Pocket ObGyn – Newborn Respiratory Distress
See Abbreviations
Epidemiology (Am Fam Physician 2007;76:987)
- 7% of Most common causes: Transient tachypnea of the newborn, respiratory distress syn, mec aspiration syn.
- Less common causes: Delayed transition, infxn, persistent pHTN, PTX, nonpulmonary causes (anemia, CHD)
Signs and Symptoms
- Tachypnea (>60 breaths/min), nasal flaring, poor feeding, grunting, subor intracostal retractions, insp stridor, apnea, cyanosis
Transient Tachypnea of the Newborn
- >40% of cases of respiratory distress
- Inadeq fluid clearance from lung ® decreased pulm compliance ® tachypnea
- Onset w/i 2 h of birth; usually resolves in <72 h
- CXR: Diffuse parenchymal infiltrates
Respiratory Distress Syndrome (Hyaline Membrane Disease)
- Affects 24000 infants in US annually Most common before 28 w gest 1/3 of infants 28–34 w gest
<5% of infants after 34 w gest
- Surfactant deficiency causing atelectasis & V/Q mismatching ® hypoxemia
- Incid for newborns of diabetic moms
- CXR: Homogenous, opaque infiltrates, & air bronchograms
Meconium Aspiration Syndrome
- Mec-stained amniotic fluid = 15% of deliveries ® 10–15% of those get mec aspiration syn; mec = irritative, obstructive, medium for bact culture
- Usually term or postterm infants; signif respiratory distress immediately after deliv
- CXR: Patchy atelectasis or consolidation
General Management
- Diagnostic CXR; CBC, bld gas, bld cx
- Supplemental oxygen therapy, w/ assisted ventilation if necessary
- Supportive care w/ fluid/electrolyte mgmt & neutral thermal environment Oral feeding often withheld w/ respiratory rate >80 breaths/min
- Empiric ampicillin & gentamicin if risk factors for sepsis or refrac/persistent sx
- Surfactant administration may be req