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Newborn
Periodic Breathing
A. Pattern
B. Found in prematures up to 36th
week
C. Considered normal
IV. Apnea > 20 sec. plus bradycardia
Cardiovascular
Hypotension, hypertension, heart failure,
anemia, hypovolemia, vagal tone
Idiopathic
Immaturity of respiratory center, sleep state,
upper airway collapse
IV. Apnea
E. Clinical manifestations
1. Rare on first day
2. Apnea with prematurity occurs on 2nd -
7th day of life
3. 2nd week - warrants investigation
F. Treatment:
1. Theophylline
2. Treat the underlying cause
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
A. Incidence
1. 50% of all neonatal deaths
2. 60 to 80% < 28 wks.
3. 15-30% 32-36 wks.
4. 5% beyond term
5. Term - IDM
6. Preterm male
7. Reduced incidence - maternal hypertension,
PROM, opiate addiction, antenatal corticosteroid
use
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
B. Pathophysiology
1. Insufficient amounts of surfactant
a. 20 weeks - good concentration - does
not reach surface of the lungs
b. 28-32 weeks - not enough amounts
reaching the surface
c. > 35 weeks - mature amounts
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
B. Pathophysiology
2. Components of Surfactants
3. Surfactant synthesis depends on:
a. Normal pH
b. Temperature
c. perfusion
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
B. Pathophysiology
4. Ischemia -- necrosis -- damage
capillary endothelium -- transudation of
fluids into alveoli entrapping necrotic
C. Clinical Manifestations:
1. “Golden Period” - 72 hours after delivery
2. Sign Symptoms of respiratory distress
which worsens
3. Occasional rales, decreased breath sounds
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
D. Prevention
1. Prenatal check-ups
2. L/S ratio
3. Betamethasone to mothers in their < 32nd
week of gestation and may deliver within 42-
72 hours. L/S ratio shows lung maturity
4. Surfactant Therapy
V. Hyaline Membrane Disease or
Respiratory Distress Syndrome
E. Diagnosis: Chest X-ray -- “white out” appearance
F. Treatment
1. Mechanical ventilation
2. Supportive
a. temperature
b. oxygenation
c. acidosis
d. electrolytes
e. blood glucose
3. Antibiotics
VI. Interstitial Pulmonary Fibrosis
D. Increasing dependency on O2
E. Roentgenogram: hyper lussent “bubbly”
appearance because several small areas of
atelectasis-cystic lesions
F. Treatment Supportive
VII. Transient Tachypnea of the
Newborn
A. Usually in Cesarean deliveries
B. slow absorption of fetal lung fluids
C. Clinical Manifestation
1. Tachypneic
2. Cyanosis relieved by Oxygen
3. Recovers after 3 days
D. Treatment is supportive
VIII. Air Leak Syndromes
A. Pneumothorax
1. Incidence
a. 1 - 2%
b. males
c. term and postterm
d. Meconium aspiration
e. mechanical ventilation
f. vigorous resuscitation
g. RDS
VIII. Air Leak Syndromes
A. Pneumothorax
2. Pathogenesis
a. alveolar rupture - pulmonary interstitial
emphysema
b. alveolar rupture - perivascular sheaths
C. Clinical Manifestations
--- tachypnea, grunting, cyanosis, retractions
after delivery
D. Diagnosis
1. History
2. Chest X-ray: flattening of the diaphragm,
patchy infiltrates on both lungs
IX. Meconium Aspiration
E. Treatment:
1. Direct laryngoscopy and suction
2. Mechanical ventilation
3. Supportive
F. Complications:
1. Pneumothorax
2. Persistent fetal circulation
X. Persistent fetal Circulation
A. Found in term and post term infants with:
1. Birth asphyxia
2. MAS
3. Hypoglycemia
4. Polycythemia
5. Pulmonary hypoplasia --- diaphragmatic hernia
6. Oligohydramnios
7. Pleural effusions
8. Idiopathic
X. Persistent fetal Circulation
B. Pathophysiology
--- increased pulmonary vascular resistance -
persistence of R to L shunting
D. Diagnosis
1. Hypoxia is labile and out of proportion -
chest roentgenograms
2. Unresponsive to oxygen by cannula or
hood
3. Right to left shunting by Doppler flow
studies in foramen ovale and ductus
arteriosus
X. Persistent fetal Circulation
E. Treatment:
1. Treat underlying cause
2. Mechanical ventilation-hyperventilation-
decrease pCO2
3. Tolazoline-alpha adrenergic antagonist
- increase fluids plus dopamine
4. Extracorporeal Membrane Oxygenation
XI. Pulmonary Hemorrhage