ABSTRACT
Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn.
Subject(s)
Continuous Positive Airway Pressure , Intubation , Practice Guidelines as Topic , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/therapy , Surface-Active Agents/therapeutic use , Education, Medical, Continuing , Female , Humans , Infant, Newborn , Male , Treatment OutcomeABSTRACT
The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy. Intervention with oxygenation, ventilation, and surfactant replacement is often necessary. Prenatal administration of corticosteroids between 24 and 34 weeks' gestation reduces the risk of respiratory distress syndrome of the newborn when the risk of preterm delivery is high. Meconium aspiration syndrome is thought to occur in utero as a result of fetal distress by hypoxia. The incidence is not reduced by use of amnio-infusion before delivery nor by suctioning of the infant during delivery. Treatment options are resuscitation, oxygenation, surfactant replacement, and ventilation. Other etiologies of respiratory distress include pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension, and congenital malformations; treatment is disease specific. Initial evaluation for persistent or severe respiratory distress may include complete blood count with differential, chest radiography, and pulse oximetry.
Subject(s)
Respiratory Distress Syndrome, Newborn , Algorithms , Diagnosis, Differential , Humans , Infant, Newborn , Meconium Aspiration Syndrome/diagnosis , Meconium Aspiration Syndrome/therapy , Respiration Disorders/complications , Respiration Disorders/diagnosis , Respiration Disorders/therapy , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapyABSTRACT
Exercise-induced bronchospasm (EIB) is an often-undiagnosed but common problem affecting both recreational and elite athletes. Although exercise can trigger exacerbation of chronic asthma, EIB should not be confused with the chronic inflammatory disease. In this article, Drs Hermansen and Kirchner review the incidence, diagnosis, and treatment of EIB and explain how to distinguish EIB from chronic asthma.
ABSTRACT
Exercise-induced bronchospasm (EIB) is an often-undiagnosed but common problem affecting both recreational and elite athletes. Although exercise can trigger exacerbation of chronic asthma, EIB should not be confused with the chronic inflammatory disease. In this article, Drs Hermansen and Kirchner review the incidence, diagnosis, and treatment of EIB and explain how to distinguish EIB from chronic asthma.
