Respiratory Distress Syndrome Case Study

Neonatal RDS is a condition of increasing respiratory distress commencing at or shortly after birth (BAPM-2006). It’s the single most important cause of morbidity and mortality in preterm infants (Greenough, et al 2004). Typically RDS affects preterm infants with the incidence being inversely proportional to the gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are affected (Fraser, et al 2004) Incidence also increases in infants of diabetic mothers those born via elective caesarean section (Fraser, et al 2004) and perinatal asphyxia (Rodriguez, 2003).

The new versus classic BPD features have changed over the years. The approaches to care, including surfactant administration, permissive hypercapnia, and noninvasive ventilation have changed. All these has increased the survival of low birth weight infants as before with classic BPD. The classic BPD was before surfactant and more management techniques, and inflammation and alveolar septal fibrosis. All these changes were associated with oxygen toxicity, infection, and barotrauma.

Premature birth has been linked to a vast array of lungs problems, the earlier the birth the greater risk of health complications(Davis R and Mychaliska G, 2013). A majority of the health problems will affect the infant for the rest of their life (Davis R and Mychaliska G, 2013). Infants born between the canalicular and the saccular period (week 25) have lung development that is unsuitable for gas exchange (Davis R and Mychaliska G, 2013). Two major complications that arise with undeveloped lungs is bronchopulmonary dysplasia, and pulmonary arterial hypertension (Mahgoub L. et al. 2017).

The patient population is the preterm babies that are less than 37 weeks’ and weight

According to the World Health Organisation [WHO] (2014) pre-term babies are at increased risk of illness, disability and death. It also states that globally 15 million babies are born pre-term and the figures are rising. In England and Wales during 2012 7.3% of live births were pre-term under 37 weeks nearly 85% of all babies born prematurely will have a very low birth weight (Office for National Statistics, 2012). Pre-term birth is associated with respiratory complications and lung disease, long-tern neurological damage and problems with bowel function (Henderson & Macdonald, 2011). Neonatal services provide care to babies who are born prematurely or are ill and require specialist care. It is seen that sixty per cent of infant deaths occur in the neonatal period (DH,

Jace Sauseda Clinical Rotation Mrs. Ysaguirre 17 November 2015 NICU Clinical Report At the Neonatal Intensive Care Unit doctors, nurses, and all staff unite together with one primary goal for each new life they receive, that goal being to achieve the best outcome for each premature and critically ill baby. The NICU, at University Hospital, care for 600 infants annually. Inside is a 58-bed facility, offering the highest level care led by on-site neonatologist (University Health system). The (NICU) is specialized to care for premature infants (those less than 37 weeks gestation) as well as sick newborns.

For the past two decades, the limit of gestational viability has been 22-24 weeks (Bhat, Weinberger, & Hanna, 2012). Around 50 years ago, a premature infant born between 22-24 weeks was not considered viable and resuscitation was only considered at 27-28 weeks (Kushchel & Kent, 2011). Medicine and technology advances have improved neonatology drastically and infants are surviving at lower gestational ages. However, many studies show very low survival rates of 22-week neonates and some physician refuse to resuscitate and provide only comfort care. In the NICHD Neonatal Network between 2003 and 2007, infants that were incubated and resuscitated had a 6% survival rate at 22 weeks and a 55% survival rate at 24 weeks (Bhat et al, 2012). Another study followed a hospital for many years were they delivered 85 infants at 22-week

Now, medical advances make it possible for even the most severe premature babies to survive. Preterm babies as young as 22 to 23 weeks gestation can survive, but the costs associated with them is high (Kornhauser & Schneiderman, 2010). The higher cost is attributed to the extended hospital stay of micro preemies in Level 3 NICU (Bird, 2014). Level 3 NICU offers a wide range of neonatal services that include special imaging techniques, advanced ventilation

Another group of patients which require challenging ventilation strategies are the preterm infants. The lungs of preterm infants have undeveloped distal airway structures, with a thick air/blood barrier and a small surface area for gas-exchange (Wallace et al., 2009). They are most likely to be surfactant deficient due to under-developed epithelial cells which lack the type II alveolar cells (Wallace et al., 2009). As a result, preterm infants often require respiratory support in the minutes following birth (Roupie et al., 1995).

