RESPIRATORY DISTRESS

SYNDROME

MECONIUM ASPIRATION
SYNDROME

SEPSIS

HYPERBILIRUBINEMIA

SUDDEN DEATH SYNDROME

¨ RDS occurs primarily in premature infants;
its incidence is inversely related to
gestational age and birthweight
¨ The incidence is highest in preterm male
¨ The most common cause of death of
premature infants
¨ This is a serious lung disorder
characterized by insufficient
surfactant that causes the alveoli to
collapse on expiration that greatly
increases the work of breathing.
¨ Surfactants:
Lecithin/Sphingomyelin – 2:1
Phosphatidylcholine
Phosphatidylglycerol
¨ PREMATURITY
¨ MATERNAL DIABETES
¨ MECONIUM ASPIRATION SYNDROME
¨ PNEUMONIA – associated with PROM and
prolonged labor
¨ ASPHYXIA
¨ TRANSIENT TACHYPNEA
¨ CNS DEPRESSION – associated with
maternal analgesia and anesthesia
¨ Surfactant deficiency (decreased
production and secretion) is the primary
cause of RDS
¨ The major constituents of surfactant are
dipalmitoyl phosphatidylcholine (lecithin),
phosphatidylglycerol, apoproteins
(surfactant proteins SP-A, -B, -C, -D), and
cholesterol
¨ Synthesized and stored in type II alveolar
cells
¨ Mature levels of pulmonary surfactant are
¨ Tachypnea
¨ prominent (often audible) grunting
on expiration
¨ chest retractions
¨ nasal flaring
¨ Generalized cyanosis increases
often relatively unresponsive to
oxygen administration
¨ pallor
¨ Decreased breath sounds
¨ Hypotension and shock
¨ Clinical course
¨ x-ray of the chest
¨ blood gases- respiratory acidosis
(higher level of carbon dioxide) and
hypoxemia (decreased oxygen level)
¨ Pulse oxymetry
¨ Electrocardiograms
¨ Silverman-Andersen Index
 Assess 0 1 2

Chest Synchronized Lag on See-saw

movement respiration respiration
Intercoastal None Just visible Marked
Retraction

Xiphoid None Just visible Marked

Retraction
Nares dilatation None Minimal Marked

Respiratory None Audible by Audible by ear

grunt stethoscope
¨ Avoidance of unnecessary or poorly timed
cesarean section, appropriate management
of high-risk pregnancy and labor, and
prediction and possible in utero
acceleration of pulmonary immaturity
¨ Administration of betamethasone to women
48 hr before the delivery of fetuses between
24 and 34 wk of gestation significantly
reduces the incidence, mortality, and
morbidity of RDS
¨ Monitor blood gases, auscultate
breath sounds
¨ Keep in isolette or radiant warmer
to avoid hypothermia and
minimize oxygen consumption
¨ Maintain core temperature
between 36.5 and 37.2°C
¨ CPAP (Continuous positive airway
pressure)
Therapeutic range is 10-12 cm of water
pressure.
- first 72 hours – increase pressure to keep
airway open
- After 72 hours – decrease pressure for
airways are already open
¨ Glucocorticoid (Celestone) – artificial
surfactant
¨ BT to replace extracted blood used
for tests
¨ Give milk by gavage (orogastric) if
newborn has mild tachypnea
¨ Place NB on the back or in a side
lying position with the neck slightly
extended
¨ Hold BF to conserve energy –
maybe on NPO and given IVF
¨ TEMPERATURE: 36.5-37.5
¨ Ph: 7.35-7.45
¨ pCO2: 35-45
¨ pO2: 80-100
¨ HCO3: 22-26
¨ O2 Saturation: 94-100%
¨ Septicemia
¨ Bronchopulmonary dysplasia (BPD)
¨ Patent ductus arteriosus (PDA)
¨ Pulmonary hemorrhage
¨ Apnea/bradycardia
¨ Retinopathy of prematurity
¨ Occurs when the meconium
stained amniotic fluid is aspirated
by the fetus before or after
delivery
¨ Meconium-stained amniotic fluid
is found in 10–15% of births and
usually occurs in term or post-
term infants
¨ Relaxation of anal sphincter
¨ Accelerated intestinal peristalsis and
passage of meconium
¨ Reflex gasping and aspiration of
meconium mixed in amniotic fluid
¨ Air trapping, mechanical obstruction by
particles of meconium - more often with the
1st breath, thick, particulate meconium is
aspirated into the lungs
¨ The resulting small airway obstruction may
produce respiratory distress within the 1st
hours, with tachypnea, retractions, grunting,
and cyanosis observed in severely affected
infants
¨ Signs of infection
¨ Overdistention of the chest may be
prominent
¨ The condition usually improves within
72 hr, but when its course requires
assisted ventilation, it may be severe
with a high risk for mortality
¨ Tachypnea may persist for many days
or even several weeks
¨ rapid identification of fetal
distress and initiating prompt
delivery in the presence of fetal
acidosis, late decelerations, or
poor beat-to-beat variability
¨ SUCTIONING AFTER HEAD IS
DELIVERED
¨ OXYGENATION AND VENTILATION
¨ ADMINISTER PRESCRIBED:
- ANTIBIOTIC THERAPY
- BICARBONATE FOR ACIDOSIS
¨ MONITORING OF BLOOD GASES
¨ WATCH OUT FOR SEIZURE, GIT
BLEEDING, AND RENAL FAILURE
¨ Routine intubation to aspirate the
lungs of vigorous infants born
through meconium-stained fluid is not
recommended
¨ Depressed infants (those with
hypotonia, bradycardia, fetal acidosis,
or apnea) should undergo
endotracheal intubation, and suction
should be applied directly to the
endotracheal tube to remove
meconium from the airway
¨ The systemic inflammatory response
syndrome (SIRS) is an inflammatory
cascade that is initiated by the host in
response to infection with bacteria,
rickettsiae, fungi, viruses, and
protozoa

