Overview of Disease
Each day there are thousands of babies born, and families wait for their new loved ones to enter the world. However, there are also many complications that may occur with child birth. “Approximately 50% of neonates born at 26-28 weeks ' gestation develop respiratory distress syndrome, whereas less than 30% of premature neonates born at 30-31 weeks’ gestation develop the condition” (MedScape). Infant Respiratory Distress Syndrome, or IRDS for short, is a restrictive lung disease that commonly occurs in premature babies. A common cause is a lack of surfactant that is commonly found in developed lungs. Surfactant is a liquid that uses proteins and lipids to help decrease the surface tension between the alveoli to create
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Pathophysiology
When premature babies are born they do not have fully developed lungs because the lungs are one of the last organs in the body to be produced. The alveoli in the baby’s lungs have not yet started making surfactant, which is typically produced when the baby is 34-36 weeks’ gestation. When the alveoli do not have surfactant, the alveoli want to naturally collapse. Surfactant helps to keep the alveoli open and create more surface area for gas exchange. If you were to look at the infant’s lungs using a microscope, you can see that lungs look as though they are solid from the areas where the alveoli have collapsed, also known as atelectasis. To try to compensate for the atelectasis, “the respiratory bronchioles, alveolar ducts, and some of the alveoli dilate to decrease airway resistance and increase gas exchange” (Jardins 476). As the disease worsens, the walls of the alveoli become lined with a hyaline membrane that is made up of dead cells and proteins that make it nearly impossible for gas exchange to occur. It makes the lungs stiff and much harder to ventilate. With the lungs being noncompliant, the baby starts to become hypoxic. When the infant becomes hypoxic, blood is shunted away from the other organs in the body and venous return and cardiac output are decreased. “Hypoxemia is common in pulmonary hypertension (PH) and may be partly related to ventilation/perfusion mismatch, low diffusion
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).
Undeveloped lungs are especially found in children that are born premature. A premature baby is classified as one who is born before thirty-seven weeks. Premature babies have a higher chance of developing more health problems, and usually stay in the hospital longer than healthy babies. Premature babies also have the potential to have long-term health problems
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).
Premature babies sometimes have apnea. It may happen together with a slow heart rate. Respiratory distress syndrome or RDS is a breathing problem most common in babies born before 34 weeks of pregnancy.” Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. “Intraventricular hemorrhage or IVH is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricles is a space in the brain that’s filled with fluid. Patent ductus ateriosus or PDA is a heart problem that happens in the connection between two major blood vessels near the heart. If the ductus do not close properly after birth, a baby can have breathing problems or heart failure. Heart failure is when enough blood can’t get pumped into the heart causing it to shut down. Necrotizing enter colitis (NEC) is a problem with a baby’s intestines. It causes feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature bay has been born. Retinopathy of prematurity (ROP) is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss. Jaundice is when a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working well. Anemia is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. Bronchopulmonary dysplasia (BPD) is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage. Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and
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
Patent Ductus Arteriosus is a common condition seen in preterm infants. PDA may cause congestive heart failure, respiratory distress, necrotizing enterocolitis, and renal impairment. Cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used in management of this condition. In small infants, surgical closure can be difficult, therefore medical closure offers a great advantage.
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).
Respiratory distress syndrome – “an acute lung disease present at birth, which usually affects premature babies. Layers of tissue called hyaline membranes keep the oxygen that is breathed in from passing into the blood. The lungs are said to be ‘airless’.” (https://medical-dictionary.thefreedictionary.com/respiratory+distress+syndrome)
Surfactant is a natural production around 30 weeks and is fully sufficient to for a baby to breath normally. Fortunately, there are artificial surfactant that can be given to babies to prevent or get rid of respiratory, distress syndrome (RDS). Babies that respond well require less support from ventilators and lower additional oxygen
A 5 year old Hispanic male patient was admitted to hospital for respiratory distress. He is verbally nonresponsive and does not have family at bedside. He is currently on CPAP (continuous positive airway pressure) and when removed, he begins gasping for air.
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
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.