Prepared By
L. Diva Chanu
Asso Prof
AIN
COMMON NEONATAL
DISORDERS
AND ITS MANAGEMENT
3. Problems of respiratory system
.
1. RESPIRATORY
DISTRESS SYNDROME
INTRODUCTION TO RESPIRATORY
SYSTEM
INTRODUCTION TO RESPIRATORY
SYSTEM
INTRODUCTION
Respiratory distress syndrome of new born
previously called hyaline membrane
disease, is a syndrome in premature infant
caused by development insufficiency of
surfactant production and structural
immaturity of the lungs. Respiratory
Distress syndrome is the leading cause of
death in preterm infants.
It occurs in 50% babies born at
26-28 weeks and 25%of babies born at
30-31 weeks
Definition:
Hyaline membrane disease (HM)
is a disease manifesting within 6
hrs. of birth being related to
deficiency of surfactant in the
alveoli, leading to acute respiratory
distress with fatal termination if
not treated promptly.
Etiology:
1. Deficiency of surfactant in the pulmonary
alveoli.
2.Small alveoli which are difficult to inflate and tend
to collapse with expiration.
3.Weak and excessively complaint chest wall.
4. Contributing factors are any
factors that decreases surfactant: such as
• Premature and immature alveolar lining cells
• Acidosis
• Hypothermia
• Asphyxiated newborn
PATHOPHYSIOLOGY Prematurity
Immature lung with underdeveloped and uninflated alveoli
Decreased surfactant
Increased alveoli surface tension
Atelectasis
Hypoxemia CO2 Retention
Acidosis
Pulmonary vasoconstriction & hypo perfusion
Capillary damage
Plasma Leak
Fibrinogen
Fibrin ( Hyaline membrane
Clinical features
– Peripheral edema increases
– Muscle tone decreases
– Cyanosis increases
• -- Body temperature drops
• -- Bradycardia may occur
• -- Diminished breath sounds
Secondary signs and symptoms
•Hypotension
•Edema of the hands and feet
• Absent bowel sounds
•Decreased urine out put
Investigation
Antenatal period
- Examination of the amniotic fluid Lecithin
sphingomyelin ratio ;
• > 2 full maturation
• 1.5 – 1.99 borderline maturation
• < - associated with sever RDS
INVESTIGATION CONTD……
Laboratory tests :
- Paco2 elevated
- Partial pressure of arterial oxygen – low
- Blood PH – low due to metabolic acidosis
- Calcium – low
- Serum glucose – low
Chest X- ray
• “ Ground glass appearance” or “ White wash lung”
Blood gas analysis
•Low po2 < 50mmhg, Paco2 > 50 mmHg and
indicates respiratory failure
Management
Supportive
1. Maintain of oxygenation – Pao2 at 60 to
80 mmHg , t prevent hypoxia
2.Maintenance of normal body temperature .
3.Maintenance of fluid , electrolytes and acid
base balance – Metabolic acidosis buffered
with sodium bicarbonate
4.Maintenance of nutrition – Iv dextrose 10 % in
water usually required
Management Contd….
5. Antibiotic as needed to treat infection .
6. Constant observation of complication –
Pneumothroax , DIC , PDA
7. Prevent hypotension
8. Maintain a hematocrit of 40% to 45% .
9. Maintenance of respiration with
ventilation support , if necessary
Aggressive :
- Administration of exogenous surfactant in to lungs
early in the diseases
- Especially beneficial in the very low birth weight
infant
- May be given preventively to VLBW infant at birth
- Surfactant replacement therapy
- Prophylactic surfactant therapy ; infants at increased
risk of RDS , infant of less than 30 weeks gestational
age , infants with a birth weight of less than 1,250g
Management Contd..
• Treatment initiated after infant
is stabilized in the
delivery room or within 30 minutes of life .
• Benefits of surfactant ; increased oxygen
requirement
• Antibiotics – To prevent infection ;
Ampicillin 200mg/ kg IV 12 hrly with
Gentamicin 5mg/kg IV 12 hrly .
Complication
• Intra ventricular hemorrhage.
• Pulmonary hemorrhage
• Pneumothorax
• Retrolental fibroplasia (RLF)
• Neurological abnormalities
Nursing Diagnosis
1. Impaired gas exchange related to diseases
process
2.Imbalanced nutritional less than body requirement
related to prematurity and increased energy
expenditure on breathing
3.Ineffective thermoregulation related to
immaturity .
4.Impaired parenting related to separation from the
neonate due to hospitalization .
Nursing Intervention
Promote adequate gas exchange
•Administer supplemental oxygen .
•Measure oxygen concentration every hour and
recorded
•Monitor ABG levels as appropriate .
•Observe the infants response to oxygen therapy .
• Position theinfant to allow
for maximal lung expansion.
•Suction as needed
•Observe for complication
Nursing Intervention Contd..
Promote adequate Nutrition and
Hydration:
Administer IV fluids or enteral feeding as
ordered
Observe IV sites for infiltration or infection
Provide adequate caloric intake and output chart
Administer medication as per order .
