SlideShare una empresa de Scribd logo
1 de 30
Descargar para leer sin conexión
NEONATAL ACUTE
RESPIRATORY
DISTRESS
SYNDROME
SUDESHNA BANERJEE
M.SC (N) 2ND YEAR
HFCON
Definition
Acute lung disease of the newborn caused by
surfactant deficiency. RDS is the clinical expression of
surfactant deficiency and its histologic counterpart,
Hyaline Membrane Disease (HMD).
Development of Lungs
Surfactant
Surfactant is identifiable in fetal lung as early as 16 weeks,
though its proper secretion begins after 24 weeks gestation
and is synthesized most abundantly after the 35th week of
gestation.
Pulmonary Surfactants are phospholipids synthesized in the
type II cells lining the alveoli surfactant.
Phospholipid produced by alveolar type II cells.
Lowers surface tension.
As alveoli radius decreases, surfactant’s ability to lower
surface tension increases.
The half-life of surfactant is 30 hours
Function of the
Surfactant
Causes of surfactant
deficiency
Decrease the surface
tension
To promote lung
expansion during
inspiration.
To prevent alveolar
collapse and loss of
lung volume at the
end of expiration.
Pulmonary infections e.g. group B Strep
Pulmonary hemorrhage
Meconium aspiration pneumonia
O2 toxicity; barotrauma or volutrauma
to the lungs.
Congenital diaphragmatic hernia and
pulmonary hypoplasia
Pathophysiology
NEONATAL RESPIRATORY DISTRESS SYNDROME
Risk factors
Prematurity
Multiple births
Maternal diabetes, C-section without labor
Perinatal asphyxia
Cold stress
White race, male sex
Hypothermia, hypothyroidism
2nd twin
Clinical Manifestations
Appear within minutes of birth may not be recognized for several hours in
larger preterm.
Tachypnea (>60 breaths/min), nasal flaring, subcostal and intercostal
retractions, cyanosis & expiratory grunting.
Breath sounds may be normal or diminished and fine rales may be heard.
Progressive worsening of cyanosis & dyspnea.
Cyanosis and pallor increase & grunting decreases.
Apnea and irregular respirations are ominous signs.
In most cases, symptoms and signs reach a peak within 3 days, after which
improvement occurs gradually.
Diagnosis
Chest x-ray:
Grade 1 (mild cases): The lungs show fine homogenous ground
glass shadowing.
Grade 2: Widespread air bronchogram become
visible.
Grade 3: Confluent alveolar shadowing.
Grade 4: Complete white lung fields with obscuring of
the cardiac shadow.
Investigations cont…
• Blood gas analysis:
Shows low oxygen and excess acid in the body fluids.
• Laboratory findings are initially characterized
by hypoxemia and later by progressive hypoxemia,
hypercapnia, and variable metabolic acidosis.
Progression of the disease
Acute phase
First 48-72 hr. after birth, newborn begins to have tachypnea,
chest tightness.
The sign and symptoms are peak on day 1-2.
Patients may die if they did not receive adequate treatment.
Recovery phase
Start on day 3-5
Type II Pneumocytes are regenerated
Decrease oxygen requirement
Management
Antenatal corticosteroid therapy:
Betamethasone 12 mg IM for 2 doses, 24 hrs apart, or Dexamethasone 6 mg IM
for 4 doses, 12 hrs apart.
 They induce surfactant production and accelerate fetal lung maturation.
 Are indicated in pregnant women 24-34 weeks' gestation
 Optimal benefit begins 24 hrs after initiation of therapy and lasts seven days.
 Early surfactant therapy: prophylactic use of surfactant in preterm newborn
<27 weeks' gestation.
 Early CPAP administration in the delivery room.
Treatment
Supportive treatment:
 Body temperature -
 Scheduled “touch times” to avoid hypothermia and
minimize oxygen consumption.
 Placed in an isolette or radiant warmer to maintain core
temperature between 37 ± 0.5 °C.
Nutritional support -
For the 1st 24 hour, 10%DW should be infused through a
peripheral vein at a rate of 65–75 mL/kg/day.
For VLBW and ELBW, TPN should be added Day 2-3, Na 3-4
mEq/kg/day and K 2-3 mEq/kg/day should be added
Give a blood transfer when Hct is less than 40%
Oxygen therapy
 Warm humidified oxygen should be provided at a concentration
initially sufficient to keep PaO2 50-80 mmHg, pH 7.25-7.45,
PaCO2 40-50 mmHg and SpO2 90–95%.
 To maintain normal tissue oxygenation while minimizing the risk
