1. Respiratory distress in newborn 4 th year seminar

2. RDS Most common respiratory illness in NICU Occur in premature neonate Surfactant deficiency Risk factors –Asphyxia and stress –Male –Acidosis –DM mother

3. signs tachypnea retraction grunting Nasal flaring apneic episode cyanosis extremities puffy or swollen

4. Chest X-ray Ground glass appearance Reticulogranular With air bronchograms

7. Physiologic abnormalities Lung compliance 10-20% of norm Atelectasis…areas not ventilated Areas not perfused Decrease alveolar ventilation Reduce lung volume

9. surfactant Type 2 pneumocytes lamillar body 22weeks…34-36wks Phosphatidylcholine Surfactant specific protein Recycling and regeneration (including externally given surfactant)

10. surfactant Decrease surface tension at air liquid level Equalize tension in alveoli of different size Increase in lung compliance. Absence of surfactant cause RDS Pulmonary hypertension

11. Treatment Surfactant Fujiwara…1990s –Prevention –rescue Supportive –Thermal –Fluid and nutrition –oxygen Mechanical ventilation

12. Acid base In RDS pH PaCO2 PaO2 HCO3 Base deficit

13. complications Pneumothorax PDA Chronic lung disease Sepsis Line problems

14. Meconium aspiration First stool that constitutes the GI epithilium and secretion during fetal life Stress and intra-uterine meconium in term infant Gasping cause the aspiration Chemical diffuse peumonitis Same signes of distrss and PPHN. Treatment maily supprtive

16. Congenital pneumonia Sepsis risk factors –PROM –Preamturity –Maternal fever, dicharge, abdominal pain, leukocytosis –Colonization with GBS Same signs of RDS X-ray

18. Transient tachypnia of newborn Term Cesarian delivery Usually tachypnia without O2 requirment Resolve in 48-72 houres Lung fluid X-ray