Respiratory Problems in Newborn (Edited)

REVIEW IN
PEDIATRIC
NURSING
PREPARED BY:
MARY HAZEL S. FACUNDO
Edit: Rachel Fuentes Noe.
Elizabeth T. Benigno
Objectives
• Compare & contrast a termed neonate from a preterm neonate
• Explain how cold stress could occur in preterm babies
• List down nursing responsibilities essential for the first few
hours of the preterm neonate
• Discuss how RDS develops
• Explain the effects of meconium aspiration
• List at least 3 preventive measures for SIDS,
Pediatric Nursing
• is the medical care of neonates and children up to adolescence,
usually in an in-patient hospital or day-clinic.
Prematurity
• Born before 37th week of
gestation
• 0-12 weeks-1st trimester
• 12-24 weeks -2nd trimester
• 24- 37 weeks – 3rd trimester
• 37-38 weeks-normal age of
term babies
• 40-42 weeks – post term
Prematurity
• Low birth weight (LBW) – 1501
to 2500 gm
• 3 lbs and 5 oz to 5 lbs and 8 oz
• Very low birth weight(VLBW) –
1500 gm
• Appropriate for GA – 6 lbs

• Large for GA – 8 lbs
ACUTE CONDITIONS OF
THE NEONATES
Infantile Respiratory Distress Syndrome
also called respiratory is a syndrome in premature

infants caused by developmental
distress syndrome of insufficiency of pulmonary
newborn, or surfactant production and structural
increasingly surfactant immaturity in the lungs. It can also
deficiency disorder (SDD), be a consequence of neonatal
and previously called hyaline infection and can result from a
genetic problem with the production
membrane disease (HMD) of surfactant-associated proteins.
Appear within minutes of birth may not be recognized for
several hours in larger preterm.
Tachypnea (>60 breaths/min), nasal flaring, subcostal

and intercostal retractions, cyanosis & expiratory
grunting.
Breath sounds may be normal or diminished and fine
rales may be heard.
Progressive worsening of cyanosis & dyspnea.

Manifestations
Cyanosis and pallor increase & grunting decreases.
Apnea and irregular respirations are ominous signs.
Note:In most cases, symptoms and signs reach a peak

within 3 days, after which improvement occurs gradually.
CX-ray - "ground glass"
appearance, which often develops
6 to 12 hours after birth.
Diagnostic Blood gas Analysis

Exam
Echocardiography
Treatment
• Supportive treatment
- Scheduled “touch times” to avoid hypothermia and minimize
oxygen consumption.
- Place in an isolette or radiant warmer to maintain core
temperature between 37 °C.
• Nutritional support
• Oxygen support
- CPAP (Continuous Positive Airway Pressure)
- Intubation
- Mechanical ventilation
• Administration of Surfactant
Bronchopulmonary Dysplasia (BPD)
• BPD is a serious lung condition that affects newborns.
• Most newborns who develop BPD are born
• more than 10 weeks before their due dates
• weigh less than 2 pounds at birth
• have breathing problems
• develop it as a complication of another breathing
condition
• RDS
• infections, and lung injuries from treatments like mechanical
ventilation
Manifestations
• Breathing quickly
• Flaring nostrils
• Grunting
• Pulling at the chest (retractions)
CX-ray - the lungs of babies with
Diagnostic respiratory distress syndrome often
look like ground glass, and those with
Exam BPD often look spongy.
Blood Tests
Echocardiography
Complications
• Trouble feeding
• Gastroesophageal reflux disease
(GERD)
• Pulmonary hypertension
• Delayed speech and problems
with vision and hearing
• Infections
Treatment
The best way to treat BPD is to find the
underlying cause and treat
• NCPAP (Nasal Continuous Positive

Airway Pressure)
• Surfactant Replacement Therapy
• Medications – diuretics, bronchodilators
Immature Thermoregulating Center
Causes :
• Absence of shivering and sweating
response
• Small muscle mass
• Lack of subcutaneous fats
• Poor capillary response to
environmental changes
Cold Stress
• Hypothermia occurs
when the newborn’s
axillary temperature
drops below 36.3°C
Acrocyanosis and cool mottled or pale skin
( bluish, gray, white of fingers, toes and hands)
Hypoglycemia
Bradycardia
Tachypnea, restlessness, shallow and irregular

Manifestations respirations.
Respiratory distress, apnea, hypoxemia,
metabolic acidosis
Decreased activity, lethargy, hypotonia
Feeble cry, poor feeding.