of oxygen toxicity.
 O2 box is not recommended for newborn with VLBW and ELBW
because of high concentration of O2 may increase risk of ROP
(Retinopathy of prematurity).
Cont…
 If the PaO2 cannot be maintained above 50 mmHg at inspired
oxygen concentrations of 60% or greater, applying CPAP at a
pressure of 5–10 cm H2O by nasal prongs (CPAP prevents
collapse of surfactant-deficient alveoli, improves ventilation-
perfusion matching).
 The amount of CPAP required usually decreases abruptly at
about 72 hour of age, and infants can be weaned from CPAP
shortly thereafter.
Complications of CPAP
 Pulmonary air leaks - over distension of the lungs caused by
inappropriately high pressures
 Decreased cardiac output due to reduction in the venous
return, decreased right ventricular stroke volume
 Gastric distension and ‘CPAP belly syndrome’
 Nasal irritation, damage to the septal mucosa, or skin damage
and necrosis from the fixing devices.
Mechanical ventilation
Continue positive airway pressure (CPAP) is being use with 4-8 cm. H2O.
 To make Functional residual capacity (FRC) for the lung to prevent
atelectasis.
 Usually started with 5 cm·H2O and increased by 1 cm·H2O in
subsequent with increase oxygen by 10%.
Initial settings:
• Continuous flow, pressure-limited, ventilator conventional.
• PEEP 4-5 cm H2O
• Frequency 40-60/min
• FiO2 50-60%
Cont…
Routes of administration:
 Nasal prongs
 Nasopharyngeal tube
Indication for ventilator-
 Apnea with no improvement
 Cyanosis or PaO2 ≤ 40 mmHg (when using CPAP and high
oxygen concentration)
 Signs of Respiratory failure
 PaCO2 > 60 mmHg
 Metabolic acidosis
Surfactant replacement therapy
Surfactant replacement therapy can reduce mortality and
incidence of Chronic pulmonary disease.
There are 2 types of surfactant :
1. Natural surfactant extract
 Bovine(Survanta), Porcine(Curosurf)
Natural surfactants appear to be superior, perhaps of their
surfactant-associated protein content.
Natural surfactants have a more rapid onset and are
associated with a lower risk of pneumothorax and improved
survival.
Cont…
2. Synthetic surfactant
 Exosurf and ALEC (Artificial Lung Expanding
Compound)
3. Newer surfactant
• Synthetic surfactants with synthetic peptides modelled
on surfactant proteins, Aerosolized surfactants.
Dose:
• Survanta 100mg/kg for the first and subsequent doses.
• Curosurf 200mg/kg for the first dose and 100mg/kg for
the subsequent doses or 100mg/kg for all the doses.
Cont…
The main indications :
Prophylactic treatment:
 Being use for infant delivered during 23-29 wk of
gestation and birth weight 600-1250 g
Neonates with gestation < 30 weeks of gestation.
Surfactant given within 15 minutes of birth before a diagnosis
of RDS is made.
 Results :
Improve dyspnea in first 48-72 hr of life (Decrease O2
requirement, ventilation improved)
Decreased incidence of pneumothorax
Decrease mortality
Complications of surfactants:
• Transient hypoxia, bradycardia and fluctuating BP
• Rapid changes in lung compliance leading to
barotrauma if not monitored.
• Pulmonary hemorrhage - more with natural(5-6%) as
compared to synthetic (1 -3%).
Pharmacotherapy – beyond
surfactant:
Nitric oxide
• Inhaled nitric oxide (iNO)– a selective pulmonary
vasodilator improves oxygenation inpreterm
infants with severe RDS.
• Nitric oxide may be a signaling molecule in
parenchymal lung growth & may reduce lung
injury and chronic lung disease.
Nursing diagnosis
Impaired Gas Exchange related to decreased volumes and
lung compliance, pulmonary perfusion and alveolar
ventilation.
Ineffective breathing pattern r/t inadequte pulmonary
development secondary to prematurity.
Ineffective thermoregulation r/t lack of subcutaneous fat
secondary to prematurity and low birth weight and lack of
subcutaneous fat stores.
Imbalanced nutrition, less than body requirements r/t absent
sucking reflex secondary to preterm birth and type of feeding.
Risk for infection r/t immature body systems secondary to
prematurity.
Risk for impaired parent, infant attachment r/t premature birth
& separation, lack of privacy
NEONATAL RESPIRATORY DISTRESS SYNDROME

