Universal screening and antepartum antibiotics for group B streptococci carriers reduce early-onset disease. Early-onset pneumonia occurs within the first three days of life, resulting from placental transmission of bacteria or aspiration of infected amniotic fluid. Late-onset pneumonia occurs after hospital discharge. Bacterial pathogens are similar to those that cause sepsis. Serial complete blood counts, C-reactive protein measurements, and blood cultures help with diagnosis and treatment.
Intravenous antibiotics are administered if bacterial infection is suspected. Antibiotics should be used judiciously. Pneumothorax occurs if pulmonary space pressure exceeds extrapleural pressure, either spontaneously or secondary to an infection, aspiration, lung deformity, or ventilation barotrauma. Although transillumination can be helpful, chest radiography confirms the diagnosis.
Symptomatic newborns need supplemental oxygen. Tension pneumothorax requires immediate needle decompression or chest tube drainage. Delicate physiologic mechanisms allow for circulatory transition after birth with a resultant decrease in pulmonary vascular resistance. Failure of these mechanisms causes increased pulmonary pressures and right-to-left shunting, resulting in hypoxemia. This failure can be caused by meconium aspiration syndrome, pneumonia or sepsis, severe RDS, diaphragmatic hernia, and pulmonary hypoplasia.
Severe persistent pulmonary hypertension of the newborn PPHN occurs in two out of 1, live births. Maternal use of a selective serotonin reuptake inhibitor is associated with the condition. Data show only a small absolute risk. With PPHN, respiratory distress occurs within 24 hours of birth. On examination, a loud second heart sound and systolic murmur may be heard.
Echocardiography should be performed to confirm the diagnosis. PPHN is treated with oxygen and other support. A few cases require extracorporeal membrane oxygenation. One-fourth of cases are critical, necessitating surgery in the first year, and one-fourth of those newborns do not survive the first year.
Cardiac murmur may be heard on examination. Decreases in femoral pulses and lower extremity blood pressures may indicate coarctation of the aorta. Chest radiography and electrocardiography may indicate congenital structural abnormalities, and echocardiography can confirm the diagnosis. Department of Health and Human Services recommends pulse oximetry over physical examination alone to screen for critical congenital heart defects. The cost of treating one critical congenital heart defect exceeds the cost of screening more than 2, newborns, with 20 infant deaths prevented with screening.
The diagnosis of delayed transition is made retrospectively when symptoms cease without another identified etiology. It results from retained fluid and incompletely expanded alveoli from a precipitous vaginal delivery, as pathophysiologic mechanisms have not had sufficient time to adjust to extrauterine life. Treatment is supportive until the distress resolves a few hours after transition concludes. Maternal labor history included clear fluid rupture of amniotic membranes for seven hours.
Antenatal screening was negative for group B streptococci. Tachypnea without cyanosis was noted approximately four hours after birth. Physical examination revealed a pulse of beats per minute and respiratory rate of 82 respirations per minute with wet sounding breaths. Mild intercostal retractions were noted. Chest radiography showed increased pulmonary vascularity. A blood glucose measurement was 58 mg per dL 3. Immature to total neutrophil ratio was 0.
Oral feedings were held because of tachypnea, and oxygen was given at 2 L by nasal cannula. Over the next 12 hours, the tachypnea decreased to 50 respirations per minute, and oral feeding was successful.
Given the onset of tachypnea and risk factors male sex, non—meconium-stained fluid, and cesarean delivery , this case reflects transient tachypnea of the newborn. The newborn weighed 4 lb, 2 oz and had Apgar scores of 5 and 5. Tachypnea, retractions, and grunting occurred soon after birth. Blood glucose measurement was 47 mg per dL 2.
Arterial blood gas measurements were pH of 7. Nasal continuous positive airway pressure was started immediately, interrupted as natural surfactant was administered endotracheally in the delivery room, and resumed while the newborn's temperature was stabilized. The child was admitted to the neonatal intensive care unit. Given the immediate onset of tachypnea, this case reflects respiratory distress syndrome.
