birth or developed after a period of normal respiratory function gestational age and birth weight
Physical examination
Observation
symmetry of chest movement indicators of laboured respiration skin colour and mucous membranes for
audible expiratory wheeze, crackles) presence of cleft palate or micrognathia (small
jaw)
Diagnostic tests
Chest radiograph Blood gases
Case 1
Born at 30 weeks gestation Apgar score 61, 85 Birth weight 1500 grams Developed signs of respiratory distress
evidence of central cyanosis respiratory support vital signs: RR, HR, T, BP, SpO2
Physical examination
Examination
Auscultation of breath sounds presence of grunting, inspiratory stridor,
Surfae 1 post surfactant
Case 1
Ventilation setting unchanged Baby deteriorated rapidly, increase
oxygen concentration from 40% to 100%, mottled, heart rate is 188 bpm, air entry on left side decreased
Case 1
Causes of sudden deterioration in a ventilated baby
D…displaced endotracheal tube? accidentally extubated or the tube too far in?
O…obstructed airway or endotracheal tube? P…pneumothorax or other critical diagnosis? E…equipment working and ventilation
GBS prophylaxis
Focused respiratory history
Neonatal
umbilical cord blood gas condition at birth, including Apgar score resuscitation efforts required and response time of onset of symptoms, i.e., present from
Lack of surfactant, resulting in progressive collapse of the alveoli
Primarily a disease of preterm babies; its incidence increases with decreasing gestational age.
at 30 minutes
Case 1
Pink RR 88/min and regular, HR 140 bpm Laboured respiration Well perfused, BP 47/25 mean 33 Tone normal Temperature 36.4°C
Case 1
Respiratory Diseases of
Newborn
Focused respiratory history
Antepartum
gestation and accuracy of dates antenatal ultrasound findings maternal diabetes maternal Group B streptococcus (GBS) status administration of antenatal steroids maternal substance use family history of neonatal respiratory disorders
optimized?
Case 1
Management of symptomatic pneumothorax:
Chest tube insertion Needle aspiration
Case 2
Unremarkable pregnancy 38 weeks’ gestation Elective Caesarian Section Presented respiratory distress
Focused respiratory history
Intrapartum
fetal distress during labour and delivery presence of meconium stained liquor duration of rupture of membranes evidence of chorioamnionitis (maternal fever) nature of labour and route of delivery medications administration of intrapartum antibiotics for