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Pneumonia in children
Pneumonia in childrenPneumonia in children
Pneumonia in children
 
Transient tachypnea of newborn ttn
Transient tachypnea of newborn ttnTransient tachypnea of newborn ttn
Transient tachypnea of newborn ttn
 
Bronchiolitis in children
Bronchiolitis in childrenBronchiolitis in children
Bronchiolitis in children
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
Neonatal hypoglycemia
Neonatal hypoglycemia Neonatal hypoglycemia
Neonatal hypoglycemia
 
Neonatal sepsis
Neonatal sepsis Neonatal sepsis
Neonatal sepsis
 
Apnea of prematurity
Apnea of prematurity Apnea of prematurity
Apnea of prematurity
 
Neonatal seizures
Neonatal seizuresNeonatal seizures
Neonatal seizures
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
Birth asphyxia
Birth asphyxiaBirth asphyxia
Birth asphyxia
 
Birth Asphyxia.pptx
Birth Asphyxia.pptxBirth Asphyxia.pptx
Birth Asphyxia.pptx
 
Neonatal jaundice - 2017
Neonatal jaundice   - 2017Neonatal jaundice   - 2017
Neonatal jaundice - 2017
 
Meningitis in children
Meningitis  in children Meningitis  in children
Meningitis in children
 
Prematurity
PrematurityPrematurity
Prematurity
 
Tracheo oesophageal fistula
Tracheo oesophageal fistula Tracheo oesophageal fistula
Tracheo oesophageal fistula
 
Neonatal sepsis
Neonatal sepsisNeonatal sepsis
Neonatal sepsis
 
Prematurity
PrematurityPrematurity
Prematurity
 
Bronchiolitis
BronchiolitisBronchiolitis
Bronchiolitis
 
Febrile seizures
Febrile seizuresFebrile seizures
Febrile seizures
 
Neonatology MCQs
Neonatology MCQsNeonatology MCQs
Neonatology MCQs
 

Similar a NEONATAL RESPIRATORY DISTRESS SYNDROME

Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndromeTheShraddha
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndromeDENNIS MIRITI
 
Paediatric respiratory physiology
Paediatric  respiratory physiologyPaediatric  respiratory physiology
Paediatric respiratory physiologyPriyanka Karnik
 
Surfactant therapy |medical administration of exogenous surfactant
Surfactant therapy |medical administration of exogenous surfactantSurfactant therapy |medical administration of exogenous surfactant
Surfactant therapy |medical administration of exogenous surfactantNEHA MALIK
 
Surfactant Replacememt Therapy
Surfactant Replacememt Therapy Surfactant Replacememt Therapy
Surfactant Replacememt Therapy Mohammed Saeed
 
Respiratory Distress(RDS)
Respiratory Distress(RDS)Respiratory Distress(RDS)
Respiratory Distress(RDS)Tek Khadka
 
6--NEONATOLOGY NRDS{6}.ppt
6--NEONATOLOGY NRDS{6}.ppt6--NEONATOLOGY NRDS{6}.ppt
6--NEONATOLOGY NRDS{6}.pptShamiPokhrel2
 
Surfactant replacement therapy : RDS & beyond
Surfactant replacement therapy : RDS & beyondSurfactant replacement therapy : RDS & beyond
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
 
Weiying1新生儿
Weiying1新生儿Weiying1新生儿
Weiying1新生儿Deep Deep
 
PRE OP PC ICU CARE OF VSD IN CHILDREN
PRE OP PC ICU CARE OF VSD IN CHILDRENPRE OP PC ICU CARE OF VSD IN CHILDREN
PRE OP PC ICU CARE OF VSD IN CHILDRENRitajyoti Sengupta
 
Respiratory distress of the newborn
Respiratory distress of the newbornRespiratory distress of the newborn
Respiratory distress of the newbornsnich
 
Covid 19 mechanical ventilation managment
Covid 19 mechanical  ventilation managmentCovid 19 mechanical  ventilation managment
Covid 19 mechanical ventilation managmentAnwar Yusr
 

