Respiratory distress in the newborn 

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ADDITIONAL TAGS:
Disease:
Pathophys:
Signs / symptoms:
Diagnosis:
Treatment / mgmt:
Transient tachypnea of the newborn
Delayed reabsorption of alveolar fluid → persistent fluid retained in lungs
Risk thought to be c/sections but unclear
Tachypnea; mild; cyanosis and hypoxia are less likely
CXR: parenchymal interstitial infiltrates, appears “wet”; intralobular fluid accumulation
Supportive; +/- oxygen: +/- CPAP/intubation if needed
Respiratory distress syndrome
Low surfactant + underdeveloped lungs → increased alveolar surface tension → alveolar collapse and diffuse atelectasis → V/P mismatch → intrapulmonary shunting
Can later lead to BPD
Preterm baby; tachypnea, retractions (increased WOB), hypoxia and cyanosis within minutes to hours of birth
Breath sounds are symmetric and coarse but decreased
CSR: diffuse alveolar collapse → air bronchograms (patent air-filled bronchioles surrounded by opacified alveoli); homogeneous infiltrates; “ground glass appearance”; decreased lung volumes. lecithin/sphingomyelin (L:S) ratio 2:1
Surfactant; Antenatal corticosteroids 24 hrs before delivery
+/- CPAP
Meconium aspiration syndrome
Pass meconium in utero → gets into lungs → bronchiolar obstruction and irritation
Term or post term baby; meconium stained amniotic fluid; tachypnea; hypoxia
CXR: patchy bilateral infiltrates (looks like pneumonia) and atelectasis; lung hyperinflation; +/- consolidation
Resuscitation, ventilation, oxygen, surfactant
Broncho-
pulmonary dysplasia
Prolonged ( 1) month oxygen therapy; often caused by respiratory distress syndrome, extended ICU care
Recurrent desats, persistent O2 requirement; similar to ARDS/NRDS: tachypnea, grunting, nasal flaring
CXR: coarse lung markings with cystic changes
oxygenation, +/- diuretics, +/- glucocorticoids. Most improve over months, some → PAH
Congenital diaphragmatic hernia
Holes in diaphragm → bowel herniates → hypoplastic lung
Auscultate bowel sounds over the lungs; absent breath sounds on affected side; scaphoid abdomen; dyspnea
CXR: loops of bowel in thorax; displaced cardiac silhouette
Intubation and ventilation; +/- surfactant; stabilize → surgery
Persistent pulmonary hypertension of the newborn
Persistence of fetal high pulmonary pressures → persistent high R-L shunting across PDA
Respiratory distress; prominent S2 (signifies high pulmonary pressures)
Clinical; lower post ductal O2 (left arm, lower extrem) compared to preductal (right arm)
Oxygen, ventilation; nitric oxide which dilated pulmonary vasculature
Apnea of prematurity
Immature respiratory centers in the pons and medulla; affects 99% babies born 28 w
Intermittent apnea (breathing stops for 20 sec); +/- brachycardia; +/- desats; otherwise well appearing
Clinical; rule out other causes (infxn, seizure)
Wait it out; +/- caffeine; +/- ventilation (noninvasive)
Pneumothorax
Often i/s/o mechanical ventilation
Acute or sudden onset worsening of respiratory distress
Asymmetric breath sounds
CXR: radiolucent zone between lungs and chest wall
Supportive, possible needle decompression
Respiratory distress in the newborn
If there is neonatal cyanosis and only the distal extremities are blue with normal SpO2, then reassure, it's only peripheral cyanosis
If there is mucosal or diffuse cyanosis with low SpO2, then its central cyanosis. Give O2.
If SpO2 increases, then its pulmonary pathology and give resp support (intubate, ventilate)
If SpO2 doesn't change or patient is HD unstable, then its cardiac path, give prostaglandin to keep PDA open