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Respiratory Disorders of New born

    Respiratory Distress Syndrome (RDS) or Hyaline Membrane Disease (HMD)
    1. Almost always in pre term babies < 34 weeks Q
      Onset of RD : Within the first 6 hrs of life
    2. CXR , -ve shake test, L/S <1.5/1 in amniotic fluid
    3. Radiological features: Reticulo granular pattern Q - mild disease, poor perfusion with air bronchogram Q -moderate disease. White out lung or ground glass - severe disease Q Low volume lung.

Note:- Similar X-ray picture can be seen with Neonatal pulmonary Alveolar proteinosis (Ground glass app. Pf lungs)


  1. Secretes by TYPE 2 alveolar cells
  2. Present in lung by 20 wks and in amniotic fluids 28 wks
  3. Mature level - 35 wks.
  4. Level by steroids Q
    by insulin, thyroxine Q
  5. Diag: L/S Raito: > 2 lung maturity
    <1.5- diag of HMD
    Negative - Shake test

Clinical scoring systems for RDS

  • Downes

Silverman – Anderson scoring. D. Downes' or Silverman RDS Score


Description: silverman 

Downes Scoring system







 In room air

 In 40% FIO2







 Audible with stethoscope

 Audible without stethoscope

 Air entry


 Decreased or delayed

 Barely audible

 Respiratory rate

 Under 60


 Over 80 or apnea

> 4 = Clinical respiratory distress; monitor arterial blood gases
> 8 = Impending respiratory failure



  1. Supportive - IV fluids, oxygen Q
  2. Ventilatory supports CPAP Q [Rescue CPAP] is required in children not improving on 100% O2.
  3. Surfactants therapy prophylactic for < 28 wks gestation.
  4. INSURE techniqueIntubation; Surfactant administration via ET tube; Extubation


  1. Guidelines for CPAP use:
    1. Start at PEEP of 5 cm of H2O and FiO2 of 40-50%.
    2. If distress does not improve or worsens, impaired oxygenation then pressure is increased by 1-2 cm H2O to max of 8-10 cm H2O.
    3. If still impaired oxygenation, then increase FiO2 by 5% to max of 80%
    4. Don’t increase FiO2 before pressures are maximum.
  2. CPAP is initiated in newborns with RDS when PaO2 is approximately less than 50 mm Hg on a FiO2 of 0.40 not at 50 to 60%
  3. Definition
    1. CPAP (continuous positive airway pressure) is a modality in which increased pulmonary pressure is provided during the expiratory phase of respiration in spontaneously breathing neonates.
  4. Mechanism
    1. The mechanisms by which CPAP produces its beneficial effects include increased alveolar recruitment and stability, and redistribution of lung water. This results in improved V/Q matching.
    2. The administration of CPAP decreases oxygen requirements, decreased need for mechanical ventilation, and reduces mortality and duration of respiratory assistance.
    3. CPAP is initiated in newborns with RDS when PaO2 is approximately less than 50 mm Hg on a FiO2 of 0.40 (Option B)
  5. Indications of CPAP:
    1. Moderate to severe respiratory distress, PaO2 < 50 mm Hg while patients is breathing 60% of oxygen or if there is recurrent apnea.
    2. In treatment of RDS in both term and preterm infants
    3. Prolonged and recurrent apneic attacks of prematurity.
    4. After recent extubation following mechanical ventilation.
    5. Postoperative thoracotomy care.

  1. Transient tachypnea of newborn/ wet lung /type II RDS:
    Self limiting disorder
    Term infants
    1. Cause - delayed resorption of amniotic fluid from lung
    2. Caesarean section, delayed clomping of cord
      1. Macrosomia, male sex. Excessive maternal sedation
      2. Cord milking , Prolonged labour , Large IV fluid to mother
    3. Present soon after birth and subsides within 72 hrs.
CXR shows: Prominent vascular markings, fluids in fissures, Perihilar streaking with coarse fluffy densities representing liquid filled Alveoli
  1. Meconium aspiration syndrome:
    1. 10-15% of deliveries
    2. Aspiration — In utero, during birth and immediately after birth
    3. Thin meconium -chemical pneumonitis
    4. Thick meconium — Atelectasis. collapse, air leaks, PPHN
    5. Usually occurs in Postmature* and 1UGR babies*
    6. Onset of RD— in the lst 24 hrs of life
  2. Persistent pulmonary hypertension of newborn (PPHN):
    1. Also known as persistent fetal circulation Q
    2. Persistent elevation in pulmonary vascular resistance -> R- L shunt through Foramen ovale
    3. Term/ post term babies

Causes: Asphyxia, MAS, RDS, and diaphragmatic hernia



  1. Ventilation
  2. Drugs: Tolazoline, Magnesium Sulphate and Nitric Oxide, sildenafil citrate.
  1. APNEA
    APNEA: Cessation of respiration > 20 sec or Cessation of respiration with cyanosis/ bradycardia


  1. Occurs from 1 to 2 day upto 7 day of life Q
  2. Due to immaturity of respiratory center and collapsible airway
  3. < 34 wks
  4. 4Supportive
  5. Drugs:
    1. Aminophylline Q
    2. Caffeine Q
    3. Doxapram
  1. Tracheosophagial fistula (TEF)
    Type I (Esophageal Artesia with lower esophagus communicating bronchus) is most Common type. It occurs in 87% cases.
    VACTERL association: Vertebral, Anorectal, Cardiac, Trachael, Esophageal, Renal / Radials anomalies, Limb anomalies.
    Clinical Features: Frothing and bubbling at the mouth and nose; and episodes of coughing, cyanosis and RD associated with feeding.
    Diagnosis: Early onset respiratory distress.
  2. Congenital diaphragmatic hernia (CDH)
    Bochdalek hernia :
    1. It is most common CDH. Defect is on left side in 70-85%.
    2. Etiology: Failure of closure of posterolateral pleuroperitoneal canals.
    3. Clinical Features:
      1. Severe respiratory distress with in Ist hr of life.
      2. Scaphoid abdomen.
      3. Heart sound on right side.
    4. Diagnosis: In ANP: Maternal Polyhydraminos. On USG
    5. After birth: Clinical features and on CXR-AP and lateral views.
    6. Treatment: ECMO (extracorporeal membranous oxygenation)
      1. Initial resuscitation (T, A, B, C) and stabilization: Temp maintenance, volume resuscitation, dopamine, HCO3 to maintain (PH > 7.50)etc.
      2. Gentile ventilation with Permissive hypercapnia.
      3. Repair of diaphragms at 24-72 hr, after stabilization.
        Others: Surfactant administration, Nitric Oxide (inhaled).
        1. BPL: Bochdalek is Postero Lateral in position.
        2. ECMO with paralysis and Nasogastic suction may produce a dramatic reduction of the volume of herniated viscera.

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