Similar a NEONATAL RESPIRATORY DISTRESS SYNDROME (20)

RDS.pptx
RDS.pptxRDS.pptx
RDS.pptx
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
RDS-.pptx
RDS-.pptxRDS-.pptx
RDS-.pptx
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
Paediatric respiratory physiology
Paediatric  respiratory physiologyPaediatric  respiratory physiology
Paediatric respiratory physiology
 
Surfactant therapy |medical administration of exogenous surfactant
Surfactant therapy |medical administration of exogenous surfactantSurfactant therapy |medical administration of exogenous surfactant
Surfactant therapy |medical administration of exogenous surfactant
 
Surfactant Replacememt Therapy
Surfactant Replacememt Therapy Surfactant Replacememt Therapy
Surfactant Replacememt Therapy
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
Respiratory problems in neonate
Respiratory problems in neonateRespiratory problems in neonate
Respiratory problems in neonate
 
Respiratory Distress(RDS)
Respiratory Distress(RDS)Respiratory Distress(RDS)
Respiratory Distress(RDS)
 
Pediatric ARDS
Pediatric ARDSPediatric ARDS
Pediatric ARDS
 
6--NEONATOLOGY NRDS{6}.ppt
6--NEONATOLOGY NRDS{6}.ppt6--NEONATOLOGY NRDS{6}.ppt
6--NEONATOLOGY NRDS{6}.ppt
 
Surfactant replacement therapy : RDS & beyond
Surfactant replacement therapy : RDS & beyondSurfactant replacement therapy : RDS & beyond
Surfactant replacement therapy : RDS & beyond
 
Ards m ibrahim
Ards m ibrahimArds m ibrahim
Ards m ibrahim
 
Weiying1新生儿
Weiying1新生儿Weiying1新生儿
Weiying1新生儿
 
PRE OP PC ICU CARE OF VSD IN CHILDREN
PRE OP PC ICU CARE OF VSD IN CHILDRENPRE OP PC ICU CARE OF VSD IN CHILDREN
PRE OP PC ICU CARE OF VSD IN CHILDREN
 
Respiratory distress of the newborn
Respiratory distress of the newbornRespiratory distress of the newborn
Respiratory distress of the newborn
 
Covid 19 mechanical ventilation managment
Covid 19 mechanical  ventilation managmentCovid 19 mechanical  ventilation managment
Covid 19 mechanical ventilation managment
 
Op RDS
Op RDSOp RDS
Op RDS
 

Más de SUDESHNA BANERJEE (20)

SKELETAL SYSTEM ANATOMY
SKELETAL SYSTEM ANATOMYSKELETAL SYSTEM ANATOMY
SKELETAL SYSTEM ANATOMY
 
RESPIRATORY TRACT PATHOLOGY
RESPIRATORY TRACT PATHOLOGYRESPIRATORY TRACT PATHOLOGY
RESPIRATORY TRACT PATHOLOGY
 
NEOPLASMS
NEOPLASMS NEOPLASMS
NEOPLASMS
 
CARDIAC DISORDERS
CARDIAC DISORDERS CARDIAC DISORDERS
CARDIAC DISORDERS
 
PHARMACOVIGILANCE
PHARMACOVIGILANCEPHARMACOVIGILANCE
PHARMACOVIGILANCE
 
Cardiomyopathy
Cardiomyopathy Cardiomyopathy
Cardiomyopathy
 
Asthma
Asthma Asthma
Asthma
 
Spinal injuries
Spinal injuriesSpinal injuries
Spinal injuries
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
 
Retinal detachment & uveitis
Retinal detachment & uveitis Retinal detachment & uveitis
Retinal detachment & uveitis
 
Cataract
Cataract Cataract
Cataract
 
Glaucoma
Glaucoma Glaucoma
Glaucoma
 
Otosclerosis
Otosclerosis Otosclerosis
Otosclerosis
 
Otitis media
Otitis media Otitis media
Otitis media
 
Mastoiditis
Mastoiditis Mastoiditis
Mastoiditis
 
Sinusitis
SinusitisSinusitis
Sinusitis
 
Conjunctivitis
Conjunctivitis Conjunctivitis
Conjunctivitis
 
MTP ACT
MTP ACTMTP ACT
MTP ACT
 
Immunodeficiency disorders
Immunodeficiency disorders Immunodeficiency disorders
Immunodeficiency disorders
 
