Newborns With Acute Respiratory Distress: Diagnosis and Management

1988 ◽  
Vol 9 (9) ◽  
pp. 279-285
Author(s):  
Richard L. Schreiner ◽  
Niceta C. Bradburn
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress ◽  
Newborn Infant ◽  
Blood Gases ◽  
Indirect Measurement ◽  
Chest Roentgenogram ◽  
Inborn Errors ◽  
Severe Respiratory Distress ◽  
Glucose Determination ◽  
Arterial Blood

If respiratory distress develops in the newborn after he or she has been normal for more than a few hours, bacterial sepsis, inborn errors of metabolism, cardiac disorders, and intracranial hemorrhage should be suspected. It is virtually impossible to determine whether an infant with mild respiratory distress in the first few hours of life will have rapid resolution of disease or progress to severe respiratory distress. That is, it is difficult to differentiate among transient tachypnea of the newborn, sepsis, and pulmonary hypertension in the infant with mild respiratory distress in the first few hours of life. Transient tachypnea is a diagnosis that can only be made with certainty after the infant's respiratory distress has resolved. The newborn infant with mild respiratory distress of more than a few hours' duration requires a minimum number of laboratory tests including chest roentgenogram, hematocrit or hemoglobin, blood glucose determination, direct or indirect measurement of arterial blood gases, and blood cultures. The liberal use of oxygen in the near-term, term, or post-term vigorous but cyanotic infant in the delivery room may decrease the incidence and/or severity of respiratory distress due to pulmonary hypertension. A newborn infant with respiratory distress for more than a few hours should be considered a candidate for infection.

scholarly journals Case report on Tracheoesophageal Fistula with review of current literature

2017 ◽  
Vol 1 (1) ◽  
pp. 37
Author(s):  
Maria Khan
Keyword(s):  
Respiratory Distress ◽  
Nasogastric Tube ◽  
Tracheoesophageal Fistula ◽  
Antihypertensive Drugs ◽  
Tertiary Care ◽  
Blood Gases ◽  
Severe Respiratory Distress ◽  
Live Births ◽  
Arterial Blood ◽  
Proximal Small Bowel

Major structural anomalies occur in 2-3% of live births all around the World. The reported global incidence of tracheoesophageal fistula (TEF) is roughly 1 in 2,500 live births varying by region. In Pakistan, incidence is reported only by those tertiary care centers that have pediatric surgery facilities available, making it an underreported and often mismanaged condition. We report a case of esophageal atresia (EA),       rectovaginal fistula and tracheoesophageal fistula associated with Meconium Aspiration Syndrome (MAS) in an infant. The baby was 2 days old when she arrived at our center, born at 34 weeks, and weighed 2.3 kilograms. There was no significant   antenatal history except that the mother was on antihypertensive drugs. The baby had an Apgar score of 3 and 4 at 1 and 5 minutes respectively, severe respiratory  distress and cyanosis. Her chest examination revealed subcostal and intercostal   recessions, bilateral crepitation and tachycardia at 180/minute. She was immediately put on ventilator and required frequent suctioning due to excessive secretion,    developed abdominal distension, and had multiple episodes of desaturation and   cyanosis. Complete blood picture showed leukocytosis and arterial blood gases   signifying metabolic acidosis. Upon trying to pass to a catheter, baby passed stool through vagina. Contrast esophagogram showed evidence of distended stomach and proximal small bowel loops. No evidence of air was seen in the rectum. On passing the nasogastric tube into the esophagus, it curled on itself at D4 level with evidence of blind-ending proximal esophageal pouch that dilated with contrast medium. On 10th day of life baby’s condition deteriorated despite all efforts. Eventually she stopped breathing, her pupils dilated and all efforts to resuscitate her failed. This report  highlights the importance of thorough clinical examination and availability of support facilities in a pediatric unit. TEF/EA should be suspected in any newborn who   presents with respiratory distress, drooling, history of polyhydramnios with an    inability to pass nasogastric tube. The parents should also be counselled as TEF/EA carries a 1% risk of recurrence.

Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 295-300
Author(s):  
G. Ganesh Konduri ◽  
Daisy C. Garcia ◽  
Nadya J. Kazzi ◽  
Seetha Shankaran
Keyword(s):  
Pulmonary Hypertension ◽  
Placebo Group ◽  
Extracorporeal Membrane Oxygenation ◽  
Normal Saline ◽  
Medical Center ◽  
Blood Gases ◽  
Adenosine Infusion ◽  
Term Infants ◽  
Membrane Oxygenation ◽  
Arterial Blood

Objective. Adenosine infusion causes selective pulmonary vasodilation in fetal and neonatal lambs with pulmonary hypertension. We investigated the effects of a continuous infusion of adenosine on oxygenation in term infants with persistent pulmonary hypertension of newborn (PPHN). Design. A randomized, placebo-controlled, masked trial comparing the efficacy of intravenous infusion of adenosine to normal saline infusion over a 24-hour period. Setting. Inborn and outborn level III neonatal intensive care units at a university medical center. Participants. Eighteen term infants with PPHN and arterial postductal Po2 of 60 to 100 Torr on inspired O2 concentration of 100% and optimal hyperventilation (PaCo2 <30 Torr) were enrolled into the study. Study infants were randomly assigned to receive a placebo infusion of normal saline, or adenosine infusion in doses of 25 to 50 µg/kg/min over a 24-hour period. Results. Nine infants each received adenosine or placebo. The two groups did not differ in birth weight, gestational age, or blood gases and ventilator requirements at the time of entry into the study. Four of nine infants in the adenosine group and none of the placebo group had a significant improvement in oxygenation, defined as an increase in postductal PaO2 of ≥20 Torr from preinfusion baseline. The mean PaO2 in the adenosine group increased from 69 ± 19 at baseline to 94 ± 15 during 50 µg/kg/min infusion rate of adenosine and did not change significantly in the placebo group. Arterial blood pressure and heart rate did not change during the study in either group. The need for extracorporeal membrane oxygenation, incidence of bronchopulmonary dysplasia, and mortality were not different in the two groups. Conclusion. Data from this pilot study indicate that adenosine infusion at a dose of 50 µg/kg/min improves PaO2 in infants with PPHN without causing hypotension or tachycardia. Larger trials are needed to determine its effects on mortality and/or need for extracorporeal membrane oxygenation in infants with PPHN.

