Respiratory [Read-Only]ocw.usu.ac.id/course/download/1110000107-growth-and-development...  hyaline

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  • RRR DR D

    Neonatology DivisionNeonatology DivisionDepartment of Child Health Medical School

    U i it f S t UtVisual 1

    University of Sumatera Utara

  • Alarming Signs for RD

    CyanosisSevere apnea (coma?)Severe apnea (coma?)StridorG i ff tGasping effortsSevere respiratory retractionsPoor perfusion (shock)

    Visual 2

  • Evaluation of RespiratoryEvaluation of RespiratoryDistress Using Downs Score

    > 80/min60 80/min< 60/minRespiratory Rate

    210

    Severe retractionsMild retractionsNo retractionRetractions

    80/min60 80/min 60/minRespiratory Rate

    N i tMild d i i G d bil t l i Ai E t

    Cyanosis on O2Cyanosis relieved by O2

    No cyanosisCyanosis

    Audible with earAudible by No gruntingGrunting

    No air entryMild decrease in air entry

    Good bilateral air entry

    Air Entry

    Learning Objective 1 Visual 3

    stethoscope

  • Evaluation of RespiratoryEvaluation of Respiratory Distress Using Downs Score

    Score < 4 No respiratory distress

    Score 4 -7 Respiratory distress

    Score > 7 Impending respiratory failure (Blood gases should be obtained)

    Learning Objective 1 Visual 4

  • Be Prepared

    Resuscitation equipment and/or suppliesInvolve others (team approach)Involve others (team approach)Have staff trainedABCABC

    Airway BreathingCirculation

    Visual 5

  • Conditions Associated with Respiratory Distress

    Visual 6

  • Visual 7

  • Investigations

    Chest X-rayArterial blood gasArterial blood gasCBC (anemia, polycythemia, sepsis)Gl h k (h l i )Glucose check (hypoglycemia)Blood culture (sepsis, pneumonia)

    Visual 8

  • Treatment

    After stabilization, treat the cause of RDUse CPAPUse CPAPAvoid unnecessary exposure to oxygenA tibi ti til i i l d tAntibiotics until sepsis is ruled out

    Visual 9

  • Common Causes of RDCommon Causes of RD

    Transient tachypnea of the newborn (TTN)Hyaline membrane disease (HMD)Hyaline membrane disease (HMD)Meconium aspiration syndrome (MAS)Ai l k dAir leak syndromePneumoniaCongenital heart diseases

    Visual 10

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN)Neonate (TTN)

    Definition

    A benign disease of near-term or term neonates who have respiratory distress shortly after p y ydelivery that resolves within 3-5 days.

    Learning Objective 3 Visual 11

  • Pathogenesis of TTNPathogenesis of TTN

    How is lung fluid formed?What is the function of lung fluids?What is the function of lung fluids?What happens to lung fluids during labor?D it tt th t f l b ? Does it matter the type of labor?

    Visual 12

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN) (cont)Neonate (TTN) (cont)

    Risk factors

    Cesarean section without laborMacrosomiaMale sexProlonged laborgExcessive maternal sedation Low Apgar score (< 7 at 1 minute)

    Learning Objective 3 Visual 13

    o pga sco e ( at ute)

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN) (cont)Neonate (TTN) (cont)Clinical Presentation of TTN The neonate is usually near term or term and The neonate is usually near-term or term, and shortly after delivery has tachypnea (>80 b th / i t ) Th t l h breaths/minute). The neonate may also have grunting, nasal flaring, rib retractions, and cyanosis. The disease usually does not last longer than 72 hours.

    Learning Objective 3 Visual 14

  • Visual 15

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN) (cont)Neonate (TTN) (cont)

    Chest X-ray: Perihilar streaking, mild cardiomegaly, increased lung volume, fluid in the minor fi d h fl id i th l l fissure, and perhaps fluid in the pleural space are common findings.

    Learning Objective 3 Visual 16

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN) (cont)Neonate (TTN) (cont)

    Management of TTN

    Judicious use of oxygenFluid restriction F di t h iFeeding as tachypnea improves

    Confirm the diagnosis by excluding other causes of Confirm the diagnosis by excluding other causes of tachypnea e.g. pneumonia, congenital heart disease, hyaline membrane disease, and cerebral hyperventilation.

