+ !B hrs %I*(
