
An approach to Respiratory Distress in Newborn By GohKiamSeong HTAR, Klang 2011
Plan • Introduction • Causes and Classification • Respiratory Distress Signs • Evaluation and Investigation • General Management
Introduction Respiratory Distress in Newborn = Abnormal respiratory signs in neonates
Tachypnoea Respiratory Rate: < 1 week up to 2 months: 60 or more 2 to 12 months: 50 or more 12 months to 5 years: 40 or more
Tachypnoea • Retractions • Due to negative intrapleural pressure generated between the contraction of diaphragm, respiratory muscles and the mechanical properties of lung and chest wall • Suprasternal Retraction SSR • Intercostal Retraction ICR • Subcostal Retraction SCR
Expiration through partially closed vocal cords to increase airway pressure and lung volume resulting in improved ventilation-perfusion (V/P) ratio • Low pitched expiratory sound. • Protective phenomenon to prevent collapse of alveoli: PEEP • Grunting
Video – Baby Grunting • Grunting Baby pt. 2.flv
Narrow nasal space contributes to total lung resistance • Nasal flaring decreases the work of breathing • Nasal Flaring
Cyanosis • Clinical detection of cyanosis depends on total amount of desaturated HB in blood • Anaemic infants may have low PaO2 that is missed clinically • Polycythaemic infants with normal PaO2 can appear cyanotic
Cyanotic Baby • Pink Baby
What respiratory distress signs you can see here in this child? Central cyanosis, +ICR, +SCR, +NF
Potter face: abnormal facies with a beak nose, receding chin, broad nasal bridge, epicanthal folds, and large low set ears
Meconium stained Nail Meconium stained Cord
Silverman Anderson Score for Premature Baby Score > 6 = impending Respiratory Failure Downe’s Score for Term Baby
Look for: • O2 Saturation • Metabolic/ respiratory acidosis/ alkalosis • Blood counts (Hb/TWC/Plt/Ht) • Glucose level • Sepsis causative agent • Collapse/Air Leak/CDH/ Cardiomegaly
General Management O2 Delivery PEEP/ Mechanical ventilation (CPAP/SiPAP) Intubation and suction • HR monitoring • Continuous SPO2 monitoring • Temp/DXT monitoring • I/O charting • Feeding (PO/TPN) • Cot/Incubator nursing • According to diagnosis
Definition • PRS is a facial difference caused by underdevelopment of the lower jaw • Characterised by: • Micro- and retrognathia • glossoptosis • respiratory obstruction • With or without cleft palate. • Incidence = 1:8500-14000 birth • =
Because underdeveloped lower jaw begins a sequence of events which leads to abnormal position of tongue and cleft palate. PRS is a sequence not syndrome!
Aetiology • Unknown • Recently identify may be caused by genetic anomalies at chromosomes 2, 11, or 17
PRS is often part of an underlying disorder or syndrome • Stickler syndrome • Velocardiofacial syndrome • Fetal Alcohol syndrome • Treacher Collins Syndrome
Pathophysiology At 12 -14/52 GA
How to diagnose? • Only by examining the patient at birth Complication • Difficulties in breathing and feeding.
GERD more prevalent in children with Robin sequence. (Dudkiewicz, CPCJ Mar 2000)
Our tactics • Position: Keep in prone or lateral position • Feeding: Tube feeding or Haberman feeder • Nutrition: Increase daily calorie intake • SPO2 monitoring
Other considerations • Endotracheal intubation/tracheostomy • Tongue lip adhesion • Ophthalmology follow up – if suspect Sticker syndrome (possible retinal detachment) • Mandibular distraction (distraction osteogenesis) • Cleft palate reparation (6.5 mo- 2 yo)
ChoanalAtresia • Choanalatresia is a congenital disorder where choana is blocked by abnormal bony or soft tissue formed during fetal development • Cause: unknown (thin tissue separating the nose and mouth area during fetal development remains after birth) • Most common nasal abnormality in newborn (1 in 7,000 live births) • : = 1 : 2 • >50% associated with other congenital disorder • Diagnosed shortly after birth
Types • Unilateral • Bilateral • Membranous • Osseous
Symptoms and Signs Cyanosis during feeding Pink while crying
Inability to nurse and breathe at same time • Inability to pass a catheter through each side of the nose into the throat • Persistent one-sided nasal blockage or discharge
Associated conditions • Coloboma • Heart defects • Retardation of growth or mental development • Genital/urinary abnormalities • Ear anomalies/deafness IF associated with all these ~ CHARGE syndrome (defect in Chromosome 8 CHD7 gene)
Tests that may be done include: • CT scan • Endoscopy of the nose • Sinus x-ray