scholarly journals Effect of deep breathing exercises and incentive spirometry on respiratory distress scoring in second degree inhalational burn patients.

2019 ◽  
Vol 2 (1) ◽  
pp. 13-16
Author(s):  
Summiya Siddique Malik ◽  
Sadaf Saeed ◽  
Sumaira Kanwal
Keyword(s):  
Respiratory Distress ◽  
Vital Signs ◽  
Blood Gases ◽  
Sampling Technique ◽  
Control Group ◽  
Deep Breathing ◽  
Breathing Exercises ◽  
Arterial Blood ◽  
Experimental Group ◽  
Second Degree

Objective: Study was conducted for 6 months in PIMS Hospital Islamabad. Data was collected on self-structured Questionnaire, Respiratory distress scoring, Objective tools of Arterial blood gases and vital signs with signed consent. Methodology: The subjects were randomly allocated in experimental and control groups. Baseline data was collected and re-collected on Day 0 and Day 7 respectively and assessed using non-probability convenient sampling technique. Both groups were given standard medical and nursing care. Results: The experimental group was given single treatment regimen i.e. Deep breathing exercises (with 5-10 repetitions of each DBE being possible onto patient for 15-30 minutes twice daily). The control group was given 10-15 cycles of ISM with prior steam inhalation and nebulization with salbutamol for a period of 15-20 minutes for 35-45 minutes twice daily for a period of 07 days. Conclusion: The experimental group results show that deep breathing exercises are significantly effective in improving post burn complications like pneumonia in patients suffering from second degree inhalation burns.

Pneumothorax in the Respiratory Distress Syndrome: Incidence and Effect on Vital Signs, Blood Gases, and pH

PEDIATRICS ◽  
1976 ◽  
Vol 58 (2) ◽  
pp. 177-183
Author(s):  
Edward S. Ogata ◽  
George A. Gregory ◽  
Joseph A. Kitterman ◽  
Roderic H. Phibbs ◽  
William H. Tooley
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Vital Signs ◽  
Blood Gases ◽  
Statistical Technique ◽  
Assisted Ventilation ◽  
Arterial Blood ◽  
The Difference ◽  
Respiratory Assistance

We determined the incidence of pneumothorax in 295 infants (mean birthweight, 1,917 gm) with the respiratory distress syndrome (RDS) treated according to the same protocol. Fifty-five infants (mean birthweight, 1,594 gm) developed pneumothorax (incidence, 19%); incidence varied with severity of RDS and intensity of respiratory assistance. Pneumothorax occurred in 3.5% (2 of 58) of infants who received no assisted ventilation and in 11% (14 of 124) of infants who received continuous positive airway pressure (CPAP) as the only form of assisted ventilation; the difference between these two groups is not significant. Forty-nine infants initially treated with CPAP later required mechanical ventilation with positive end-expiratory pressure (PEEP). Pneumothorax occurred in 12 of the 49 (24%) and in 21 of 64 (33%) of those infants initially treated with PEEP; the incidence of pneumothorax for both these groups was significantly higher than for those treated with no assisted ventilation or CPAP only. To assess the value of frequent measurement of vital signs, blood gas tensions, and pH in the recognition of pneumothorax, we analyzed these variables by the cumulative sum statistical technique. We noted the following significant changes associated with pneumothorax: arterial blood pressure, heart rate, and respiratory rate decreased in 77% of cases; pulse pressure narrowed in 51% of cases; Po2 decreased in 17 of 20 cases in which ventilatory settings were constant for at least three hours prior to pneumothorax. However, pH and PCO2 showed no consistent changes. Frequent measurements of vital signs and Po2 aid in the early diagnosis of pneumothorax.

Chest Physiotherapy in the Neonate: A Controlled Study

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 282-285 ◽  
Author(s):  
N. N. Finer ◽  
J. Boyd
Keyword(s):  
Respiratory Distress ◽  
Blood Gases ◽  
Chest Physiotherapy ◽  
Significant Alteration ◽  
Controlled Study ◽  
Arterial Blood Gases ◽  
Gradual Improvement ◽  
Arterial Blood ◽  
Postural Drainage ◽  
Arterial Po2

The effect of postural drainage alone was compared to postural drainage with chest percussions on the arterial blood gases of 20 neonates with respiratory distress. There was no significant alteration in the arterial PO2 following postural drainage alone, with a significant increase (14.5 mm Hg) following postural drainage with chest percussions. The PO2 midway through postural drainage with percussions showed a small (5 mm Hg) but nonsignificant rise in the PO2, suggesting a gradual improvement throughout the use of this form of therapy. There was no significant change in the pH or PCO2 with either procedure. Appropriately performed chest percussions will result in an improvement in oxygenation in neonates with respiratory distress.

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