hx of RDS ‫د ورﻗﺎء‬

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CC--SOB since birth
he delivered at age of 8th month of gestation
he developed cyanosis and grunting <‫>اﻻم ﺗﻜﻮل ﻳﻨﺎﻫﻚ‬

improvement signs for RDS are feeding Risk factors for RDS
preterm
so ask if he starts feeding Prematurity
diabetic mother
white male infant
‫اول ﻣﺎﻳﺼﻌﺪ اﻟﻄﻔﻞ ﻣﻦ ﺻﺎﻟﻪ اﻟﻮﻻده‬ cessation section
APGAR SCORE low then mild elevation obstructive labor <asphyxia>
baby may dyspnea - cyanosis or grunting history of prior affected infants

dyspneac ‫ﺻﻌﺪه ﻟﻠﺨﺪج وﻃﻔﻞ ﺑﻌﺪ‬

start with a general examination look if cyanosis or not use stethoscope air entry
on chest
commonly hear fine cracks & poor air entry in baby with RDS
complete total examination & vital signs . calculate gestational age and ask for risk
factors like oligohydromnis ----->lung hypoplasia

what we do for this patient

- chest xray
-arterial blood gases analysis ABG
---> hypoxia & hypercapnia & Respiratory acidosis —>mean severe .
also ABG could be normal in mild cases

-RBS
regular check because if it becomes hypoglycemic, this will exacerbate
RDS
- Complete blood count
and put him in monitoring for vital signs & oxygen saturation
-. Sepsis workup: blood cultures, a complete blood count with differential,
and C-reactive protein
DDX
1- Congenital pneumonia ‫ﺷﻨﻮ ﻧﺴﺄل‬

maternal infection, specifically last trimester (last10 day)

prolong rupture of membrane

2- meconium aspiration
term & Post-term

3- Congenital lobar emphysema

4- Transient tachypnea of newborn

same presentation but more sife self limited end in 72h
xray finding perhiliar infiltration

5- Congenital diaphragmatic hernia

6- lung hypoplasia
Treatment of RDS
A. Supportive measures

1- Incubator care in NICU and respiratory support

incubator benefits
temperature-- isolation--hemodifcation

2-Temperature : goal core temperature = 36.5 – 37 C

3- Nutrition : IV fluids 10% glucose water 60ml/kg first day and increasing
everyday 15 -20 till we achieve 120ml
on the third day, change fluid to glucose saline and 20ml of KCL

4- if preterm give Surfactant

5- antibiotics cover gram postive and negative why ?
because it can't differentiate between RDS & Congenital pneumonia

ampicillin & garanmycin also use 3th generation

of cephalosporin

if there is no response after acurate management

search for another cause

pneumonia in first week represent sepsis

but after one week become localized due improving in immunity state of baby so
there will localization of infection

pathogen
of first week come from mother

second week
group B streptococcus
gram negative bacilli
 Continuous Positive Airway Pressure (CPAP)

forced positive pressure to open collapse alveoli

it works for the delivery of constant positive pressure to the airway of a spontaneously
breathing neonate, maintains adequate functional residual capacity within the alveoli
to prevent atelectasis, and improves oxygen and carbon dioxide exchange within the
pulmonary circulation.

Indications

- Respiratory Distress Syndrome (RDS)

-Apnoea of prematurity
-Transient Tachypnoea of the newborn (TTN)

so indication in this case RDS not responding to oxygen supply by nasal cannula
with O² saturation below 90

complications
◦ Pneumothorax
◦ Pneumomediastinum
◦ Pulmonary interstitial emphysema
◦ Decreased cardiac output (due to decreased venous return) with
excessive CPAP levels
◦ Gastric distension and feed intolerance