Respiratory distress Flashcards
Which two or more cardinal signs does respiratory distress presents with
- Persistent tachypnea (> 60 breaths per minute).
- Central cyanosis (tongue) in room air.
- Sternocostal (sternum and rib) recession.
- Expiratory grunting.
- Nasal flaring
Predisposing factors of respiratory distress
- Preterm delivery.
- Underweight for gestational age or wasting (especially if covered in meconium).
- Fetal distress or failure to breathe well at birth.
- Complicated labour e.g. prolonged rupture of membranes or vacuum extraction.
- Infant of diabetic mother.
- Clinical chorioamnionitis in the mother.
- Elective caesarean section.
Respiratory causes of respiratory distress
- Hyaline membrane disease.
- Wet lung syndrome (transient tachypnea of the newborn).
- Meconium aspiration.
- Pneumonia.
- Chronic lung disease (bronchopulmonary dysplasia).
- Pneumothorax.
- Lung hypoplasia.
- Persistent pulmonary hypertension of the Newborn.
- Congenital diaphragmatic hernia
Non- Respiratory causes of respiratory distress
- Hypothermia.
- Metabolic acidosis.
- Anaemia or polycythaemia.
- Patent ductus arteriosus.
- Congenital heart disease
How do identify causes of respiratory distress
chest X ray
What is Hyaline Membrane Disease (HMD)?
Hyaline Membrane Disease (HMD), also known as respiratory distress syndrome (RDS), is the most significant cause of respiratory distress in newborn infants. It primarily affects preterm infants and can also occur in term infants born to poorly controlled diabetic mothers.
What causes Hyaline Membrane Disease?
Hyaline Membrane Disease is caused by a deficiency of surfactant in the infant’s lungs. Surfactant is essential for reducing surface tension in the alveoli, allowing for efficient gas exchange during respiration. Lack of surfactant leads to progressive collapse of the alveoli.
Why are preterm infants particularly susceptible to Hyaline Membrane Disease?
Preterm infants are particularly susceptible to Hyaline Membrane Disease due to their immature lungs and insufficient surfactant production. Their underdeveloped respiratory system makes them more vulnerable to respiratory complications, including alveolar collapse.
How can healthcare providers mitigate the risk factors for Hyaline Membrane Disease in preterm infants?
Healthcare providers should make every effort to avoid risk factors such as hypoxia, acidosis, and hypothermia in preterm infants, as these factors further inhibit surfactant synthesis. Implementing strategies to optimize respiratory support and thermal regulation can help reduce the risk of Hyaline Membrane Disease in these vulnerable infants.
When do the clinical signs of respiratory distress typically become apparent in newborn infants?
The clinical signs of respiratory distress, including tachypnea, recession, grunting, and cyanosis, are usually apparent at or soon after birth. These signs may worsen over the first 72 hours if left untreated before eventually improving.
How do infants with respiratory distress typically position themselves?
Infants with respiratory distress often adopt the frog position, where they lie with their hips abducted and knees flexed. This position may help alleviate some of the respiratory effort.
What are the characteristic findings on chest X-ray in infants with respiratory distress syndrome (RDS)?
The chest X-ray of infants with respiratory distress syndrome typically shows an under-expanded chest with a fine reticulo-granular appearance over both lung fields. “Air-bronchograms” extend beyond the borders of the heart and thymus, and the outline of the cardiothymic shadow may be indistinct.
What complications may arise as Hyaline Membrane Disease progresses?
As Hyaline Membrane Disease progresses, infants may develop ventilatory failure, characterized by rising carbon dioxide concentrations in the blood. Additionally, prolonged cessations of breathing, known as “apnea,” may occur, further complicating the condition.
What measures can be taken to prevent Hyaline Membrane Disease in newborn infants?
To prevent Hyaline Membrane Disease in newborn infants, efforts should be made to avoid preterm delivery and elective cesarean section before 39 weeks gestation whenever possible. Additionally, antenatal steroids should be administered to all women at high risk of preterm delivery before 34 weeks gestation to accelerate fetal lung maturity.
How are antenatal steroids administered to pregnant women to prevent Hyaline Membrane Disease?
Antenatal steroids are typically administered intramuscularly to pregnant women at high risk of preterm delivery. Two doses of betamethasone are given 24 hours apart, with the aim of delaying delivery for at least 48 hours to allow for optimal lung maturation in the fetus.
What is the significance of antenatal steroids in preventing Hyaline Membrane Disease?
Antenatal steroids play a crucial role in reducing both the incidence and severity of Hyaline Membrane Disease. By accelerating fetal lung maturity, these steroids help reduce the risk of respiratory complications in preterm infants born prematurely.
