RESPIRATORY FAILURE IN CHILDRENN
Respiratory distress syndrome (RDS) in the newborn or hyaline membrane disease, is clinical
syndrome the exclusively affects preterm infants.
Characterized pathologically by a hyaline membrane lining the alveoli and clinically by
respiratory distress, which may be fatal.
Results from maturational deficiency of lung surfactant.
Clinical syndrome consists of
- Tachypnea
- Sternal Recession
- Cyanosis
- Present from birth over the succeeding 24-48hrs
- Most deaths occur between 48-72hrs
Clinical features :
•Begins from birth
• RR, around 100 beats / minute
•Grunting and distressed respiration
•Flaring of Alae nasae, intercostal, supraclavicular and sternal respiratory retraction.
•Tachycardia
•Cyanosis
•Auscultations – crackles
•Edema of hands and feet
•CXR shows diffuse fine granularity throughout the lungs.
•Later more uniform opacification with air bronchogram
Diagnosis :
Clinical features
CXR
-Confirmed indirectly by measurement of surfactant activity in tracheal aspirates or amniotic
fluid to assess fetal lung maturity.
- Two techniques are used, the lacithin – sphingomyelin ratio and amniotic foam test.
D/D : Congenital pneumonia
Transient Hypoxemia of newborn.
Treatment :
•Prompt resuscitative measures should be initiated on the basis of the 1-minute Apgar score.
• Supportive treatment
– maintenance of environmental warm to prevent cold stress and resultant increased O2
consumption and aggrevation of acidosis.
- O2 should be given, to maintain PaO2 60-90 mmHg
- Higher levels carry risk of retrolentral fibroplasia or pulmonary O2 toxicity.
- Blood pH should be corrected
- Close attention for fluid balance, serum calcium and glucose
- Criteria for ventilation is very ill babies have been developed PaO2 of less than 40mmHg.