Prevention and
management of
hypothermia
The “warm chain”

• Warm delivery room
• Immediate drying
• Skin-to-skin contact
• Breastfeeding
• Postpone bathing and
weighing
Prevention and
management of
hypothermia
• Appropriate clothing and blanket

• Mother and newborn together
• Warm transportation (KMC)
• Warm assessment (if newborn is
not skin-to-skin with mother)
• Training and raising awareness
• For severe hypothermia: Use a warm
incubator (should be set at 1 to 1.5°C higher
than the body temperature) and should be
adjusted as the newborn’s temperature
increases
Hyperbilirubinemia in
Neonates
• Infant jaundice
• Is a yellowish coloration
of the skin and sclera of
the eyes that develops
from deposits of the
yellow pigment bilirubin in
lipid tissues.
• Kernicterus – excessive
elevation of bilirubin 🡪
staining the base of the
brain 🡪 mental retardation
( permanent disabling)
CAUSES/FACTORS
● Physiologic Jaundice
● Breastfeeding Failure Jaundice
Genetic Problem
● Defect in the Liver
● Blockage of the bile duct
● Tumor in the Pancreas
● Gallbladder swelling
● Infection
• Unconjugated bilirubin
(Normal: 0.2 to 1.4 mg/dL) -
indirect bilirubin
- lipid soluble (indirect
reacting)
• Conjugated bilirubin
(Normal: 0.1 to 0.4 mg/dL)
- direct bilirubin
- water soluble (direct
reacting)
• Manifested as yellowing of
Clinical the:
- Face: 5 mg/dl
Assessment - Abdomen: 15mg/dl
of Jaundice - Soles: 20 mg/dl
• Jaundice usually becomes
apparent in a
cephalocaudal
progression.
• Lethargy
• Poor Feeding
direct and indirect bilirubin levels: these
reflect whether the bilirubin is bound with
other substances by the liver so that it can be
excreted (direct), or is circulating in the blood
circulation (indirect)
red blood cell counts.

Diagnostic Exam
blood type and testing for Rh incompatibility

(Coomb’s test)
• Phototherapy
• Fiberoptic blanket
• Exchange transfusion
• Ceasing breastfeeding for one
or two days
• Treat any underlying cause of
hyperbilirubinemia, such as
infection
FIBEROPTIC BLANKET/BILLI BLANKET
• A serious condition in which a
newborn breathes a mixture of
meconium and amniotic fluid
into the lungs around the time
of delivery.
• In some cases, the baby passes
stools (meconium) while still
inside the uterus.
• Result to : hypoxia in utero;
MECONIUM babies born breech
ASPIRATION
3 Ways in which meconium can cause SEVERE
Respiratory Distress
● Causes inflammation of the
bronchioles
● Can block small bronchioles

by mechanical plugging .
● Can cause a decrease in

surfactant production through
lung cell trauma.
Manifestations
Diagnostic Test Management
• oxygen therapy
• Blood Gas Test • use of a radiant warmer
• CXray
• antibiotics
• use of a ventilator
• extracorporeal membrane
oxygenation (ECMO)
ECMO
• Death of an apparently
healthy infant that remains
unexplained after a
thorough autopsy and death
scene investigation
• a baby younger than 1

Sudden year old
Infant Death
Syndrome
The “Triple-Risk Model” for SIDS
• The model holds that SIDS
occurs when three conditions
exist simultaneously
The “Triple-Risk Model” for SIDS
• the infant has an underlying
abnormality that makes him
unable to respond to low oxygen
or high carbon dioxide blood
levels ( e.g., brainstem)
• the infant is exposed to a
triggering event such as sleeping
face down on its tummy
● these events occur during a

vulnerable stage in the infant’s
development, i.e., the first six
months of life
Risks for SIDS
SIDS is more likely to affect a baby who is between 1 and 4

months old, it is more common in boys than girls, and most
deaths occur during the fall, winter, and early spring months
Risks for SIDS
Factors that may place a baby at higher risk
of dying from SIDS include the following:
• babies who sleep on their stomach or
their side rather than their back
• overheating while sleeping
• too soft a sleeping surface, with fluffy
blankets or toys
• mothers who smoke during pregnancy
• exposure to passive smoke from smoking
by mothers, fathers, and others in the
household doubles a baby's risk of SIDS
Risks for SIDS
• mothers who are younger than 20
years old at the time of their first
pregnancy
• babies born to mothers who had
little, late, or no prenatal care
• premature or low birth
weight babies
• having a sibling who died of SIDS
Reduce the risk
• putting your baby to sleep on his back
• using a firm sleep surface and keeping fluffy blankets and
stuffed animals out of his crib
• not overheating your baby or his room when he sleeps
• not smoking when you are pregnant and not allowing
anyone to smoke around the baby
• breastfeeding
END OF DISCUSSION

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REVIEW IN

• Appropriate for GA – 6 lbs

also called respiratory is a syndrome in premature

Tachypnea (>60 breaths/min), nasal flaring, subcostal

Progressive worsening of cyanosis & dyspnea.

Apnea and irregular respirations are ominous signs.

Note:In most cases, symptoms and signs reach a peak

Diagnostic Blood gas Analysis

• NCPAP (Nasal Continuous Positive

Tachypnea, restlessness, shallow and irregular

Feeble cry, poor feeding.

The “warm chain”

• Appropriate clothing and blanket

red blood cell counts.

blood type and testing for Rh incompatibility

● Can block small bronchioles

● Can cause a decrease in

• a baby younger than 1

● these events occur during a

SIDS is more likely to aﬀect a baby who is between 1 and 4

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