General Approach to Respiratory Distress in Neonates
- Neonatal Respiratory Disorders
- Neonatal respiratory distress syndrome (NRDS)
- Transient tachypnoea of the newborn (TTN)
- Meconium aspiration syndrome (MAS)
- Neonatal pneumonia
- Choanal atresia
- Spontaneous pneumothorax
- Congenital diaphragmatic hernia
- Bronchopulmonary dysplasia
- Cardinal signs of respiratory distress
- Tachypnea (>60 rpm)
- Cyanosis on room air
- Expiratory grunting (on auscultation)
- Intercostal/sternal retractions (easy to see since babies are small and thin)
- Investigations to order for neonates with respiratory distress
- CXR ( + history – preterm birth, meconium stained liquor, obstetric complications etc. will give the diagnosis in most cases)
- ABGs
- Pulse Oximetry
- Routine labs (CBC, U/E/Cs, RBS etc)
- Blood culture
- Treatment
- Supplemental oxygen: warmed and humidified, maintain pulse oximetry at 90-95%, PaO2 at 60-70mmHg
- Monitor for apnoea: will need mechanical ventilation if there is apnoea (intubation carries risk of lung damage)
- IV D5W or D10W; monitor urine output, Glucose, Electrolytes, ABGs
- Broad spectrum ABX (if congenital pneumonia cannott be ruled)
- Absolute indications for intubation
- Apnoea
- PaO2 <60 mmHg on > 60% FiO2
- PaO2 > 60mmHg
- What should you consider if the baby continues to be cyanotic on oxygen supplementation?
- Cause of cyanosis is likely to be Cardiac in origin (cyanotic congenital heart defects → TGA, TOF)
- Transposition of the great arteries (TGA) – presents in the neonatal period
- Tetralogy of fallot (TOF) – most common cyanotic heart defect
Differentials for Respiratory Distress in Neonates
| Classificatoin | Differentials | Nota bene |
|---|---|---|
| CNS | Intracranial hemorrhage, over sedation, perinatal asphyxia | Presents with slow, irregular breathing with apnoeic attacks, poor reflexes and disturbed consciousness |
| Pulmonary causes | ||
| Lung | Neonatal respiratory distress syndrome, congenital pneumonia, pulmonary hypoplasia | |
| Airway | Meconium aspiration syndrome, choanal atresia, macroglossia | |
| Pleura | Pneumothorax, pleural effusion, diaphragmatic hernia | |
| Extrapulmonary causes | ||
| Cardiac | Heart failure | |
| Hematological | Severe anaemia, polycythemia | |
| Metabolic | Hypoglycaemia, hypothermia, metabolic acidosis |