    Learning Objective 3 Visual 17

    hyperventilation.

  • Transient Tachypnea of theTransient Tachypnea of theTransient Tachypnea of the Transient Tachypnea of the Neonate (TTN) (cont)Neonate (TTN) (cont)

    Outcome and Prognosis of TTN

    The disease is self-limited and there is no risk f f th l of recurrence or further pulmonary

    dysfunction. Respiratory symptoms improve as i t l fl id i bili d d thi i intrapulmonary fluid is mobilized, and this is usually associated with diuresis.

    Learning Objective 3 Visual 18

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome)(Respiratory Distress Syndrome)

    DefinitionHyaline membrane disease (HMD) is also called respiratory distress syndrome (RDS). This condition

    ll i t t P t usually occurs in a preterm neonate. Premature lungs are surfactant deficient.

    Learning Objective 4 Visual 19

  • Hyaline Membrane Disease Hyaline Membrane Disease yy(Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)Respiratory difficulties exhibited include:

    Increasing tachypnea (> 60/min)Chest retractionsChest retractionsCyanosis on room air that persists or progresses over the first 24-48 hours of lifeprogresses over the first 24-48 hours of life.Decreased air entryGrunting

    Learning Objective 4 Visual 20

    Grunting

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)

    Incidence

    HMD occurs in about 25% of neonates born at 32 k t ti Th i id i 32 weeks gestation. The incidence increases with increasing prematurity.

    Learning Objective 4 Visual 21

  • Hyaline Membrane DiseaseHyaline Membrane Disease (Respiratory Distress Syndrome) (cont)(cont)

    Risk Factors of HMDIncreased Risk

    P t itPrematurityMale sexNeonate of diabetic Neonate of diabetic mother

    Learning Objective 4 Visual 22

  • Hyaline Membrane DiseaseHyaline Membrane Disease (Respiratory Distress Syndrome) (cont)(cont)Risk Factors of HMD

    Decreased RiskDecreased RiskChronic intrauterine stress

    Prolonged rupture of membranes o o ged uptu e o e b a esMaternal hypertensionNarcotic useIntrauterine Growth Retardation (IUGR) or Small for Intrauterine Growth Retardation (IUGR) or Small for Gestational Age (SGA)

    Corticosteroids Prenatal

    Learning Objective 4 Visual 23

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)

    Investigations for HMD (RDS)g ( )Laboratory Studies:

    Blood gases: hypoxia hypercarbia acidosisBlood gases: hypoxia, hypercarbia, acidosis.CBC and blood culture are required to rule out infection.Serum glucose levels are usually lowSerum glucose levels are usually low.

    Chest X-ray Study:Reveals ground glass appearance with air bronchograms

    Learning Objective 4 Visual 24

    Reveals ground glass appearance with air bronchograms.

  • Visual 25

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)( )( )

    Management of HMD (RDS)G lGeneral

    Thermal regulation Parenteral fluid AntibioticsContinuous monitoring

    Learning Objective 4 Visual 26

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)

    Continuous positive airway pressure (CPAP) is triedtried.If under CPAP

    PH < 7 2PH < 7.2Or PO2 < 40mmHg FiO2 > 60%Or PCO2 > 60mmHBase deficit > -10

    Endotracheal intubation and mechanical ventilation.C id f t t thLearning Objective 4 Visual 27

    Consider surfactant therapy

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)

    Caution: every 10 days on the ventilator is i t d ith 20% i d i k f associated with 20% increased risk for

    cerebral palsy

    Learning Objective 4 Visual 28

  • Hyaline Membrane DiseaseHyaline Membrane DiseaseHyaline Membrane Disease Hyaline Membrane Disease (Respiratory Distress Syndrome) (Respiratory Distress Syndrome) (cont)(cont)(cont)(cont)

    Specific TreatmentpSurfactant replacement therapy if tracheal intubation is requiredq

    OutcomeRDS accounts for 20% of all neonatal deathsRDS accounts for 20% of all neonatal deathsChronic lung diseases occurs in 29% in VLBW infants

    Learning Objective 4 Visual 29

    infants

  • Visual 30

  • Meconium Aspiration SyndromeMeconium Aspiration SyndromeMeconium Aspiration Syndrome Meconium Aspiration Syndrome (MAS)(MAS)Definition

    The respiratory distress s