The Detergents And Disinfectants For Instruments And Surfaces (Hexanios - Surfanios)

 Causes of Newborn Respiratory Failure

• RDS

• Transient tachypnea of the newborn (wet lung)

• pneumonia

• Pneumothorax

• Diaphragmatic hernia

• Tracheoesophageal fistula

• Congenital lobar emphysema

• Pulmonary hypoplasia

• Pulmonary sequestration

• Persistent fetal circulation

• Upper airway obstruction

• Anemia

• Polycythemia

• Hypotension

• Sepsis

• Cardiac causes

• Neurological problems

• Hypothermia/hyperthermia

• Metabolic problems

Criteria for respiratory failure in the newborn

laboratory criteria

• PaCO 2 > 60 mmHg

• pH < 7.20

• PaO2 < 50 mmHg

Clinical criteria

• Retractions

• Tachypnea (> 60/min)

• Cyanosis

• Apnea seizures

Respiratory Dystes Syndrome RDS

• It is an acute respiratory system disease that is usually seen in preterm newborns and presents with tachypnea, dyspnea, retractions and groans in the first hours after birth. This picture is also called "surfactant deficiency syndrome". It is observed in 60-80% of babies whose gestational age is below 28 weeks.

• 28-32. A 2/1 or higher lecithin/sphingomyelin ratio in amniocentesis and amniocentesis performed at 3 weeks indicates lung maturation. For babies of diabetic mothers, a ratio above 3/1 indicates maturation.

Causes of RDS in the term baby

diabetic mother baby

Perinatal asphyxia

Surfactant protein B deficiency (familial predisposition)

Meconium aspiration syndrome

pneumonia

clinical findings

• Tachypnea (>60/min)

• Moaning breathing

Intercostal and subcostal retraction and oxygen dependence

• These findings appear in the first 4 hours. Color pallor, peripheral circulatory disorder, hypotonia, and edema are often observed in the general appearance of the infant with RDS. These infants are prone to bradycardia and hypotension. As a result, hypoxia and acidemia depress the myocardium, and renal functions deteriorate.

• Other diseases that cause acute respiratory distress should be considered in the differential diagnosis of RDS. The most important disease among these is group B streptococcal pneumonia.

Radiological Findings

• Frosted glass appearance

• Air bronchogram

• Reticulogranular view

• The borders of the heart shadow cannot be chosen well.

Treatment

• Respiratory support is important. The patient's oxygen saturation should be maintained between 91-95%.

• Early initiation of CPAP therapy after delivery is as effective as early administration of surfactant in reducing the risk of RDS.

• Surfactant is given endotracheally. INSURE (INtubation, SURfactant, Extubation) or USA (Less Invasive Surfactant Administration) /MIST (Minimal Invasive)

Surfactant Therapy) methods.

• Role of surfactant in lung physiology:

1. Decreases surface tension in alveoli.

2. Increases compliance.

3. It reduces the work of breathing.

4. Increases alveolar stability.

5. It can prevent pulmonary edema.

Conditions that inhibit surfactant production

• Acidosis, Acute hypoxia

• Fetal hypoglycemia or hyperinsulinism

• Prematurity

• Male gender

Conditions that increase surfactant production

• Chronic fetal distress

• Theophylline

• Preeclampsia

• Thyroid hormone, Cortisol

• Premature rupture of membranes

RDS Complications

• Air leak syndromes

• Patent ductus arteriosus

• Periventricular and intraventricular bleeding

• Hypotension

• Anemia

• Pneumonia, sepsis

• Retinopathy of prematurity

• Bronchopulmonary dysplasia

• Necrotizing enterocolitis

• Kidney failure and fluid-electrolyte imbalance.

• Vocal cord paralysis

Complications of surfactant treatment;

• Transient hypoxia

• Hypercapnia

• bradycardia

• Hypotension

• Occlusion of the endotracheal tube

• Pulmonary hemorrhage

Preventive Treatment in RDS

• Antenatal steroid (betamethasone); In cases where delivery is expected before the 34th gestational week (24-34th weeks), the best practices are the applications that are not longer than 48 hours before the birth and 7 days before the birth (2-7 days before the birth).

• Prenatal steroid therapy not only reduces the risk of developing RDS, but also reduces the risks of mortality, intracranial hemorrhage, PDA, pneumothorax, necrotizing enterocolitis and periventricular leukomalacia (betamethasone only).

However, it has no effect on postnatal development, lung mechanics and infection development. Therefore, it does not reduce the development of chronic lung disease. Betamethasone reduces overall mortality better than dexamethasone.

Prognosis

• Death is mostly due to infection, intracranial hemorrhage and bronchopulmonary dysplasia.

• The most common and most important component of respiratory system sequelae is bronchopulmonary dysplasia.