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[Respiratory distress in the newborn (author's transl)]
Insights
Managing newborn respiratory distress, including infant respiratory distress syndrome (IRDS), requires careful monitoring of oxygen levels and appropriate interventions like oxygen therapy and ventilation. Prompt management improves survival rates and reduces long-term complications.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Critical Care
Context:
- Newborn respiratory distress encompasses various conditions like IRDS, RDS type II, neonatal asphyxia, and MAS.
- IRDS presents significant mortality due to surfactant deficiency and immature respiratory centers, posing challenges in prevention and management.
Purpose:
- To outline critical respiratory management strategies for newborns experiencing respiratory distress.
- To emphasize the importance of continuous oxygenation monitoring and appropriate interventions for different conditions.
Summary:
- Effective management includes arterial oxygen level estimation (using transcutaneous electrodes), understanding apnea physiology, correcting acidosis/anemia, airway maintenance, and oxygen administration to target PaO2 or tcPO2 of 60-80 mmHg.
- Artificial ventilation (CPAP, IMV), specific drug therapies (indomethacin, Tolazoline, Xanthine derivatives), and supportive care are crucial.
- While exchange transfusion is debated, proper management of general condition and respiration is vital for Type II RDS, MAS, and asphyxia, with peritoneal dialysis as a life-saving option for renal impairment.
Impact:
- Optimized respiratory management can significantly decrease newborn mortality rates and enhance survival rates without handicaps.
- Intensified, district-specific newborn medical care is essential for improving outcomes in regions like Hokkaido.
Abstract:
Diseases which manifest with the respiratory distress in the newborn include 1) respiratory diseases-IRDS, type II RDS, neonatal asphyxia, and MAS etc. 2) anemia, CHD 3) CNS and 4) metabolic diseases. Among these, IRDS has high mortality rate because of the lack of the pulmonary surfactant and immaturity of respiratory center, and has many difficult problems in terms of its prevention and respiratory management. The points of its respiratory management are as follows: 1) Estimation of the level of arterial oxygen ation-this is the most important point. It has become possible, these days, to monitor continuous oxygenation using a transcutaneous oxygen electrode. 2) Knowledge of the physiology & management of apnea, and monitoring of heart rate and respiration. 3) Correction of acidosis & anemia and the nutritional supply by the intraveonous fluid administration. 4) Airway maintenance. 5) Oxygen administration to main PaO2 or tc PO2 of 60--80 mmHg. 6) Artificial ventilation by CPAP or IMV and 7) The specific drug therapy includes indomethacin for PDA associated with IRDS, Tolazoline for the fetal circulation syndrome, and Xanthine derivatives for primary apnea. 8) However, improvement by exchange transfusion has been contro-versial. On the other hand, in the type II RDS which has a relatively good prognosis, the intact survival can be expected by means of the proper management of general condition and respiration. In MAS, pneumothorax, pneumomediastinum and severe asphyxia, the proper resuscitation, oxygen administration should be given according to several conditions, especially the degree of hypoxia. The peritoneal dialysis can be lifesaving in case of severe renal impairment with RD. As the respiratory distress in the newborn is very frequent in its occurrence and death rate, its proper management is expected to result in the decrease in the newborn death rate in Hokkaido (8.1--6.6 per 1,000 live births) and the increase in the survival rate without any handicap, particularly if hospitals in each Hokkaido district give the newborn medical care more intensively than at present.