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RDS
• Most common respiratory illness in NICU
• Occur in premature neonate
• Surfactant deficiency
• Risk factors– Asphyxia and stress– Male– Acidosis– DM mother
signs
• tachypnea
• retraction
• grunting
• Nasal flaring
• apneic episode
• cyanosis
• extremities puffy or swollen
Physiologic abnormalities
• Lung compliance 10-20% of norm
• Atelectasis…areas not ventilated
• Areas not perfused
• Decrease alveolar ventilation
• Reduce lung volume
surfactant
• Type 2 pneumocytes lamillar body 22weeks…34-36wks
• Phosphatidylcholine
• Surfactant specific protein
• Recycling and regeneration (including externally given surfactant)
surfactant
• Decrease surface tension at air liquid level
• Equalize tension in alveoli of different size
• Increase in lung compliance.
• Absence of surfactant cause RDS
• Pulmonary hypertension
Treatment
• Surfactant Fujiwara…1990s– Prevention– rescue
• Supportive– Thermal– Fluid and nutrition– oxygen
• Mechanical ventilation
Meconium aspiration
• First stool that constitutes the GI epithilium and secretion during fetal life
• Stress and intra-uterine meconium in term infant• Gasping cause the aspiration• Chemical diffuse peumonitis • Same signes of distrss and PPHN.• Treatment maily supprtive
Congenital pneumonia
• Sepsis risk factors– PROM– Preamturity– Maternal fever, dicharge, abdominal pain,
leukocytosis– Colonization with GBS
• Same signs of RDS
• X-ray
Transient tachypnia of newborn
• Term
• Cesarian delivery
• Usually tachypnia without O2 requirment
• Resolve in 48-72 houres
• Lung fluid
• X-ray