¨ This inflammatory cascade occurs

when the host defense system does
not adequately recognize or clear the
infection
¨ Type of neonatal infection and
specifically refers to the presence of
bacterial blood stream infection (BSIS) in
newborn.
EARLY ONSET:
- Within 24-72 hours

- Onset is most rapid in premature

neonates
- Associated with acquisition of m.o. from
the mother:
¨ Etiologic Agents:
- Grp B streptococcus

- E. coli

- Haemophilus influenzae

- Lysteria monocytogenes

Ex. Pneumonia
LATE ONSET
- 4-90 days of life from the caregiving
environment
Etiologic agent:
1. E. coli

2. Staphylococcus aureus

3. Pseudomonas

4. candida

- Ex. Meningitis

- bacteremia
Early Onset:
¨ Prematurity

¨ ROM longer than 18 hours before birth

¨ Infection of the placenta and amniotic

fluid
Late Onset:
¨ Presence of IV cannula for a long time

¨ Prolonged hospitalization
¨ SEPSIS
¨ SEVERE SEPSIS – organ dysfunction

-decreased urine output

- Altered mental status

- -abdominal pain

- Decreased platelet count

¨ SEPTIC SHOCK –sepsis-induced

hypotension
DEATH
¨ Body temperature changes
¨ Breathing problems
¨ Diarrhea or decreased bowel movement
¨ Low blood sugar
¨ Reduced movements
¨ Reduced sucking
¨ Tachycardia/bradycardia
¨ Vomiting
¨ jaundice
¨ Blood Culture
¨ CBC
¨ Lumbar puncture
¨ Chest X-ray
¨ Antibiotic – IV
¨ IVF – prevent dehydration and kidney
failure
¨ Oxygen administration

¨ Vasopressors to increase BP

Ex. Dobutamine
Blood transfusion: PRBCs, platelets, Fresh
Frozen Plasma (FFP )
¨A
CONDITION IN
WHICH THERE IS TOO
MUCH BILIRUBIN IN
THE BLOOD
¨ Bilirubin is the yellow breakdown product
of normal haeme catabolism. Haeme is
found in haemoglobin, a principal
component of red blood cells. Bilirubin is
excreted in bile and urine, and elevated
levels may indicate certain diseases.
¨ Formula: C33H36N4O6
¨ Molar mass: 584.66 g/mol
¨ Soluble in: Water
Normal level: 1mg/dl of blood
@ 2-3 mg/dl = jaundice
4-6 = very pathological
12-20 = KERNICTERUS
¨ Occurs around the second to the third
day of life
¨ More than 50% of all FT babies and as
many as 80% or premature infants
¨ Occurs first in the face, then the chest,
stomach and legs
¨ Lasts for a week to 10 days in FT
¨ Lasts for 2 weeks in premature and
breastfed babies
¨ Breast Milk – has component that blocks
action of GLUCORONYL
TRANSFERASE converts INDIRECTS to
DIRECT BILIRUBIN to be excreted by
the body.

¨ MGT: SUNLIGHT – promotes oxidation

of indirect bilirubin

¨ Expose baby only until 7:30am

¨ Occurs as a result of a disease or
abnormal condition
¨ Major danger: KERNICTERUS
¨ May lead to brain damage, deafness,
severe developmental disabilities and an
unusual form of cerebral palsy
1. Present at birth or during the first 24 hours
¡ Prematurity – immature liver
¡ Hemolytic disease – Rh or ABO
incompatibility
¡ Birth trauma with subsequent bleeding
(Cephalhematoma)
¡ Infection
¡ Breastmilk hormone pregnanediol
¡ Hypothermia
¡ Medications
2. Develop during or that lasts past the
second week of life:
¨ Liver malfunction

¨ Severe infection

¨ Enzyme deficiency

¨ Abnormality of infant’s RBCs

¨ Appears early, up to 24 hours after birth
¨ Unusual pattern of progression is from
head to feet
¨ Yellow to bronze coloration of the skin,
sclera and mucous membranes
¨ Dark concentrated urine (often
dehydrated)
¨ Behavior changes (irritability, lethargy)
¨ Poor muscle tone
¨ Increased serum bilirubin
¨ Prevent conditions that contribute to
development of hyperbilirubinemia (cold
stress, hypoxia, hypoglycemia,
dehydration and infection).
¨ Carefully asses NB at risk for
hyperbilirubinemia for early recognition
and treatment
¨ More frequent feedings
¨ Using formula milk
¨ Implement phototherapy if ordered

! Color of light = bluish to purple

! Distance (baby and lamp) = 12-18 inches

CONSIDERATIONS:
! Unclothe infant for maximum skin
exposure to light, diaper minimally
! Cover eyes to prevent retinal damage

! Cover genitalia
! Frequent position change – every 2 hours
! Frequently check TEMPERATURE
! Inform mother that stool will be dark in
color
! Remove from phototherapy for feeding
! Observe skin for signs of irritation
! Record phototherapy time
! Provide extra fluids to excrete bilirubin
¨ Sudden unexplained death in infancy
¨ Peak age of incidence – 2 to 4 mos
¨ Cause is unknown
¨ Apnea
¨ Viral respiratory
¨ Pulmonary edema
¨ Brain stem abnormalities
¨ Neurotransmitter deficiencies
¨ Heart rate abnormalities
¨ Distorted familial breathing patterns
¨ Decreased arousal responses
¨ Possible lack of surfactant in alveoli
¨ Sleeping prone