Surfactant Replacement Therapy And The Affects On Rds And Other Pulmonary Disorders

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 simple act of breathing as we know it, is not as simple as it seems. Breathing takes numerous organs and requires a variety of complex operations to correctly occur. One of the most unique factors of breathing is pulmonary surfactant. Pulmonary Surfactant is an oily fluid that is composed of a mixture of lipids and protein molecules that coats the inner alveolar surface (McKinley, 2016). The internal surface of alveoli is moist, which makes it prone to collapsing because of its high surface tension, pulmonary surfactant keeps the alveoli and lungs from collapsing (McKinley, 2016).

Postnatal respiratory complications among newborns are common. The most commonly reported cause of neonatal respiratory distress is transient tachypnea of the newborn (TTN), with an estimated incidence of 1% to 2% of in all newborns.1

Surfactant is an essential component for the respiratory system to function properly. Knowing the physiology of surfactant in the alveoli is important to know when learning the structure of the air sacs and how they work. This experiment is designed to make the understanding of surfactant in the alveolar film easier to learn, because it's not very simple. Surfactant is a detergent-like substance produced by the Type II alveolar cells in the walls of the alveoli. Surfactant is produced to reduce the surface tension of the water molecules that primarily compose the walls of the alveoli. For this experiment, we will be using milk and food coloring to represent the water (milk) and gas (food coloring) in

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

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).

If you're not familiar with asthma, asthma is a type of breathing problem, this condition is where your airways become narrowed and start to swell, doing so, you produce extra mucus which can make breathing difficult, this could trigger coughing, wheezing, and shortness in your breath. That is why people have inhalers, the inhalers have a type of medication that sprays out as a mist, the mist is called Albuterol Sulfate. What Albuterol Sulfate does, is opens up your airways to help you be able to breathe a lot better. To use the inhaler you shake it up very well and take two hits of it.

Ineffective breathing pattern related to the increased work of breathing and decreased energy as evidenced by intercostal retractions, use of accessory muscles for breathing, and nasal flaring. Check respiratory status (noting rate, rhythm, and depth) a minimum of every 2–4 hours or more often as needed for a decreasing respiratory rate and periods of apnea. Monitor cardiorespiratory monitor and pulse oximeter attached with alarms set, if ordered. Record and report changes promptly to physician. Rationale: Changes in breathing pattern may occur quickly as the child’s energy reserves are depleted. Establishing and monitoring a baseline reveal rate

In the article, unplanned extubation (UE) is shown to be one of the complications that occur frequently with mechanical ventilation in neonates in the neonatal intensive care unit. This warranties the trial of other techniques such as Noninvasive ventilation (NIV). According to the author, this technique is only adequate for neonates that display adequate respiratory effort. In the article, a study was carried out to determine the effectiveness of NIV in providing ventilatory support in neonates with unplanned extubation as a result of the use of conventional ventilatory techniques. The study extended to establish instances that NIV failed to restore the condition in neonates.

Therapeutic techniques offered by midwives, such as hydrotherapy and water births, have been a topic of debate. Critics claim that water births can cause a series of problems for the mother and the baby. Water temperature has been an issue brought up, obstetricians feared babies would breathe in water and drown, and pediatricians worried that infants would develop infections. According to Sheila Kitzinger, “further investigation revealed that [temperature] was very unlikely to be the cause of these babies’ problems” (214). An infant drowning is an understandable fear; however, a baby is more likely to drink the water than to breathe it in and retain fluid in their lungs. A baby’s lungs are not fully developed at birth, and this is why aspiration

In conclusion, the purpose of this experiment was to show how “[t]he main function of surfactant is to lower the surface tension at the air/liquid interface within the alveoli of the lung. This is needed to lower the work of breathing and to prevent alveolar collapse at end-expiration” (Veldhuizen and Haagsman). Although the blue food coloring moved slowly at first, I did not anticipate it would be forced to submerge and move at its own pace. However, when the surfactant was added, it forced the blue food coloring to move at faster rate pushing up and out to integrate with the rest of the water particles changing the entire contents of the petri dish. Surfactant is important to help breakdown and decrease the surface tension allowing the gases

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.