RESPIRATORY DISORDERS

Dr. Abdurahman Sukadi, dr., SpAK

RESPIRATORY DISORDERS
DEFINITION :

The respiratory rate is over 60 x/Min

DIAGNOSIS
Respiration : > 60 x/Min Physical Examination : Dyspnea Cyanosis Retractions Grunting

MANAGEMENT
Temperature : 36,50C 37,50C Oksigen Fluid Therapy Minimal Handling Position Chest Radiograph Antibiotics Blood pressure monitoring Arterial Blood gas Analysis and pH Laboratorium :
Blood Count and differential Culture

MECONIUM ASPIRATION

Definition :

Aspiration of mecoinum-stained amniotic fluid by the fetus in utero or by the newborn during labor and delivery

PATHOPHYSIOLOGY
Physiologic meconium passage (particulary if postdates) Fetal compromised (hypoxia, cord compression, etc.) meconium passage Meconium stainned amniotic fluid Post partum aspiration In utero gasping

Meconium aspiration Peripheral airway obstruction Complete Atelectasis V/Q mismatch Partial Ball valve effect Air - trapping Air - leaks Acidosis Hypoxemia Hypercapnia Proximal airway obstruction Inflammatory and chemical pneumonitis

Continued compromise

Remodeling of pulmonary vasculature

Persistent pulmonary hypertension

THERAPY
Delivery Room Management
Meconium in amniotic fluid

Meconium in amniotic fluid

Thin Infant active Observe Resuscitate PRN Infant depressed Suction trachea

Thick

Resuscitate PRN

GENERAL MANAGEMENT
Temperature Metabolic Cardiopulmonary Function Fluid Antibiotics

OKSIGEN
PaO2 : 50 80 mmHg.

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

DEFINITION :

Also known as wet lung and type II respiratory distress syndrome. It is a benign disease of near term, term or large prematur infants who have respiratory distress shortly after delivery that usually resolves within 3 days. Delayed resorption of fetal lung fluid Pulmonary immaturity Mild surfactan deficiensy

PATHOPHYSIOLOGY

DIAGNOSIS
CLINICAL PRESENTATION :
Term infant Family with risk factor Tachypnea ( > 60 x/min)

LABORATORIUM :
Hypoxemia Mild respiratory acidosis Improvement within 24 hours

RADIOLOGIC :
Hyperaeration, mild cardiomegaly Sunburst Resolves within 2 3 days

THERAPY
Oksigen Fluid restriction Resolves within 48 72 hours

APNEA
DEFINITION :
Absence of respiratory, with or without bradycardia or cyanosis

CLASSIFICATION :

Central Apnea Obstructive Apnea Mixed Apnea

ETIOLOGY, based on :
Disease Gestational age Post natal age

PATHOPHYSIOLOGY
Immaturity of respiratory control Sleep realted response Protective reflexes Muscle weakness All of the above point to an immature respiratory control mechanism in the pretern infant

DIAGNOSIS
HISTORY CLINICAL PRESENTATION :
Lethargy Hypothermia Intracranial High pressure Abdomen distention

LABORATORIUM :

Blood count and morphology Arterial blood gas Serum glucose, electrolyte

RADIOLOGY

Chest X Ray Abdominal X Ray Ultrasonography of the head CT Scan of the head

THERAPY
Preventive Aminophyllin Continuous positive airway presure (CPAP) Mechanical ventilation

HYALINE MEMBRANE DISEASE (RESPIRATORY DISTRESS SYNDROME)

DEFINITION :

Respiratory distress syndrome in a preterm newborn with respiratory difficulty, including tachypnea, chest retraction and cyanosis, that persists or progresses over the first 48 96 hours of life and with a characteristic chest x ray film (uniform reticulogranular pattern and air bronchograms)

PATHOPHYSIOLOGY
Prematurity
Surfactant synthesis and release

Alveolar surface tension

Atelectasis Hypoxemia, Hypercarbia Acidosis (respiratory and metabolic) Pulmonary vascular resistance and vasoconstriction Pulmonary capillary leak Hyaline membranes ( diffusion block)

DIAGNOSIS
Preterm infant, respiratory difficulty Chest x ray : Uniform reticulogranular Pattern and Air Brochograms Laboratorium :

Blood count : No Infection Blood culture : Negative Arterial Blood gas : Hipoxemia and Acidemia L/S Ratio : <2:1

THERAPY :
Temperature Oksigen Fluid and Electrolyte Circulation Antibiotics