Transcript The effects of partial liquid ventilation on meconium

Nonatology:
Neonatal Respiratory Distress
Lecture Points
•
•
•
•
•
•
Neonatal pulmonary function
Clinical Manifestation
The main causes
Main types of the disease
Case discussion and presentation
Summary and conclusion
Pulmonary function of the
newborns in particular
• Relative small capacity of the lungs：
limited reserved volume 
poor compensation, likely to be distressed
• Respiratory on abdomen and diaphragmatic
movement  Distension: likely to be
respiratory distressed
• pulmonary surfactant (PS) relative in small
amount in preterms and easily to be deficiency
• Diseased lungs trends poor compliance and
even ARDS
Neonatal Respiratory Distress
General picture
• commonly occurs during neonatal
period caused by various pathogeneses
• breath or 、irregular, apnea
• With or without retraction at breathing,
suprasternal and intercostal
• usually with cyanosis more or less
Causation of
neonatal respiratory distress
• Upper respiratory tract：
choana, macrotongue, micrognathia
• Larynx/throat and trachea：intenerate
• pulmonary disease：
inflamation、abnormality
or hypogenesis
• others：congenital heart disease
metabolic problems, CNS caused
Pathophysiology in
neonatal respiratory distress
hypoxic and /or hypoventilation

hypoxemia, PCO2

respiration center
peripheral biochemical sensors

breath or 、irregular, apnea
Neonatal Respiratory Distress
• Hyaline Membrane Disease
（HMD、RDS)
• Neonatal infectious Pneumonia
• Meconium Aspiration Syndrome (MAS)
for differentiation
Hyaline Membrane Disease（HMD/RDS）
Clinical manifestation
• preterms
• normal at birth, respiratory distressed
in several hours after birth
• progressively developing and
deterioration
• self cured process during the sickness
Neonatal infectious Pneumonia
Clinical manifestation
• After birth commonly seen, intrauterine
infectious pneumonia relatively less seen
• Occurring in neonates with different GAs
and ages
• General appearance of infection
• Various in severity of respiratory distress
• Blood-gas：PaO2  、PaCO2 
Meconium Aspiration Syndrome (MAS)
Clinical manifestation
• Terms and post-terms commonly seen
• History of intrauterine distress
• amniotic fluid stained by meconium
• Lower Apgar’s score
• Distress occurs soon after birth
• Tachypnea and withdrawal at breathing
• Blood-gas：PaO2 , PaCO2  and
acidosis
CXR:HMD
CXR: pneumonia
CXR:MAS
CXR: MAS
Clinical management for
neonatal respiratory distress
Monitoring
• General appearance：T; response,
skin color, feeding tolerance
• respiration（frequency, pattern and
apnea）
• Other systems: HR, liver, abdomen
• Blood-gas, Pa O2 、SaO2
Clinical management for
neonatal respiratory distress
Oxygen therapy
• Nasal tube
• Mask and tent
• Pressed facial mask
Attention! fio2 O2 concentration
ROP,CLD/BPD
Clinical management for
neonatal respiratory distress
Mechanical ventilation
• Target：early intervention and early
withdraw
• Indication：
persistent cyanosis under oxygen
therapy
Remarkable SaO2 
PaO2  and /or PaCO2  indicated by ABG
Clinical management for
neonatal respiratory distress
Mechanical ventilation
• Ventilation modes and parameters
• Continuous positive airway pressure (CPAP)：
4 - 8 cmH2O;
• Assistant/control (A/C) ：
PIP 15-25 cmH2O；RR 25-35；
I/E：1：1.5-2.5；PEEP： 4 - 12 cmH2O
• Pressure support ventilation ( PSV )：6-10 cmH2O
• High frequency oxillation ventilation: HFOV
Clinical management for
neonatal respiratory distress
Medication
• antibiotics
penicillin: 10-40 万u/kg/d
ampicillin: 50-75mg /kg/d
cephalosporin: 25-50mg /kg/d
• PS:
80-120 mg /kg, 1 to 2 dose
Clinical management for
neonatal respiratory distress
Keep the baby warm
• Incubator
• Radiator
• Stable room
tempereture
Clinical management for
neonatal respiratory distress
Clinical nutrition
• Feeding: Breast milk/Formulas
decreasing volume
feeding as needed
• Parenteral nutrition（T/PPN）
Thanks for listening
Questions please?