Surfactant Replacement in Neonates with Respiratory Distress Syndrome Type

RDS is characterised by tachypnoea, nasal flaring, intercostal and sub costal in drawing with sternal retraction and a predominantly a diaphragmatic breathing pattern and a characteristic expiratory grunt or moan and cyanosis without oxygen, all persisting within 4-6 hours of delivery. Diagnosis can be confirmed by history, blood gases showing impaired respiratory function and an X-ray film showing ground glass appearance and air bronchograms (Fraser, et al 2004)

Compared to the general adult population the maternal airway management can be more challenging as changes during pregnancy can increase the difficulty of intubation (Brien and Conlon, 2013). Its makes hard to insert laryngoscope when the patient have a large breast, the chance of bleeding and swelling increases due to oedema and vascularity of the upper respiratory tract, and the patient desaturate quicker as there is increase in oxygen requirements and there is reduced in functional residual capacity (Mushambi et al, 2015). As a result of all the changes during pregnancy, if the problems encountered during the intubation of Mrs D were to happen to an obstetric patient, it is important to provide optimal surgical condition for to progress rapidly while aiming for a good neonatal outcome (Local theatre policy, 2015b). In obstetric patients, much of the issue is about the urgency with which the foetus must be delivered and the surgical operation must be done as quickly as possible - therefore making decisions in the event of certain clinical situations occurring will require a much quicker decision making process because there is an immediate threat to the life of the woman or foetus (Mushambi et al, 2015). This is why emergency obstetric anaesthesia is such a potentially hazardous

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).

overexposed to oxygen for extended periods (Jobe & Kallapur, 2010). When a baby is born

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,

Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function.

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).

When a baby is in Utero, the oxygen saturation is well below what it should be after birth (Lee, 2015). There is a

Transient tachypnea of the newborn at birth is a condition in which fluid remaining in the lungs results in respiratory distress2. It is characterized chiefly by tachypnea shortly after birth, which clears quickly within 2 to 5 days and shows itself by a typical clinical and radiographical presentation3. It is generally believed that once TTN resolves itself, there is no further increased risk for respiratory disease or other long-term sequelae.4 A number of previous studies have demonstrated that TTN is associated

Therefore, planned pregnancy is a huge key factor in preventing birth defects, because often times birth defects develop even before women might know they are pregnant. Because women don’t know they are pregnant, they may consume alcohol, causing harm to their babies. Smoking causes harm to infants before, during, and after pregnancies. Even in the womb nicotine, carbon monoxide, and many other poisons women inhale from cigarettes are carried through their bloodstream. Smoking while pregnant causes many developmental issues including birth defects, lung problems, stunted growth, increase in babies heart rates, low birth weight, or result in stillbirths. However, there are many other agents known to cause these developmental defects. For example, drugs and other medications such as; thalidomide, isotretinoin, valproic acid, methotrexate, and mycophenolate mofetil are also known to cause the same birth defects (Simeone, et al., 2015). Putting healthy supplements, unlike these types of drugs into individuals systems when pregnant can help prevent infant

"Up to 12% of deliveries in developed countries are preterm." This is approximately 500,000 premature births per year. In 2009, my cousin was born ten weeks prematurely, weighing merely two pounds, four ounces. After spending a copious amount of time in and out of the Neonatal Intensive Care Unit (NICU) with my family over the course of a month, I developed an interest in its operation. Being a neonatologist became my leading occupation of interest. I chose to further research this topic in hopes of finding out whether or not this is the career path for me. In my research paper, I plan to go into further detail about the Neonatal Intensive Care Unit (NICU), common medical conditions found in premature infants, how to react and treat these medical conditions, and necessary education to become a neonatologist.

The placenta is a major source of fetal prostaglandins and its removal after birth allows for the lungs to expand and become metabolically active, where most prostaglandins are degraded. This, in combination with increased pulmonary oxygen tension, in healthy full-term infants, normally causes functional closure of the ductus arteriosus within 15 hours after birth.

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

Prematurity is the main risk factor for RDS. Other risk factors associated with RDS include maternal diabetes, multiple gestation, elective cesarean delivery without labor, Caucasian race, male sex, precipitous delivery, and perinatal asphyxia. Factors associated with decreased risk for RDS include chronic hypertension, pre-eclampsia, chorioamnionitis, and prolonged rupture of membranes.