Respiratory Distress Syndrome

Respiratory
Distress

Sequele/Disabili
ty

Diagnostic Approach
Respiratory Distress

of

History

Death
Early
Diagnosis,
Quick
Prompt treatment
Occurs in 4-6% newborn
Many are preventable

and

Respiratory distress due to several

causes with the symptom comprises :

RR > 60 x/mnt

in room temperature

Bleed

Metabolic Hypoglycemia
Medical
:
MAS,
TTN,
Pneumonia , Asphyxia, Acidosis

HMD,

Medical : Meconeum Aspirattion

Syndrome , Transient Tachypnea of
Newborn , Hyaline Membrane Disease,
Pneumonia , Asphyxia, Acidosis
Surgical
:
Tracheo-oesophageal
Diaphragmatic hernia

Hyaline Membrane Disease

Pneumonia
Transient takhypnea
Asphyxia

KKA-172

PROM,

Antenatal steroids
Predisposing
fever

factors

Asphyxia
Aspiration

None
None
Good

Transient Takhypnea of Newborn

1
2
6080
>80
None with Needs>40%
40% Fi O2
FiO2
Mild
Severe
Minimal
Obvious
Decreased
Very poor

Chest Examination

Air entry

Mediastinal shift
Adventitious sounds
Hyperinflation
Heart sound

Pre-term
etiology

Possible

Eary progressive - RDS or

HMD

Asphyxia,
Hypotermia

Pneumonia

Early
transient
Metabolic
causes,

Term Possible etiology

Acidosis
Others

Gestation

Retraction
Grunting
Air entry

Meconeum aspiration Syndrome

Malformation

PROM,

Aspiration

0
< 60
None

Pneumothorax,
fistula,

In Term :

Asphyxia

Score
Rate
Cyanosis

In Preterm :

factors

Assessment of Respiratory
Distress

Cardiac

Congenital
Heart
Disease , Myocardial dysfunction
CNS Asphyxia, IC

Predisposing
fever

Chest indrawing

Causes of Respiratory Distress

Pulmonary

Grunting

Cyanotic

Antenatal steroids

Examination

Onset of distress

Dyspnea
Tachypnea :

Gestation

Definition

Onset of distress

Early well looking - TTN,

Polycythemia
Early severe distress MAS < Asphyxia, Malformation
Mira Yulianti (01-107)

Late
sick
hepatomegaly - Cardiac
Late sick with
Acidosis

with
shock

PROM
IUGR
Steroids, TRH

Investigation
Gastric aspirate : Shake test,
Polymorph count
Sepsis screen : Septic Work Up
Chest Xray : absolutely to be
done

Shake Test

Take a test tube mix

ml gastric aspirate
+
0,5 ml absolute alcohol

0.5

Shake for 15 seconds

Allow to stand

15 minutes

Suspect Surgical Cause

Surfactant Deficiency
(amniotic
fluid
,
gastric
aspirate =

Respiratory Distress
Management

Congenital
Malformation
--- Respiratory Distress
Tracheo

oesophageal

fistula
Diaphragmatic hernia
Lobar emphysema
Pierre Robin Syndrome
Choanal atresia

ratio
test

Preterm baby
Early onset within 6 hrs
Supportive evidence of L/S
< 1.5 , or negative Shake
Radiology evidence

Pathogenesis of RDS

Decreased
or
abnormal
surfactant
Alveolar collapse
Impaired gas exchange
Respiratory failure

Predisposing factor - RDS

Prematurity
Caesarean section
Asphyxia
Maternal diabetes

Protective factor - RDS

KKA-172

I V fluids
Maintain vital sign
Oxygen therapy
Respiratory support
Specific

Antenatal corticosteroid
Simple therapy that saves neonatal
lives !!!

Preterm
labor
2434
weeks of gestation
irrespective
of
PROM,
hypertension
and
diabetes

Dose
:
Injection
Betamethasone 12 mg IM every 24 hrs,
two
doses,
or
Injection
Dexamethasone 6 mg IM every 12 hrs,
four doses

Respiratory Distress
Syndrome

Monitoring
Supportive :

Obvious malformation
Scaphoid Abdomen
Frothing
History of aspiration

Shake test
Lecithin/Sphingomyelin ratio
Phosphatidyl glycerol level

Oxygen Therapy
Indications :
All babies with distress
Cyanosis
Hypoxia

Methods :
Nasal catheter
Nasal prongs
Mask
Hood/Head Box
Ventilator Mechanic

I.V. Fluids

Depend
baby :

on

conditions

of

Shock, Dehydrated ?
Birth weight
Metabolic Disturbance

D 5%, D 10%,
saline, Mixing Fluids

Dose : depend on body weight

and day of life

RL,

Normal

Mira Yulianti (01-107)

Consider
requirement

Electrolyte

Supportive treatment
Medication

Nutrition or Feeding
Nursing care

Medication
Antibiotics
:
if
infection
developes
Ampicilline + Gentamicin
Cefotaxime , etc
Depend on culture and/or Clinical
signs
Sodium
bicarbonate,
Epinephrine
etc
Calcium Gluconate
etc

Nutrition
Breast Feeding

First choice

Given as soon as
possible
regarded
to
baby
condition :
stable, possible
to be given oral feeding

Might be given to
ventilated baby

Parenteral
Nutrion :

Total
Parenteral Nutrition

Partia
l Parenteral Nutrition
Nursing Care

surface etc

procedures.

Physiotherapy

if indicated

Warm,
Limited

dry

cot,

Meconium Aspiration Syndrome

Meconium staining : Antepartum,

intrapartum

Thin : Chemical pneumonitis

Thick : Atelectasis, airway

blockage , airleak syndrome

Post term/SFD

Meconium staining : cord, nail,

skin

Onset within 4 to 6 hrs

KKA-172

Prevention
by
suction
before
shoulder

Elective ET suction if baby is

depressed and or thick meconium

Oxygen therapy

oropharyngeal
delivery
of

IV fluids
Antibiotics if indicated

Congenital Pneumonia

Predisposing factors :

PROM > 24 hrs

foul smelling liquor
peripartal fever
unclean or multiple P/V
Treatment :
Thermoneutral environment,
Nil per oral , IV Fluids,
Oxygen
Antibiotics (Ampi + Genta)

Pneumothorax

Etiology : Spontaneous, MAS

Clinical features :

Proper daily care

Rehabilitation

Specific Condition

Hyperinflated

Transient Tachypnea of The Newborn

Caesarean born

Delayed clearence of lung fluid

Diagnosis by exclusion

Management supportive

Prognosis Good

invasive

Blood transfusion :

Chest x ray :
chest
Management :

Sudden distress
Indistinct heart sounds
Management :
Needle aspiration
Chest tube

RDS : Needing Referral

RDS (HMD)
MAS
Surgical or Cardiac disease
PPHN
Severe or worsening distress

Mira Yulianti (01-107)