Why is delaying delivery for 48 hours after administering antenatal steroids important?
Delaying delivery for 48 hours after administering antenatal steroids allows sufficient time for the steroids to exert their effects and promote fetal lung maturation. This delay enhances the efficacy of the steroids in preventing Hyaline Membrane Disease in preterm infants.
What is the primary aim of treatment in newborn infants with respiratory distress syndrome (RDS)?
The primary aim of treatment in newborn infants with respiratory distress syndrome (RDS) is to prevent progressive alveolar collapse, maintain oxygen saturation at 88 to 92%, regulate body temperature, and ensure normal blood glucose concentration. Adequate nutrition is also essential for supporting the infant’s growth and development.
How should sick infants with respiratory distress syndrome be managed in terms of handling and monitoring?
Sick infants with respiratory distress syndrome should be handled as little as possible to minimize stress and respiratory effort. Regular and frequent observations, including monitoring of skin temperature, color, heart rate, and respiration, should be recorded to assess the infant’s condition and response to treatment.
Why is it important to maintain oxygen saturation within the range of 88 to 92% in infants with respiratory distress syndrome?
Maintaining oxygen saturation within the range of 88 to 92% in infants with respiratory distress syndrome helps prevent the potential complications associated with both hypoxia and hyperoxia. This optimal oxygen saturation range balances the need for sufficient tissue oxygenation while minimizing the risk of oxygen toxicity.
How can healthcare providers ensure adequate nutrition for infants with respiratory distress syndrome?
Healthcare providers can ensure adequate nutrition for infants with respiratory distress syndrome by providing appropriate feeding support, which may include enteral feeding via feeding tubes or parenteral nutrition if enteral feeding is not feasible. Ensuring adequate caloric intake is crucial for supporting the infant’s energy needs during this critical period of growth and development
What is the primary objective of treatment for newborn infants with respiratory distress syndrome (RDS)?
The primary objective of treatment for newborn infants with respiratory distress syndrome (RDS) is to relieve hypoxia, which is achieved by ensuring adequate oxygenation of the lungs and tissues.
What is the preferred method for providing respiratory support in infants with RDS, and why?
Nasal prong CPAP (continuous positive airway pressure) is the preferred method for providing respiratory support in infants with RDS, as it helps maintain lung expansion and prevents alveolar collapse. Early initiation of nasal CPAP is essential to improve oxygenation and respiratory function.
Why is it important to monitor oxygen concentration and arterial blood gases in infants receiving oxygen therapy?
Monitoring oxygen concentration (FiO2) and arterial blood gases (PaO2 and SaO2) is crucial in infants receiving oxygen therapy to prevent potential complications associated with both hypoxia and hyperoxia. This ensures that the infant receives the appropriate level of oxygen to maintain optimal oxygen saturation without causing oxygen toxicity
How is oxygen saturation typically monitored in infants with respiratory distress syndrome?
Oxygen saturation is typically monitored using a pulse oximeter, which provides continuous non-invasive monitoring of oxygen saturation levels in the blood. This allows healthcare providers to assess the infant’s oxygenation status and adjust oxygen therapy as needed.
What is the target range for arterial oxygen tension (PaO2) in infants with respiratory distress syndrome?
The target range for arterial oxygen tension (PaO2) in infants with respiratory distress syndrome is between 7 and 10 kPa (50–80 mmHg). This range ensures adequate oxygenation of tissues while minimizing the risk of oxygen toxicity.
What is the standard procedure for administering surfactant replacement therapy in newborns with respiratory distress syndrome (RDS)?
The standard procedure for administering surfactant replacement therapy in newborns with respiratory distress syndrome (RDS) is known as Less Invasive Surfactant Administration (LISA). This involves administering surfactant via the endotracheal route using an ‘in-and-out’ technique.
When should surfactant replacement therapy be considered in infants with worsening respiratory distress syndrome?
Surfactant replacement therapy should be considered in infants with worsening respiratory distress syndrome if the condition deteriorates despite other interventions such as nasal CPAP. If respiratory distress continues to worsen, surfactant therapy can be initiated to improve lung function and oxygenation.
What are the potential treatment options if respiratory distress syndrome does not respond to surfactant replacement therapy?
If respiratory distress syndrome does not respond to surfactant replacement therapy, other treatment options may include intermittent positive pressure ventilation or high-frequency oscillation. These advanced ventilation techniques help support respiratory function in infants with severe respiratory distress.
What is the typical outcome for infants with hyaline membrane disease (HMD) after receiving surfactant replacement therapy?