The INSURE intubate, administer surfactant, extubate to nasal continuous positive airway pressure technique is emphasized. Data Sources : A PubMed search was completed in Clinical Queries using the key terms newborn, distress, respiratory, meconium, and tachypnea. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Search dates: October to March Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Christian L.
Reprints not available from the authors. Respiratory distress of the term newborn infant. Paediatr Respir Rev. Respiratory distress syndrome. Breathing in America: Diseases, Progress, and Hope. Verklan MT. So, he's a little premature Late-preterm birth: does the changing obstetric paradigm alter the epidemiology of respiratory complications?
Obstet Gynecol. Relationship between prenatal care and the outcome of pregnancy in low-risk pregnancies. Open J Obstet Gynecol. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial.
Obstetric care consensus no. Jobe AH, Bancalari E. Bhandari A, Bhandari V. Bronchopulmonary dysplasia: an update. Indian J Pediatr. Murphy K, Weiner J. Use of leukocyte counts in evaluation of early-onset neonatal sepsis. Pediatr Infect Dis J. Role of C-reactive protein in early onset neonatal sepsis. Internet J Pediatr Neonatol. Continuous positive airway pressure therapy for infants with respiratory distress in non tertiary care centers: a randomized, controlled trial [published correction appears in Pediatrics.
Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Pediatr Adolesc Med. Kinetics of surfactant in respiratory diseases of the newborn infant. J Matern Fetal Neonatal Med. Oxygen and carbon dioxide flow through the blood in the placenta.
Most of it goes to the heart and flows through the baby's body. At birth, the baby's lungs are filled with fluid. They are not inflated. The baby takes the first breath within about 10 seconds after delivery. This breath sounds like a gasp, as the newborn's central nervous system reacts to the sudden change in temperature and environment.
Once the baby takes the first breath, a number of changes occur in the infant's lungs and circulatory system:. A developing baby produces about twice as much heat as an adult. A small amount of heat is removed through the developing baby's skin, the amniotic fluid, and the uterine wall. After delivery, the newborn begins to lose heat. Receptors on the baby's skin send messages to the brain that the baby's body is cold. The baby's body creates heat by burning stores of brown fat, a type of fat found only in fetuses and newborns.
Newborns are rarely seen to shiver. In the baby, the liver acts as a storage site for sugar glycogen and iron. When the baby is born, the liver has various functions:. In late pregnancy, the baby produces a tarry green or black waste substance called meconium.
Meconium is the medical term for the newborn infant's first stools. The fluid in the lungs is removed through the blood and lymph system, and is replaced by air. At the same time, vigorous blood circulation in the lungs will begin. The first few breaths after birth may be the most difficult breaths your baby will take for the rest of their life. There are a couple of things that will stimulate your baby to take their first breath.
The bones of the rib cage encircle our vital organs. As a baby grows, these bones will grow harder and the lungs will be more secure. This is an important part of respiratory development.
The ribs will also rise in the chest to take an adult shape. Sometimes a baby will involuntarily swallow or inhale parts of its first bowel movement during birth.
This first bowel movement is called the meconium. Pneumonia and a condition called respiratory distress syndrome RDS can result. One way to avoid a premature birth is to pay careful attention to your diet and lifestyle choices during pregnancy.
The American Pregnancy Association recommends that pregnant women avoid:. Pregnant women should limit their intake of caffeine, and avoid alcoholic beverages.
You should also avoid chemicals like salicylic acid, found in certain cosmetics and skin products. If one of the medications you have been prescribed is on the list of unsafe medications, speak to your doctor about the risks of continuing to use it.
When a baby is delivered, the amniotic fluid should be expelled from their lungs. If you are at risk for preterm labor, several screening tests can help you and your doctor determine the extent of your risk.
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