Respiratory distress after birth

Chief Complaint A 26 y/o female gave birth to a male child at 36 weeks with a weight of 2.6 kg. After birth color changes and respiratory distress was noted. History He was a product of consanguineous marriage. No complications noted in whole pregnancy. Antenatal scans show no abnormality. Investigations Apgar score is 8. Cardiac, neurological examinations were wnl. But U & L lobe consolidation were noted on chest x-ray and usg. Bronchoscopy shows tracheal obstruction. Management What do you advise?



Tracheal intubation. Surgically removed the obstructive mass by bronchoscopy. O2 inhalation and regular monitoring of o2 level. Inj ceftam 1gm iv bd. Correction of electrolytes imbalance and maintain iv infusion. Needs regular monitoring and constant evaluation.

O2 antibiotics and see response then only go further bronchoscopy etc

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Pulmonaryagenesis in segment likely agenasis of respective bronchus APGARscore is critical Child needs intubation and ventilatory support till atelectated lobe reopens Hrct /bronchoscopy could be advised Iv support for feed and broadspectrum antibiotics like inj piperacillin+inj tazobactum

Thanx dr Ashok Leel

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It’s AGA baby c normal BW & Apgar score, Tracheal obstruction may be partial tracheal stenosis,any Haemingoma/web/cyst or any extrinsic Vascular compression. consolidation of lungs may be due to Neonatal Pneumonia mainly byGBS or Gram -ve enteric bacilli. First baby managed for Respiratory distress& consolidation, after stabilisation Ped.Pulmonologist opinion sought.

Can put tracheal tube inside the trachea Mass should be removed surgically Antibiotics iv O2 continue Nebulize With Seroflo & Duoline Parentral fuids iv drip Maintain acid base balance

Apgar score tell us Difficult breathing Bronchoscopic consolidation Treat as pneumonia Abg studies Admit in nicu


Tnx Dr Ashok Leel sir

Treatment depends on the cause of the blockage. Objects stuck in the airway may be removed with special instruments. A tube may be inserted into the airway (endotracheal tube) to help with breathing. Sometimes an opening is made through the neck into the airway (tracheostomy or cricothyrotomy).

Newborn respiratory distress syndrome (NRDS) happens when a baby's lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies. It's also known as infant respiratory distress syndrome, hyaline membrane disease or surfactant deficiency lung disease. Despite having a similar name, NRDS is not related to acute respiratory distress syndrome (ARDS). Why it happens NRDS usually occurs when the baby's lungs have not produced enough surfactant. This substance, made up of proteins and fats, helps keep the lungs inflated and prevents them collapsing. A baby normally begins producing surfactant sometime between weeks 24 and 28 of pregnancy. Most babies produce enough to breathe normally by week 34. If your baby is born prematurely, they may not have enough surfactant in their lungs. Occasionally, NRDS affects babies that are not born prematurely. For example, when: the mother has diabetes the baby is underweight the baby's lungs have not developed properly Around half of all babies born between 28 and 32 weeks of pregnancy develop NRDS. In recent years the number of premature babies born with NRDS has been reduced with the use of steroid injections, which can be given to mothers during premature labour. Symptoms of NRDS The symptoms of NRDS are often noticeable immediately after birth and get worse over the following few days. They can include: blue-coloured lips, fingers and toes rapid, shallow breathing flaring nostrils a grunting sound when breathing If you're not in hospital when you give birth and notice the symptoms of NRDS in your baby, Diagnosing NRDS A number of tests can be used to diagnose NRDS and rule out other possible causes. These include: a physical examination blood tests to measure the amount of oxygen in the baby's blood and check for an infection a pulse oximetry test to measure how much oxygen is in the baby's blood using a sensor attached to their fingertip, ear or toe a chest X-ray to look for the distinctive cloudy appearance of the lungs in NRDS Treatment after the birth Your baby may be transferred to a ward that provides specialist care for premature babies (a neonatal unit). If the symptoms are mild, they may only need extra oxygen. It's usually given through an incubator or tubes into their nose. If symptoms are more severe, your baby will be attached to a breathing machine (ventilator) to either support or take over their breathing. These treatments are often started immediately in the delivery room before transfer to the neonatal unit. Your baby may also be given a dose of artificial surfactant, usually through a breathing tube. Evidence suggests early treatment within 2 hours of delivery is more beneficial than if treatment is delayed. They'll also be given fluids and nutrition through a tube connected to a vein. Some babies with NRDS only need help with breathing for a few days. But some, usually those born extremely prematurely, may need support for weeks or even months. Premature babies often have multiple problems that keep them in hospital, but generally they're well enough to go home around their original expected delivery date. The length of time your baby needs to stay in hospital will depend on how early they were born.

Antibiotics O2 see response then go subsequently bronchoscopy

Adv medical management with antibiotics and hemodynamics. Sos therapeutic bronchoscopic lavage.

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