Master the board step 3

Pediatrics
Respiratory Distress in the Newborn
Keep the following in mind for all cases of respiratory distress in the newborn:
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Best initial diagnostic test: Chest x-ray
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Other diagnostic studies:
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ABG
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Blood cultures (sepsis)
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Blood glucose (hypoglycemia)
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CBC (anemia or polycythemia)
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Cranial ultrasound (intracranial hemorrhage)
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Best initial treatment:
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Oxygen: Keep SaO 2 > 95 percent.
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Give nasal CPAP if high O 2 requirements to prevent barotrauma and
bronchopulmonary dysplasia.
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Consider empiric antibiotics for suspected sepsis.
CCS Tip: In cases of newborn respiratory distress, when hypoxia does not
improve with oxygen therapy, evaluate the patient for cardiac causes of hypoxia (i.e.,
congenital heart defects).
Respiratory Distress Syndrome (RDS)
Clinical features are a premature neonate with the following:
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Tachypnea
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Nasal grunting
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Intercostals retractions within hours of birth
The hallmark finding is hypoxemia. Eventually hypercarbia and respiratory
acidosis develop.
Diagnostic Testing
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Best initial tests: Chest x-ray (ground-glass appearance), atelectasis, air
bronchograms
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Best predictive test: Lecithin-sphingomyelin (L/S) ratio on amniotic fluid
prior to birth
Treatment
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Best initial treatments: Oxygen and nasal CPAP
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Most effective treatment: Exogenous surfactant administration (proven to
decrease mortality)
Pneumonia and RDS look
identical on chest x-ray. If
in doubt, give antibiotics.
Lucinactant is the first
synthetic peptidecontaining
surfactant
approved for treatment of
neonatal RDS.
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