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Respiratory Distress Syndrome Transient Tachypnea of the Newborn

A newborn with respiratory distress. Newborn 33 week male (BW 1800g) uncomplicated pregnancyAll serology negativeGBS unknown, ROM x2hSVD, no significant resuscitationPlaced on the Ohio in the resus roomGrunting and off color . First steps?. Differential diagnosis?Immediate treatments?Inv

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Respiratory Distress Syndrome Transient Tachypnea of the Newborn

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    1. Respiratory Distress Syndrome & Transient Tachypnea of the Newborn Chelsea A. Ruth, FRCPC

    2. A newborn with respiratory distress Newborn 33 week male (BW 1800g) uncomplicated pregnancy All serology negative GBS unknown, ROM x2h SVD, no significant resuscitation Placed on the Ohio in the resus room Grunting and off color

    3. First steps? Differential diagnosis? Immediate treatments? Investigations?

    4. Respiratory Distress Syndrome Respiratory distress ? RDS Incidence around 50% 70% in less than 1000g 30% in greater than 1500g Does exist in late preterm and term Congenital SP – B deficiency

    5. RDS = Surfactant Deficiency Inflammation Pulmonary edema Type II pneumatocytes Start producing surfactant around 20 weeks Lipid and protein components SP-B is vital Decreased compliance and FRC Increased dead space

    6. Risk factors Prematurity Infant of a Diabetic Mother Intrauterine or postnatal asphyxia B, bad, boy Secondary to pulmonary hemorrhage Sepsis Family history

    7. Protective Factors Chorioamnionitis Maternal narcotic use PPROM Hypertension Antenatal corticosteroids

    8. Symptoms Respiratory distress Grunting, tachypnea, increased WOB Hypoxemia CO2 retention Pneumothorax, PIE Fluid retention – pulmonary and systemic edema Multi-organ failure

    9. RDS = low volume, granular

    10. Natural History Rarely seen currently Worsens over first 24 – 72 hours Reduced in severity and shortened by surfactant

    11. Detergent anyone? Surfactant therapy mainstay of treatment Prophylactic or rescue surfactant Less than 30 weeks Natural surfactants quicker acting than artificial Decreased incidence of air leak, death, NEC, ventilation and improved oxygenation Does not decrease incidence of CLD Second dose if still ventilated decreases NEC and mortality

    12. Good supportive care Avoidance = antenatal steroids Maintain pH >7.25, CO2 40 – 60 Maintain O2 saturations 88 – 92% Aim is to await resolution and do as little damage as possible

    13. Some controversies in management Ventilation or CPAP? CPAP +/- surfactant HFOV or conventional ventilation? Postnatal steroids? Target gases and O2 saturation Upper age limit for prophylactic treatment iNO

    14. TTN – the poor cousin More common in term and late preterm deliveries Incidence 5.7 per 1000 births Predominantly tachypnea, mild oxygen requirement with mild increased WOB Risk factors – cesarean section, IDM, maternal asthma

    15. Pathophysiology Hormonal changes in later pregnancy promotes resorption of Na and fluid Increased expression of the epithelial Na channel Passive resorption of fluid due to increased oncotic pressure Decreased compliance, atelectasis and air trapping

    16. TTN = high volume, wet

    17. Natural History Usually present at birth Improves over first 12 – 24 hours Alone should not necessitate ventilation

    18. Management Good supportive care IV fluids if hypoglycemic or prolonged Thermoregulation Hands off Oxygen as required to maintain O2 saturations >90 – 92% CPAP if needed Blood gas as suggested by clinical course

    19. Most common but a diagnosis of exclusion Sepsis screen + antibiotics based on risk factors and time course CXR – r/o pneumonia, pneumothorax or RDS Don’t assume its TTN!

    20. Back to our baby… O2?CPAP?ventilation Measurement of vital signs CXR Blood gases Ensure good perfusion Watch and wait

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