Respiratory Distress Children

7/23/2019 Respiratory Distress Children

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RD- RD-Teaching Aids: NNF 11

Respiratory distressRespiratory distress

• Cause of significant morbidity andCause of significant morbidity and

mortalitymortality

• Incidence 4 to 6% of live birthsIncidence 4 to 6% of live births

• Many are preventableMany are preventable

• Early recognition timely referralEarly recognition timely referralappropriate treatment essentialappropriate treatment essential

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RD- RD-Teaching Aids: NNF ##


• RR $ 6& minRR $ 6& min''

•

RetractionsRetractions• (runt(runt

• )) CyanosisCyanosis

' *achypnea' *achypnea



RD- RD-Teaching Aids: NNF ++

Causes of respiratory distressCauses of respiratory distress

• ,ulmonary,ulmonary

• Cardiac- Congenital heart diseaseCardiac- Congenital heart disease

• C./- 0sphyia IC bleedC./- 0sphyia IC bleed

• Metabolic-2ypoglycemia acidosisMetabolic-2ypoglycemia acidosis




Causes of respiratory distress - MedicalCauses of respiratory distress - Medical

• Respiratory distress syndrome 3R/5Respiratory distress syndrome 3R/5

•

Meconium aspiration syndrome 3M0/5Meconium aspiration syndrome 3M0/5• *ransient tachypnoea of ne!born 3**.5*ransient tachypnoea of ne!born 3**.5

• 0sphyial lung disease 0sphyial lung disease

• ,neumonia- Congenital aspiration nosocomial,neumonia- Congenital aspiration nosocomial

• ,ersistent pulmonary hypertension 3,,2.5,ersistent pulmonary hypertension 3,,2.5




/urgical causes of respiratory distress/urgical causes of respiratory distress

• *racheo-esophageal fistula*racheo-esophageal fistula

• iaphragmatic herniaiaphragmatic hernia

• 8obar emphysema8obar emphysema

• ,ierre -Robin syndrome,ierre -Robin syndrome

• Choanal atresiaChoanal atresia




0pproach to respiratory distress 0pproach to respiratory distress

HistoryHistory

• 9nset of distress9nset of distress

• (estation(estation

• 0ntenatal steroids 0ntenatal steroids

•

,redisposing factors- ,R9M fever ,redisposing factors- ,R9M fever • Meconium stained amniotic fluidMeconium stained amniotic fluid

• 0sphyia 0sphyia



RD- RD-Teaching Aids: NNF ::


ExaminationExamination

• /everity of respiratory distress/everity of respiratory distress

•

.eurological status.eurological status• lood pressure C;*lood pressure C;*

• 2epatomegaly2epatomegaly

• CyanosisCyanosis• ;eatures of sepsis;eatures of sepsis

• 8oo< for malformations8oo< for malformations



RD- RD-Teaching Aids: NNF ==

0ssessment of respiratory distress 0ssessment of respiratory distress

/core '/core ' 1 # 1 #

1"1" Resp" rateResp" rate >6 >6 6-= 6-= $= $=

#"#" CentralCentral .one .one .one !ith .eeds.one !ith .eedscyanosiscyanosis 40%40% ;i9;i922 >>4% ;i94% ;i922

1"1" Retractions .oneRetractions .one Mild Mild /evere /evere

#"#" (runting(runting .one Minimal .one Minimal 9bvious 9bvious

+"+" 0ir entry 0ir entry (ood (ood ecreased ecreased ?ery poor ?ery poor

' /core $ 6 indicates severe distress' /core $ 6 indicates severe distress



RD- RD-Teaching Aids: NNF @@


Chest examinationChest examination

• 0ir entry 0ir entry

• Mediastinal shiftMediastinal shift

• 0dventitious sounds 0dventitious sounds

• 2yperinflation2yperinflation

• 2eart sounds2eart sounds




,reterm - ,ossible etiology,reterm - ,ossible etiology

Early progressive -Early progressive - Respiratory distressRespiratory distress

syndrome or hyalinesyndrome or hyaline

membrane diseasemembrane disease32M532M5

Early transient -Early transient - 0sphyia metabolic 0sphyia metabolic

causes hypothermiacauses hypothermia

0nytime - ,neumonia 0nytime - ,neumonia




*erm A ,ossible etiology*erm A ,ossible etiology

Early !ell loo<ingEarly !ell loo<ing -- **.**. ppolycythemiaolycythemia

Early severe distressEarly severe distress - M0/ asphyia- M0/ asphyia

malformationsmalformations

8ate sic< !ith - Cardiac8ate sic< !ith - Cardiac

hepatomegalyhepatomegaly

8ate sic< !ith shoc<8ate sic< !ith shoc< - 0cidosis - 0cidosis

0nytime 0nytime - ,neumonia- ,neumonia



RD- RD-Teaching Aids: NNF 1#1#

/uspect surgical cause/uspect surgical cause

• 9bvious malformation9bvious malformation

• /caphoid abdomen/caphoid abdomen

• ;rothing;rothing

• 2istory of aspiration2istory of aspiration



RD- RD-Teaching Aids: NNF 1+1+

InvestigationsInvestigations

• (astric aspirate(astric aspirate

• ,olymorph count,olymorph count• /epsis screen/epsis screen

• Chest B-rayChest B-ray

• lood gas analysislood gas analysis




/ha<e test/ha<e test

• *a<e a test tube

• Mi "7 ml gastric aspirate )

