1、Nonatology:Neonatal Respiratory DistressLecture Points Neonatal pulmonary function Clinical Manifestation The main causes Main types of the disease Case discussion and presentation Summary and conclusionPulmonary function of the newborns in particular Relative small capacity of the lungs：limited res
2、erved volume poor compensation,likely to be distressedRespiratory on abdomen and diaphragmatic movement Distension:likely to be respiratory distressedpulmonary surfactant(PS)relative in small amount in preterms and easily to be deficiencyDiseased lungs trends poor compliance and even ARDSNeonatal Re
3、spiratory DistressGeneral picture commonly occurs during neonatal period caused by various pathogeneses breath or 、irregular,apnea With or without retraction at breathing,suprasternal and intercostal usually with cyanosis more or less Causation of neonatal respiratory distress Upper respiratory trac
4、t：choana,macrotongue,micrognathia Larynx/throat and trachea：intenerate pulmonary disease：inflammation、abnormality or hypogenesis others：congenital heart disease metabolic problems,CNS causedPathophysiology in neonatal respiratory distress hypoxic and/or hypoventilation hypoxemia,PCO2 respiration cen
5、ter peripheral biochemical sensors breath or 、irregular,apnea Neonatal Respiratory Distress Hyaline Membrane Disease （HMD、RDS)Neonatal infectious Pneumonia Meconium Aspiration Syndrome(MAS)for differentiationHyaline Membrane Disease（HMD/RDS）Clinical manifestation preterms normal at birth,respiratory
6、 distressed in several hours after birth progressively developing and deterioration self cured process during the sickness Clinical manifestation After birth commonly seen,intrauterine infectious pneumonia relatively less seen Occurring in neonates with different GAs and ages General appearance of i
7、nfection Various in severity of respiratory distress Blood-gas：PaO2 、PaCO2 Neonatal infectious Pneumonia Meconium Aspiration Syndrome(MAS)Clinical manifestation Terms and post-terms commonly seen History of intrauterine distress amniotic fluid stained by meconium Lower Apgars score Distress occurs s
8、oon after birth Tachypnea and withdrawal at breathing Blood-gas：PaO2 ,PaCO2 and acidosisCXR:HMDCXR:pneumonia CXR:MASCXR:MAS Clinical management for neonatal respiratory distressMonitoring General appearance：T;response,skin color,feeding tolerance respiration（frequency,pattern and apnea）Other systems
9、:HR,liver,abdomen Blood-gas,Pa O2、SaO2Clinical management for neonatal respiratory distressOxygen therapy Nasal tube Mask and tent Pressed facial maskAttention!fio2 O2 concentration ROP,CLD/BPDClinical management for neonatal respiratory distressMechanical ventilation Target：early intervention and e
10、arly withdraw Indication：persistent cyanosis under oxygen therapy Remarkable SaO2 PaO2 and/or PaCO2 indicated by ABG Clinical management for neonatal respiratory distressMechanical ventilation Ventilation modes and parameters Continuous positive airway pressure(CPAP)：4-8 cmH2O;Assistant/control(A/C)
11、：PIP 15-25 cmH2O；RR 25-35；I/E：1：1.5-2.5；PEEP：4-12 cmH2O Pressure support ventilation(PSV)：6-10 cmH2O High frequency oxillation ventilation:HFOVClinical management for neonatal respiratory distressMedication antibiotics penicillin:10-40 万万u/kg/d ampicillin:50-75mg/kg/d cephalosporin:25-50mg/kg/d PS:8
12、0-120 mg/kg,1 to 2 dose Clinical management for neonatal respiratory distressKeep the baby warm Incubator Radiator Stable room temperetureClinical management for neonatal respiratory distressClinical nutrition Feeding:Breast milk/Formulas decreasing volume feeding as needed Parenteral nutrition（T/PPN）Thanks for listening Questions please?