Now, medical advances make it possible for even the most severe premature babies to survive. As in case of Preterm babies as young as 22 to 23 weeks ( Micro preemies), level 3 NICU offers a wide range of neonatal services including special imaging techniques, advanced ventilation procedures, and special surgeries (Bird, 2014). Advanced technology has helped to increase the survival rate for even the most severe preterm babies, but the costs associated with them is high (Kornhauser & Schneiderman, 2010). The average cost for treating the micro preemie has been estimated to be more than $ 2 million (Kornhauser & Schneiderman, 2010). Nevertheless, this projected cost is excluding the cost of treating long term outcomes in the micro preemies. The

In many neonatal intensive care units, the nasal continuous positive airway pressure is a common mode of respiratory support for preterm infants. (Yong et. al., 2005). During my exposure in the neonatal unit, I have noticed that many of the babies are on nasal CPAP. I believe that this a good choice, given the benefits of using the NCPAP for respiratory support. Improved oxygenation and gas exchange, prevention of atelectasis and apnoea, stabilisation of needed functional residual capacity, and surfactant conservation are advantages of using NCPAP according to Newnam et. al. (2013). Xie (2014) further added that NCPAP lowers upper airway resistance and most importantly, it eliminates the use of endotracheal tube and ventilator along with its

In a trial by Arti et al, researchers used chlorhexidine to attempt to prevent ventilator-associated pneumonia in children (2013). The group included 86 patients who were divided into two groups to complete a double-blind, randomized placebo controlled trial. The first group included 41 children who received 1% chlorhexidine gel every eight hours. The second group included 45 children who received a placebo gel. The length of the study was three weeks, or until the patient was extubated. The results demonstrated that 12 of out of the 41 children who received chlorhexidine and 14 out of the 45 placebo patients developed ventilator-associated pneumonia. The results showed that there was no clear reduction in the occurrence of pneumonia

Necrosis of the cells in the small, lower airways occurs, and mucous secretions are increased (Conquest, Cremonesini, & Neill, 2013). Because of the ciliary damage in the infants’ lungs, it is almost impossible for the secretions to be cleared. Bronchiolar level obstruction is caused by these mucosusal secretions, as is desquamation of the dead skin cells and edema (Conquest, Cremonesini, & Neill, 2013). Plugs of soughed, necrotic epithelium and fibrin in the airways will cause partial or total obstruction to airflow, making it very difficult for he infant to exhale which will consequently result in air becoming trapped and will reduce gaseous exchange (Conquest, Cremonesini, & Neill, 2013).

The most serious of these being hyaline membrane disease (HMD), most commonly known as RDS or respiratory distress syndrome. Babies that suffer from this condition will tend to find it very difficult to breathe due to the increased surface tension and the ultimate lack of oxygen transported through the body can seriously impair and damage the functions of the brain and other organs of the baby. Surfactant deficiency’s can also sometimes be caused by mutations in a particular gene. An example of this is surfactant protein or SP-B deficiency. This particular dysfunction is hereditary and is caused by a gene mutation on chromes number two. Babies that suffer from tis condition rarely survive past a few months. However there are some procedures that can help babies who may have been born prematurely and have not manufactured enough surfactants to support regular functions. Surfactant replacement therapy and surfactant supplements are amongst the most popular treatments of these types of surfactant deficiencies in newly born

Respiratory distress syndrome (RDS) is a common lung disorder that mostly affects preterm infants. RDS is caused by insufficient surfactant production and structural immaturity of the lungs leading to alveolar collapse. Clinically, RDS presents soon after birth with tachypnea, nasal flaring, grunting, retractions, hypercapnia, and/or an oxygen need. The usual course is clinical worsening followed by recovery in 3 to 5 days as adequate surfactant production occurs. Research in the prevention and treatment of this disease has led to major improvements in the care of preterm infants with RDS and increased survival. However, RDS remains an important cause of morbidity and mortality especially in the most preterm infants. This chapter reviews the most current evidence-based management of RDS, including prevention, delivery room stabilization, respiratory management, and supportive care.