"7 ml absolute alcohol

• /ha<e for 17 seconds

• 0llo! to stand 17 minutes forinterpretation of result




Respiratory distress -Respiratory distress -

ManagementManagement

• MonitoringMonitoring

• /upportive/upportive

-- I? fluidI? fluid

- Maintain vital signs- Maintain vital signs

- 9ygen therapy- 9ygen therapy

- Respiratory support- Respiratory support

• /pecific/pecific




9ygen therapy'9ygen therapy'

IndicationsIndications

• 0ll babies !ith distress 0ll babies !ith distress

• CyanosisCyanosis

• ,ulse oimetry /a9,ulse oimetry /a922 << @%@%

MethodMethod

• ;lo! rate #-7 8& min;lo! rate #-7 8& min

• 2umidified oygen by hood or nasal prongs2umidified oygen by hood or nasal prongs

' Cautious administration in pre-term' Cautious administration in pre-term



RD- RD-Teaching Aids: NNF 1:1:

,ulse oimetry,ulse oimetry

• Effective non invasive monitoring ofEffective non invasive monitoring of

oygen therapyoygen therapy

• Ideally must for all sic< neonates andIdeally must for all sic< neonates and

those reuiring oygen therapythose reuiring oygen therapy

• Maintain /a9Maintain /a9## bet!een @ A @+ %bet!een @ A @+ %



RD- RD-Teaching Aids: NNF 1=1=

Respiratory distress syndrome 3R/5Respiratory distress syndrome 3R/5

• ,re-term baby,re-term baby

• Early onset !ithin 6 hoursEarly onset !ithin 6 hours

• /upportive evidenceD .egative sha<e test/upportive evidenceD .egative sha<e test

• Radiological evidenceRadiological evidence



RD- RD-Teaching Aids: NNF 1@1@

B-ray - R/B-ray - R/



RD- RD-Teaching Aids: NNF ##

,athogenesis of R/,athogenesis of R/

• ecreased or abnormal surfactantecreased or abnormal surfactant

• 0lveolar collapse 0lveolar collapse

• Impaired gas echangeImpaired gas echange

• Respiratory failureRespiratory failure



RD- RD-Teaching Aids: NNF #1#1

R/ - ,redisposing factorsR/ - ,redisposing factors

• ,rematurity,rematurity

• Cesarean bornCesarean born

• 0sphyia 0sphyia

• Maternal diabetesMaternal diabetes

RDS - Protective factorsRDS - Protective factors

• ,R9M,R9M

• I(RI(R

• /teroids/teroids



RD- RD-Teaching Aids: NNF ####

0ntenatal corticosteroid 0ntenatal corticosteroid

-- Simple therapy that saves neonatal livesSimple therapy that saves neonatal lives

• ,reterm labor #4-+4 !ee<s of gestation,reterm labor #4-+4 !ee<s of gestation

irrespective of ,R9M hypertension andirrespective of ,R9M hypertension and

diabetesdiabetes• oseDoseD

InF etamethasone 1#mg IM every #4 hrs BInF etamethasone 1#mg IM every #4 hrs B

# dosesG or InF eamethasone 6 mg IM# dosesG or InF eamethasone 6 mg IMevery 1# hrs B 4 dosesevery 1# hrs B 4 doses

• Multiple doses not beneficialMultiple doses not beneficial



RD- RD-Teaching Aids: NNF #+#+

/urfactant therapy - Issues/urfactant therapy - Issues

• /hould be used only if facilities for/hould be used only if facilities for

ventilation availableventilation available

• CostCost

• ,rophylactic ?s rescue,rophylactic ?s rescue




,rophylactic therapy,rophylactic therapy

Etremely preterm >#= !<sEtremely preterm >#= !<s

>1 gm>1 gm

.ot routine in India.ot routine in India

Rescue therapyRescue therapy

0ny neonate diagnosed to have R/ 0ny neonate diagnosed to have R/

/urfactant therapy - Issues/urfactant therapy - Issues

Dose 100mg/kg phospholipid Intra trachealDose 100mg/kg phospholipid Intra tracheal




