RESPIRATORY DISTRESS

Respiratory distress occurs when there is failure to maintain adequate exchange of oxygen and carbon dioxide by the lungs for a variety of reasons. It is characterized by: Respiration rate of 60/minute or more (tachypnoea), expiratory
grunt, chest or subcostal recession, cyanosis, and flaring of alae nasi.

Causes of respiratory distress

  • Respiratory distress syndrome (RDS),
  • Pneumonia,
  • Aspiration of meconium or feeds,
  • Transient tachypnoea of newborn,
  • Congenital heart disease, and (rarely)
  • Congenital anomalies of the oesophagus, airways or diaphragm.

Clinical Features That May Assist in Diagnosis

  • Respiratory distress syndrome (RDS) is most common in premature babies, but can occur in infants of diabetic mothers and following caesarian section.
  • Pneumonia: may be suspected with a history of prolonged rupture of membranes (more than 12 hours) and maternal fever, offensive liquor, or vaginal discharge. These are features of sepsis in the mother.
  • Meconium aspiration: Meconium stained liquor and staining of skin, nails, and cord.
  • Transient tachypnoea of newborn: Difficult to differentiate from RDS but usually in term/near term babies. Resolves within 24 hours.
  • Cardiac lesion: May or may not have murmurs depending on the defect.

Investigations

  • Full blood count
  • Blood culture
  • Chest x-ray
  • Special tests according to suspected problem

Management

  • Admit.
  • Treat danger signs if present.
  • Supportive therapy as in sepsis.
  • Antibiotics: An infection cannot usually be excluded.
  • Note: A baby who has pneumonia that does not respond to usual antibiotics could be having Chlamydia trachomatis infection. If this is so, the baby will respond to erythromycin 50mg/kg/day for 14 days
  • Re-evaluate or consult if not improving within 2–3 days of treatment.
  • Refer to specialists as needed to deal with any complex problem for further management.