Neonatal Respiratory Distress and treatment modalities

Dr Piyush Shah, Dr. R. Kishore Kumar
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Management
• Use of continuous positive airway pressure (CPAP) and if need supplemental oxygenation (target SPO2 90-95%).
• Use of assisted ventilation: CPAP/ Intermittent Positive Pressure ventilation (IPPV) if in respiratory failure.
• Avoid hypo- hyperthermia; maintain euglycemia
• Achieve optimum organ perfusion with use of inotropes
• Optimum nutrition; enteral feeds with parenteral nutrition to meet calories and protein needs.
• Consider antibiotics after septic workup.
Specific:
• Use of antenatal steroids in mother, early PEEP with nasal CPAP, and use of exogenous surfactant for RDS(8).
• Use of pulmonary vasodilators(7) – inhaled Nitirc Oxide, intravenous Sildenafil for PPHN
CPAP: The continuous distending pressure at end of expiration improves oxygenation. CPAP decreases atelectasis, helps in establishing FRC and eliminating foetal lung fluid. The resultant PEEP improves V/Q matching(9,10). It also splints the upper airway, decreasing resistance to the airway. It is useful in infants with RD with good spontaneously breathing efforts. It is increasingly used in the early acute and late weaning/recovery phases of RD. Consider starting CPAP at PEEP 4-6 cm of H2O and inspired oxygen of 30%.

Intermittent Positive Pressure ventilation (IPPV): IPPV delivered by constant flow, time-cycled, pressure limited ventilators is the most frequently used modality of neonatal ventilation. On a constant flow of gas through the circuit, the neonate breaths to set positive inspiratory pressures above PEEP. With newer modalities, the ventilator breaths can now be synchronized to those of neonate. Also, now calculated pre- set TV can be given, as part of lung protective strategy.

References
Neonatal Respiratory Distress and treatment modalities Neonatal Respiratory Distress and treatment modalities 09/05/2018
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