respiratory issues in fetus

why do respiratory issues occur in the newborn?

• lungs need to go from fluid filled & compact to air filled

• airway resistance needs 2 decrease in other for the functional residual capacity 2 increase (how easily the baby can breathe)

• blood pressure in the lungs needs to fall (which supports the oxygenation)

what are the common respiratory problems?

1. transient tachypnoea of the newborn

2. persistent pulmonary hypertention of the newborn

3. meconium aspiration syndrome

4. respiratory distress syndrome (RDS)
   

transient tachypnoea (shallow quick breathing) of the newborn

• lungs are not fully cleared of the fluid at birth

• causing problems with gas exchange

persistent pulmonary hypertention of the newborn

• blood pressure doen’t fall causing issues with oxygination, gas exchange and blood supply

meconium aspiration syndrome

• if baby breathes meconium stained fluid before being fully delivered

• baby can aspirate & develop aspiration pneumonia

respiratory distress syndrome (RDS)

• caused by deficiency in surfactant

• mainly affects pre-term but can affected babies from diabetic mum or babies that develop asphyxia (02 deprivation)at birth

what is curosurf

• artificial surfactant

• baby must be intubated

what is surfactant

• fat-based layer that lines the airway preventing the lungs from sticking together

• produced by type 2 alveolar cells- fully by 28 wwks (not mature until 34 wwks)

who are surfactants given to

• neonates with RDS or other respiratory distress conditions

• “ “ < 32 wwks

• “ “ needing >40% 02

respiratory distress signs

1. range outside of 30-60 breaths x min

2. recessions (resistance to air entry is increased so the effort to inhale pulls immature muscles inwards)

3. nasal flaring

4. head bobbing
   

what causes tachypnia ?

• > 60 bpm

• (body conpensating for changes in blood gases & pH in body e.g. decreased 02, increased CO2)
  

respiratory assessment

1. take detailed history

2. observe chest at rest

3. check skin colour

4. check pattern of breathing - baby should breathe through nose

5. look out for symmetry of the chest (assymatry may indicate pneumothorax)

6. count resps & auscultate lungs (listen out for clear lungs)

7. think about why your concerned for this baby

unsual breathing

• stridor - high pitched noise on inspiration

• wheeze- variable pitch heard in expiration

• grunting- sudden expiratory sound due to the glotts closing

• crackles- short intermitted sounds during expiration

• plerual rub- inflammed plerual noises

physiological reasons neonates struggle to breathe

• small delicate airway

• reduced alveolar surface area

• residual lung fluid following delivery
  

what 2 do if baby is struggling to breathe

• 5 inflation breaths

• listen to HR

• (if HR still not up) inflation breaths again

• 3 cardiac pushes x 1 ventilation breath

what do antenatal steroids do ?

• accelerate lung growth

• enlarge alveoli