Project
Project Project
Project
 

Último

CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 

Último (20)

GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 

NEONATAL RESPIRATORY DISTRESS SYNDROME

  • 2. Definition Acute lung disease of the newborn caused by surfactant deficiency. RDS is the clinical expression of surfactant deficiency and its histologic counterpart, Hyaline Membrane Disease (HMD).
  • 4. Surfactant Surfactant is identifiable in fetal lung as early as 16 weeks, though its proper secretion begins after 24 weeks gestation and is synthesized most abundantly after the 35th week of gestation. Pulmonary Surfactants are phospholipids synthesized in the type II cells lining the alveoli surfactant. Phospholipid produced by alveolar type II cells. Lowers surface tension. As alveoli radius decreases, surfactant’s ability to lower surface tension increases. The half-life of surfactant is 30 hours
  • 5. Function of the Surfactant Causes of surfactant deficiency Decrease the surface tension To promote lung expansion during inspiration. To prevent alveolar collapse and loss of lung volume at the end of expiration. Pulmonary infections e.g. group B Strep Pulmonary hemorrhage Meconium aspiration pneumonia O2 toxicity; barotrauma or volutrauma to the lungs. Congenital diaphragmatic hernia and pulmonary hypoplasia
  • 8. Risk factors Prematurity Multiple births Maternal diabetes, C-section without labor Perinatal asphyxia Cold stress White race, male sex Hypothermia, hypothyroidism 2nd twin
  • 9. Clinical Manifestations Appear within minutes of birth may not be recognized for several hours in larger preterm. Tachypnea (>60 breaths/min), nasal flaring, subcostal and intercostal retractions, cyanosis & expiratory grunting. Breath sounds may be normal or diminished and fine rales may be heard. Progressive worsening of cyanosis & dyspnea. Cyanosis and pallor increase & grunting decreases. Apnea and irregular respirations are ominous signs. In most cases, symptoms and signs reach a peak within 3 days, after which improvement occurs gradually.
  • 10. Diagnosis Chest x-ray: Grade 1 (mild cases): The lungs show fine homogenous ground glass shadowing.
  • 11. Grade 2: Widespread air bronchogram become visible.
  • 12. Grade 3: Confluent alveolar shadowing.
  • 13. Grade 4: Complete white lung fields with obscuring of the cardiac shadow.
  • 14. Investigations cont… • Blood gas analysis: Shows low oxygen and excess acid in the body fluids. • Laboratory findings are initially characterized by hypoxemia and later by progressive hypoxemia, hypercapnia, and variable metabolic acidosis.
  • 15. Progression of the disease Acute phase First 48-72 hr. after birth, newborn begins to have tachypnea, chest tightness. The sign and symptoms are peak on day 1-2. Patients may die if they did not receive adequate treatment. Recovery phase Start on day 3-5 Type II Pneumocytes are regenerated Decrease oxygen requirement
  • 16. Management Antenatal corticosteroid therapy: Betamethasone 12 mg IM for 2 doses, 24 hrs apart, or Dexamethasone 6 mg IM for 4 doses, 12 hrs apart.  They induce surfactant production and accelerate fetal lung maturation.  Are indicated in pregnant women 24-34 weeks' gestation  Optimal benefit begins 24 hrs after initiation of therapy and lasts seven days.  Early surfactant therapy: prophylactic use of surfactant in preterm newborn <27 weeks' gestation.  Early CPAP administration in the delivery room.
  • 17. Treatment Supportive treatment:  Body temperature -  Scheduled “touch times” to avoid hypothermia and minimize oxygen consumption.  Placed in an isolette or radiant warmer to maintain core temperature between 37 ± 0.5 °C.
  • 18. Nutritional support - For the 1st 24 hour, 10%DW should be infused through a peripheral vein at a rate of 65–75 mL/kg/day. For VLBW and ELBW, TPN should be added Day 2-3, Na 3-4 mEq/kg/day and K 2-3 mEq/kg/day should be added Give a blood transfer when Hct is less than 40%