Meconium aspiration syndrome 3M0/5Meconium aspiration syndrome 3M0/5

• Meconium stainingMeconium staining

- 0ntepartum intrapartum- 0ntepartum intrapartum

• *hin*hin

- Chemical pneumonitis- Chemical pneumonitis

• *hic<*hic<

- 0telectasis air!ay bloc<age air- 0telectasis air!ay bloc<age air

lea< syndromelea< syndrome




Meconium aspiration syndromeMeconium aspiration syndrome

• ,ost term&/;,ost term&/;

• Meconium staining A cord nails s<inMeconium staining A cord nails s<in

• 9nset !ithin 4 to 6 hours9nset !ithin 4 to 6 hours

• 2yperinflated chest2yperinflated chest



RD- RD-Teaching Aids: NNF #:#:

B-ray - M0/B-ray - M0/



RD- RD-Teaching Aids: NNF #=#=

M0/ - ,reventionM0/ - ,revention

• 9ropharyngeal suction before delivery of9ropharyngeal suction before delivery of

shoulder forshoulder for allall neonates born throughneonates born throughM/0;M/0;

• Endotracheal suction forEndotracheal suction for non vigorous'non vigorous'

neonates born through M/0;neonates born through M/0; '' Avoid bag & mask ventilation till trachea is Avoid bag & mask ventilation till trachea is

cleared cleared



RD- RD-Teaching Aids: NNF #@#@

*ransient tachypnoea of ne!born*ransient tachypnoea of ne!born

3**.53**.5• Cesarean born term babyCesarean born term baby

• elayed clearance of lung fluidelayed clearance of lung fluid

• iagnosis by eclusioniagnosis by eclusion

• ManagementD supportiveManagementD supportive

• ,rognosis - good,rognosis - good



RD- RD-Teaching Aids: NNF ++

X-ray- TTNBX-ray- TTNB



RD- RD-Teaching Aids: NNF +1+1

Congenital pneumoniaCongenital pneumonia

Preis!osin" factorsPreis!osin" factors

,R9M $#4 hours foul smelling liuor,R9M $#4 hours foul smelling liuor

,eripartal fever unclean or multiple per,eripartal fever unclean or multiple pervaginalvaginal

TreatmentTreatment

*hermoneutral environment .,9 I?*hermoneutral environment .,9 I?

fluids 9ygen antibiotics-fluids 9ygen antibiotics-

30mp)(entamicin530mp)(entamicin5



RD- RD-Teaching Aids: NNF +#+#

B-ray A Congenital pneumoniaB-ray A Congenital pneumonia



RD- RD-Teaching Aids: NNF ++++

.osocomial pneumonia.osocomial pneumonia

Ris< ;actorRis< ;actor D ?entilated neonatesD ?entilated neonates

D ,reterm neonatesD ,reterm neonates

,revention,revention D 2and!ashD 2and!ash

D se of disposablesD se of disposables

D Infection controlD Infection control

measures measures

0ntibiotics 0ntibiotics D sually reuire higherD sually reuire higherantibiotics antibiotics




Respiratory distress in a neonate !ithRespiratory distress in a neonate !ith

asphyiaasphyia

• Myocardial dysfunctionMyocardial dysfunction

• Cerebral edemaCerebral edema

• 0sphyial lung inFury 0sphyial lung inFury

• Metabolic acidosisMetabolic acidosis• ,ersistent pulmonary hypertension,ersistent pulmonary hypertension




,neumothora,neumothora

Etio#o"yEtio#o"y

/pontaneous M0/ ,ositive pressure/pontaneous M0/ ,ositive pressureventilation 3,,?5ventilation 3,,?5

C#inica# feat$resC#inica# feat$res

/udden distress indistinct heart sounds/udden distress indistinct heart sounds

%ana"ement%ana"ement

.eedle aspiration chest tube.eedle aspiration chest tube




B-ray - ,neumothoraB-ray - ,neumothora



RD- RD-Teaching Aids: NNF +:+:

,ersistent pulmonary,ersistent pulmonary

hypertension 3,,2.5hypertension 3,,2.5

Ca$sesCa$ses

• ,rimary,rimary

•

/econdaryD M0/ asphyia sepsis/econdaryD M0/ asphyia sepsis

%ana"ement%ana"ement

• /evere respiratory distress needing/evere respiratory distress needing

ventilatory support pulmonaryventilatory support pulmonaryvasodilatorsvasodilators

• ,oor prognosis,oor prognosis



RDRDT hi Aid NNF +=+=


3needing referral53needing referral5

• R/ 32M5R/ 32M5

• M0/M0/• /urgical or cardiac cause/urgical or cardiac cause

• ,,2.,,2.

• /evere or !orsening distress/evere or !orsening distress

Documents

Respiratory Distress Children