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Mechanical obstruction of the airways and air is allowed in but not exhaled causing
alveoli to overdistend
Chemical pneumonitis which may lead to the development of secondary bacterial
pneumonias
Inactivation of natural surfactant
Alternative names: none
Causes & Clinical Manifestations:
many infants require mechanical ventilation at birth due to immediate signs of distress
o generalized cyanosis
o tachypnea
o severe retractions
an overdistended, barrel-shaped chest with increased anteroposterior diameter
auscultation reveals diminished air movement with prominent rales and rhonchi
Katlyn Carter
abdominal palpation may find a displaced liver (from over expansion of the lungs)
yellowish/pale green staining of the skin, nails, and umbilical cord
Differential diagnoses:
Sepsis
Pneumonia
Delayed transition from fetal circulation
Pneumothorax
Pulmonary edema
Blood aspiration
Pulmonary hypertension
Congenital heart disease
The neonate must expend increasing amounts of energy to reopen the collapsed alveoli
with every breath, so each breathe becomes more difficult than the last
Progressive symptoms
o Cyanosis
o Apnea
o Tachypnea
o Nasal flaring
o Shallow breathing
o Grunting
o Retractions
Differential diagnoses:
Pathophysiology & Causes: The neonate may have had intrauterine or intrapartum asphyxia due
to maternal oversedation or poor uterin profusion, maternal bleeding, prolapsed cord, or breech
presentation. The newborn then fails to clear the airway of lung fluid, mucus, and other debris or
an excess of fluid in the lungs due to aspiration of amniotic or tracheal fluid.
Symptoms:
Same as RDS
shunting of blood away from the lungs and through the fetal ductus arteriosus and patent
foramen ovale, thus bypassing the lungs and the ability to be oxygenated, causing worsening
hypoxia and acidosis. The hypoxia and acidosis are the most potent stimulants of pulmonary
vasoconstriction and increased vascular resistance. This creates its own cycle that is self-
perpetuating and is hard to interrupt. There is often rapid deterioration.
alternative names: none
Symptoms:
Signs of respiratory distress which usually occur in the first 12-24 hours of life
o Grunting
o Nasal flaring
o Tachypnea
o Increasing diameter of the anteroposterior diameter of the chest
o cyanosis
Differential diagnoses:
neonates with PPHN are critically ill and require intense care and very careful monitoring
with limited stimulation
(Davidson, et al., p. 828, 2016)
References:
Davidson, M., London, M., & Ladewig, P. (2016). Olds’ maternal-newborn nursing & women’s
health across the lifespan. Boston: Pearson.
King, T. L., Brucker, M. C., Kriebs, J. M., & Fahey, J. O., Gegor, C. L., Varney, H.
(2015). Varney's midwifery. Jones & Bartlett Learning.
Marshall, J. E., Raynor, M. D. (2015). Myles textbook for midwives. Philadelphia, PA: Elsevier
Ltd.
Katlyn Carter