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