  • 19. Oxygen therapy  Warm humidified oxygen should be provided at a concentration initially sufficient to keep PaO2 50-80 mmHg, pH 7.25-7.45, PaCO2 40-50 mmHg and SpO2 90–95%.  To maintain normal tissue oxygenation while minimizing the risk of oxygen toxicity.  O2 box is not recommended for newborn with VLBW and ELBW because of high concentration of O2 may increase risk of ROP (Retinopathy of prematurity).
  • 20. Cont…  If the PaO2 cannot be maintained above 50 mmHg at inspired oxygen concentrations of 60% or greater, applying CPAP at a pressure of 5–10 cm H2O by nasal prongs (CPAP prevents collapse of surfactant-deficient alveoli, improves ventilation- perfusion matching).  The amount of CPAP required usually decreases abruptly at about 72 hour of age, and infants can be weaned from CPAP shortly thereafter.
  • 21. Complications of CPAP  Pulmonary air leaks - over distension of the lungs caused by inappropriately high pressures  Decreased cardiac output due to reduction in the venous return, decreased right ventricular stroke volume  Gastric distension and ‘CPAP belly syndrome’  Nasal irritation, damage to the septal mucosa, or skin damage and necrosis from the fixing devices.
  • 22. Mechanical ventilation Continue positive airway pressure (CPAP) is being use with 4-8 cm. H2O.  To make Functional residual capacity (FRC) for the lung to prevent atelectasis.  Usually started with 5 cm·H2O and increased by 1 cm·H2O in subsequent with increase oxygen by 10%. Initial settings: • Continuous flow, pressure-limited, ventilator conventional. • PEEP 4-5 cm H2O • Frequency 40-60/min • FiO2 50-60%
  • 23. Cont… Routes of administration:  Nasal prongs  Nasopharyngeal tube Indication for ventilator-  Apnea with no improvement  Cyanosis or PaO2 ≤ 40 mmHg (when using CPAP and high oxygen concentration)  Signs of Respiratory failure  PaCO2 > 60 mmHg  Metabolic acidosis
  • 24. Surfactant replacement therapy Surfactant replacement therapy can reduce mortality and incidence of Chronic pulmonary disease. There are 2 types of surfactant : 1. Natural surfactant extract  Bovine(Survanta), Porcine(Curosurf) Natural surfactants appear to be superior, perhaps of their surfactant-associated protein content. Natural surfactants have a more rapid onset and are associated with a lower risk of pneumothorax and improved survival.
  • 25. Cont… 2. Synthetic surfactant  Exosurf and ALEC (Artificial Lung Expanding Compound) 3. Newer surfactant • Synthetic surfactants with synthetic peptides modelled on surfactant proteins, Aerosolized surfactants. Dose: • Survanta 100mg/kg for the first and subsequent doses. • Curosurf 200mg/kg for the first dose and 100mg/kg for the subsequent doses or 100mg/kg for all the doses.
  • 26. Cont… The main indications : Prophylactic treatment:  Being use for infant delivered during 23-29 wk of gestation and birth weight 600-1250 g Neonates with gestation < 30 weeks of gestation. Surfactant given within 15 minutes of birth before a diagnosis of RDS is made.  Results : Improve dyspnea in first 48-72 hr of life (Decrease O2 requirement, ventilation improved) Decreased incidence of pneumothorax Decrease mortality
  • 27. Complications of surfactants: • Transient hypoxia, bradycardia and fluctuating BP • Rapid changes in lung compliance leading to barotrauma if not monitored. • Pulmonary hemorrhage - more with natural(5-6%) as compared to synthetic (1 -3%).
  • 28. Pharmacotherapy – beyond surfactant: Nitric oxide • Inhaled nitric oxide (iNO)– a selective pulmonary vasodilator improves oxygenation inpreterm infants with severe RDS. • Nitric oxide may be a signaling molecule in parenchymal lung growth & may reduce lung injury and chronic lung disease.
  • 29. Nursing diagnosis Impaired Gas Exchange related to decreased volumes and lung compliance, pulmonary perfusion and alveolar ventilation. Ineffective breathing pattern r/t inadequte pulmonary development secondary to prematurity. Ineffective thermoregulation r/t lack of subcutaneous fat secondary to prematurity and low birth weight and lack of subcutaneous fat stores. Imbalanced nutrition, less than body requirements r/t absent sucking reflex secondary to preterm birth and type of feeding. Risk for infection r/t immature body systems secondary to prematurity. Risk for impaired parent, infant attachment r/t premature birth & separation, lack of privacy