Infants with hyaline membrane disease (HMD) typically show improvement in respiratory distress following surfactant replacement therapy. With appropriate management including antenatal steroids, surfactant administration, and early nasal CPAP, many infants with HMD can avoid the need for mechanical ventilation, leading to better outcomes and shorter hospital stays.
How can hypothermia be prevented in newborn infants?
Hypothermia in newborn infants can be prevented by ensuring they are nursed under a radiant heat source or in a closed incubator with temperature control to maintain a neutral thermal environment. This helps minimize oxygen requirements and prevents heat loss from the infant’s body.
What are the recommended methods for providing nutrition to newborn infants initially?
: Initially, fluid, electrolyte, and energy requirements should be supplied by intravenous infusion. Milk feeds via nasogastric tube should be initiated as soon as possible, provided the infant does not vomit. In some cases, total parenteral nutrition may be necessary for a few days to ensure adequate nutrition.
Why is it important to prevent hypothermia in newborn infants?
Preventing hypothermia in newborn infants is crucial because hypothermia can lead to various complications, including respiratory distress, hypoglycemia, and increased oxygen requirements. Maintaining a stable body temperature helps optimize physiological function and promotes overall well-being in newborns.
When should milk feeds via nasogastric tube be initiated in newborn infants?
Milk feeds via nasogastric tube should be initiated as soon as possible in newborn infants, provided they do not have any contraindications such as vomiting. Early initiation of feeds helps meet the infant’s nutritional needs and supports growth and development.
How can respiratory acidosis due to high PaCO2 be corrected in newborn infants?
Respiratory acidosis due to high PaCO2 in newborn infants can be corrected by improving ventilation. This may involve interventions such as adjusting ventilator settings or providing respiratory support to enhance gas exchange and decrease carbon dioxide levels in the blood.
Is mild respiratory acidosis a cause for concern in newborn infants?
Mild respiratory acidosis is generally well tolerated and is not typically an indication for ventilation in newborn infants. However, healthcare providers should monitor the infant’s condition closely and intervene if respiratory acidosis worsens or if other complications arise.
How can metabolic acidosis in newborn infants be managed effectively?
Metabolic acidosis in newborn infants can usually be managed effectively by ensuring adequate oxygenation, maintaining normal body temperature, and providing hydration. Addressing the underlying cause of metabolic acidosis, such as fluid imbalance or electrolyte abnormalities, is essential for correction
What interventions can help improve metabolic acidosis in newborn infants?
Improving metabolic acidosis in newborn infants involves addressing contributing factors such as hypoxia, hypothermia, or dehydration. Providing appropriate oxygen therapy, maintaining normal body temperature, and ensuring adequate fluid intake can help correct metabolic acidosis and restore acid-base balance
Early Complications of HMD
- Pneumothorax.
- Intraventricular haemorrhage.
- Heart failure due to a persistent patent ductus arteriosus
Late Complications of HMD
Chronic lung disease (Bronchopulmonary dysplasia)
What is transient tachypnoea of the newborn (TTN)/ Wet lung syndrome
Transient tachypnoea of the newborn (TTN) is a respiratory condition that occurs shortly after delivery, typically in term newborn infants, especially following elective Caesarean section. It is characterized by rapid breathing (tachypnoea) and signs of respiratory distress due to retained lung fluid.
What is the most common cause of respiratory distress in term newborn infants?
The most common cause of respiratory distress in term newborn infants is transient tachypnoea of the newborn (TTN). This condition typically occurs shortly after delivery and is characterized by rapid breathing and chest recession due to retained lung fluid.
What are the typical symptoms of transient tachypnoea of the newborn (TTN)?
Typical symptoms of transient tachypnoea of the newborn (TTN) include rapid breathing (tachypnoea), chest recession (visible inward movement of the chest wall), and signs of respiratory distress such as nasal flaring or grunting. Infants with TTN may also present with mild cyanosis or difficulty feeding.
How is transient tachypnoea of the newborn (TTN) managed?
Management of transient tachypnoea of the newborn (TTN) often involves supportive care to ensure adequate oxygenation and respiratory function. This may include supplemental oxygen therapy, respiratory support such as nasal continuous positive airway pressure (CPAP), and close monitoring of the infant’s respiratory status. In most cases, TTN resolves spontaneously within a few days.
What are the features of respiratory distress in newborns with wet lung syndrome (transient tachypnoea of the newborn)?
Newborns with wet lung syndrome typically exhibit respiratory distress within an hour or two of birth. Signs may include rapid breathing, chest recession, and hyperinflation of the chest. Infants may also present with symptoms such as nasal flaring, grunting, or mild cyanosis.