Revise the assessment and management of respiratory distress syndrome in newborns and outline the key clinical parameters that would require transfer to a neonatal intensive care unit

Tachypnoea (RR > 60)
Intercostal and subcostal recession (excessive use of accessory muscles of respiration)
Sternal and rib retraction
Flaring of nasal nares
Grunting
Cyanosis
Apnoea
Tracheal tug
Lethargy, pallor, bradycardia, apnoea (may be the first signs in young children)
CXR (as normal breath sounds can be heard in auscultation)

Causes

Respiratory HMD; meconium aspiration syndrome; TTN; congential pneumonia; pneumothorax; hydro/hemothorax
Upper airway abnormalities/ upper airway obstruction laryngomalacia; micrognathia; vocal cord anomalies; choanal atresia
Lower airway obstruction --> Tracheomalacia; tracheal stenosis; vascular stenosis; bronchiolar obstruction
Cardiac anomalies --> heart failure; mycoarditis; pericardial effusion; transpoistion of great arteries
Structural abnormalities --> diaphragmatic hernia; congential cystic lesions; diaphragmatic paralyssis
Chest deformities --> arthrohryposis; thoracic dystrophy
Haematological causes --> anaemia
CNS lesions --> Infections
Metabolic conditions --> metabolic acidosis

Meconium Aspiration Syndrome (MES)
- early onset of respiratory distress (within 2 hours) and hypoxaemia in a meconium stained infant due to passage of meconium at or prior to delivery. Commonly occurs at term or frequently:
Tachypnoea; cyanosis; hyperinflation
Inspiratory crackles; expiraotyr noises may be present
Global atelectasis; widespread opacification accompanied with hyperfinaltion and/ or atelectasis
O2; suctioning; nasal CPAP; intubation and PPV; fluid restriction; antibiotic therapy; IV therapy

Hyaline Membrane disease/ Respiratory distress syndrome

6 hours of birth --> worse after 12- 72 hours --> preterm infants; low gestational age. Incidence increases with decreasing gestation; RDS due to immaturitiy of surfactant and fluid clearance --> therefore lungs cant expand evenly or evenly) -->
Grunting; intercostal recession; nasal flaring; cyanosis; increased oxygen reequirements
ground glass; respiratory support with oxygen; assisted ventilation CPAP and IPPV and surfactant therapy; keep them warm; 10% dextrose if not feeding

	Created by Raymond Prasad over 7 years ago

Respiratory Note on Neonatal respiratory, created by Raymond Prasad on 23/04/2017.