1. Respiratory Distress in Neonates
Dr.Mohammad Saquib Mallick, FRCS
Consultant Paediatric Surgeon ,
King Fahd Medical City.
Riyadh

2. Principles of Neonatal Surgery
Types of Newborns:
Full-term: >38 weeks and weight > 2.5 kg
preterm infant: <38 weeks with appropriate weight
SGA: >38 weeks and weight< 2.5 kg
VLBW: <32 weeks and <1.5 kg
There are physiologic differences between all these infants

3. Respiratory Distress
The newborn suspected of having respiratory distress should be studied in a logical step by step manner.
It is important to establish that the infant has a surgical problem before surgery is performed.
Resuscitation must be done before operation
Every condition will be dealt accordingly

4. Respiratory Distress Causes Surgical Upper airway obstruction
Congenital diaphragmatic hernia
Eventration of Diaphragm
Esophageal atresia with TOF
Pneumothorax
Congenital lobar emphysema
Congenital cystic adenomatoid malformation
Pulmonary Sequestration

5. Respiratory Distress Congenital Diaphragmatic Hernia
Incidence: 1:2000 to 5000,
female more affected,
prematurity and low BW,
Left side

6. Diaphragmatic Hernia
Symptoms None to severe Polyhydramnios Presents birth to after many days
Signs Scaphoid abdomen Audible bowel sound in the chest

7. Diaphragmatic Hernia Diagnosis: Prenatal <25wks, prognosis bad
Clinical
CXR
10% >after neonatal period

8. Diaphragmatic Hernia

9. Diaphragmatic Hernia Management Reussciataion and stabilization
Laparotomy
Primary
Patch by silo or muscle
Laparoscopic repair

10. Eventration of Diaphragm
Def: Abnormal elevation of diaphragm that results in paradoxical motion of affected hemidiaphragm during inspiration and expiration
Cause:
Congenital
Acquired
Symptoms:
None
Resp. distress
Wheezing, repeated URI,

11. Eventration of Diaphragm
Diagnosis:
CXR
Fluoroscopy or
Real time US

12. Eventration of Diaphragm
Management:
Conservative
plication

13. Oesophageal atresia & TOF
Incidence: 1: 5000 live births, 50% associated with anomalies
Types:
Symptoms and Signs:
Excessive salivation
Respiratory Distress
Inability to pass NG tube
Choking and coughing on feeding
VACTERL Syndrome

14. Oesophageal atresia & TOF
Diagnosis – Clinical & CXR
Management: Resuscitation
Common type
Right thoracotomy
Division and repair of TOF
Primary anastomosis
Pure TOF
Division and repair
Isolated atresia
>3 vertebra
Staged surgery (gastrostomy and followed in 3-6 months by delayed repair. If fails then need esophageal replacement (stomach or colon)

16. Respiratory Distress Pneumothorax:
The collection of air in the pleural cavity in neonates.
Causes: Hyaline membrane disease
Meconium aspiration
Pulmonary hemorrhage
Traumatic
Rupture of cong.lung cyst

17. Respiratory Distress
Diagnosis:
Clinical
Radiological

18. Respiratory Distress

19. Respiratory Distress Treatment: 1, Decompression by inserting
chest tube
2, Treat the cause

20. Respiratory Distress Congenital Lobar Emphysema:
“ massive over distension of a lobe or a segment of the lung that causes compression of normal lungs and medistinum“

21. Respiratory Distress Etiology;
air trapping due to abnormalities in the bronchial cartilages.
bronchial cartilage may be
absent, hypoplastic, or dysplastic

22. Respiratory Distress
X-rays

23. Respiratory Distress
CT Scan:

24. Respiratory Distress Management:
Surgical excision of of the involved lobe or lobes is the treatment of choice.

26. QUESTIONS ?