Neonatal Respiratory Distress

Differential Diagnosis

  • Respiratory distress syndrome (Hyaline membrane disease)
  • Pneumonia
  • Pneumothorax
  • Surgical conditions (diaphragmatic hernia)
  • Cardiac causes

History

  • Pregnancy (GA)
  • Ultrasound results
  • Labor (febrile, meconium)
  • Length of ruptured membranes

Clinical features

  • Tachypnea (>60)
  • Indrawing, tracheal tug
  • Cyanosis
  • Expiratory grunting
  • Poor saturation on room air

Investigations

  • CXR

Management

  • O2, suction , keep warm at delivery
  • NPO
  • Monitor vital signs
  • Monitor blood gas
  • Respiratory support (O2, CPAP, IPPV)
  • Treat infection

Hyaline Membrane Disease

  • Surfactant deficiency in the immature lung
  • Commonest cause of death in premature infants
  • Commonest cause of disability in infants who survive the condition
  • 70% GA 28wk, 25% GA 34wk
  • Chest x-ray shows: air bronchograms, ground-glass appearance of lung fields
  • Treatment: Titrate O2, CPAP, mechanical ventilation, exogenous surfactant (steroids may be given to mother 48hr prior to delivery)

Transient Tachypnea of Newborn

  • Due to “wet lungs”
  • More likely to present following quick labour (slow or decreased absorption of fetal lung fluid)
  • Child will be in respiratory distress – early onset tachypnea, may have indrawing, grunting, cyanosis
  • Relieved by minimal oxygenations (<40%)
  • Chest x-ray shows: prominent central pulmonary vascular markings, fluid lines in fissures, hyperaeration, flat diaphragm, cardiomegaly, pleural fluid
  • Self limited condition with no recurrence and no residual pulmonary dysfunction – improvement within 12 – 72 hours

Meconium Aspiration Syndrome

  • Aspiration induces hypoxia via 3 major pulmonary effects, which are airway obstruction, surfactant dysfunction, and chemical pneumonitis
  • History: Presence of meconium in amniotic fluid is required; urine may be green due to meconium pigments absorbed in lung and excreted in urine

Pneumonia

  • Newborn: Listeria, Enterococcus, E.coli, GBS, S. aureus
  • Child: Mycoplasma, Strep pneumo, Hemophilus, Chlamydia

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