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CHAPTER 4
DISCUSSION & DUMMARY

1.1.

Discussion
The most common etiology of neonatal respiratory distress is transient

tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms
usually resolve spontaneously. Respiratory distress syndrome can occur in premature
infants as a result of surfactant deficiency and underdeveloped lung anatomy.
Intervention with oxygenation, ventilation, and surfactant replacement is often
necessary. Prenatal administration of corticosteroids between 24 and 34 weeks
gestation reduces the risk of respiratory distress syndrome of the newborn when the
risk of preterm delivery is high. Meconium aspiration syndrome is thought to occur
in utero as a result of fetal distress by hypoxia. The incidence is not reduced by use
of amnioinfusion before delivery nor by suctioning of the infant during delivery.
Treatment options are resuscitation, oxygenation, surfactant replacement, and
ventilation.
Respiratory distress syndrome (RDS), previously called hyaline membrane
disease, is a common cause of morbidity and mortality associated with premature
delivery. RDS is a developmental disorder rather than a disease process per se, and it
is usually associated with premature birth. In premature infants, respiratory distress
syndrome develops because of impaired surfactant synthesis and secretion leading to
atelectasis, ventilation-perfusion (V/Q) inequality, and hypoventilation with resultant
hypoxemia and hypercarbia. Blood gases show respiratory and metabolic
acidosis that cause pulmonary vasoconstriction, resulting in impaired endothelial and
epithelial integrity with leakage of proteinaceous exudate and formation of hyaline
membranes.
Adequacy of ventilation and oxyegenation must be established as soon as
possible to avoid pulmonary vasoconstriction, further ventilation-perfusion
abnormalities, and atelectasis. Mild or moderate RDS can be managed by CPAP
applied by mask, nasal cannula, nasal prongs, or endotracheal or nasopharyngeal
tubes. Careful attention to the mechanical details of application of CPAP or
mechanical respirators is required. Mandatory ventilation should be instituted well in

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advance of respiratory failure and severe respiratory acidosis to avoid severe

hypoxemia and atelectasis. Ventilation is maintained through an endotracheal tube,
which can be placed nasally or orally, for delivery of oxygen and positive pressure.
Pressure-cycled ventilators are most frequently used in the neonatal intensive care
unit (NICU) and are controlled by setting positive inspiratory pressure, rate,
inspiratory-expiratory times, and positive end-expiratory pressure (PEEP).

1.2.

Summary
A male newborn, named DNM, was admitted to the neonatal unit at General

Hospital Haji Adam Malik Medan (RSUP HAM) on June 9, 2015 with shortness of
breath as the chief complaint. The neonate was born on the same day, about one hour
before admission to the hospital with gestational age = 30-32 weeks. This complaint
had been experienced since delivery with no history of bluishness. When admitted,
the newborn had weak cry, less of activity, and weak suckle.
Diagnosis
:
Respiratory distress ec. Hyaline Membrane Disease
Suspect of neonatal sepsis
Low birth weight (LBW)
Preterm newborn- appropriate for gestational age (AGA)
Treatment
-

CPAP with FiO2 = 25%, PEEP = 6, O2 Flow = 8L/min, SpO2 = 93-95 %

Total fluid requisite = 80 cc/kgBW/day = 148.8 cc/day, consisting of:
o Parenteral = 80 cc/kgBW/day = 148.8 cc/day
IVFD D10% + Ca. Gluconas 10 cc 6 cc/ hour
o Enteral = diet is ceased for a while
- Vit. K injection 1 mg (IM)
- Cefotaxime injection 90mg/12 hrs (IV)
-Gentamycine injection 9mg/ 36 hrs (IV)