Page 1 of 2: respiratory distress syndrome

zolt · Credits: 9181 My Scrapbook My Reading List 40 Books

the score used in respiratory distress syndrome is
a. sarnat & sarnat
b. dubowitz score
c. silverman anderson
d. ballard score

guest · Credits: 78425 My Scrapbook My Reading List 262569 Books

It is Silverman–Anderson Index, commonly referred to as the Silverman retraction score

lazybonezzz · Credits: 54675 My Scrapbook

ref???

guest · Credits: 78425 My Scrapbook My Reading List 262569 Books

Just google it! One of them is

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zolt · Credits: 9181 My Scrapbook My Reading List 40 Books

dubowitz score for gestational maturity
The Ballard Score assesses the physical and neuromuscular maturity of newborn
infants.
sarnat & sarnat staging for hypoxic ischaemic encephalopathy.
Silverman-Anderson score is a subjective assessment of respiratory distress

Bruno · Credits: 44755 My Scrapbook My Reading List 50 Books

Dear Zolt,

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You are using a LOGO from

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as your avatar without permission.......

wondergirl · Credits: 13257 My Scrapbook

jayanta · Credits: 35603 My Scrapbook My Reading List 45 Books

thanx u zolt.

parin · Credits: 14540 My Scrapbook My Reading List 1 Books

Hi friends, here is something about HMD which I had taken from several books, so I coudn't prevent myself from putting to you...

Idiopathic Respiratory Distress Syndrome(Hyaline Membrane Disease)

Pathogenesis:

a) basic abnormality is surfactant(phosphatisyl choline, phosphatidyl glycerol & proteins) deficiency --> increase surface tension --> alveoli collapse during expiration --> widespread atelectasis

b) hypoxia & acidosis --> pulmonary vasoconstriction --> right to left shunt across foramen ovale

c) Ischaemic damage to alveoli --> transudation of protein into alveoli --> hyaline membrane

Predisposing factors:

Preterm neonate
Diabetic mother
Caesarean section
Breech delivery
Hypothermia
Hypovolemia
Asphyxia
Acidosis

C/F:

They appear abruptly 4-6 hours after birth..

a) RR >60/min
b) Rib retraction
c) Expiratory grunt
d) Cyanosis
e) Decrease air entry

If 2 or more of a)-d) are present more than 1 hour apart, it can be diagnosed as HMD..

D/D

Aspiration pneumonia(liquor amnii or meconium)
Pneumothorax
Bacterial/viral pneumonia
TTN- Transient Tachypnea of Newborn
Diaphragmatic hernia
Congenital heart disease

Diagnosis:

Chest X-ray: shows ground-glass opacity, reticulo-glandular pattern, low lung volume, airbronchogram & white out lung in severe disease..

Prenatal diagnosis:
a) L/S ratio in amniotic fluid
b) Shake test

Treatment:

Apart from admission in NICU, treatment of cause & monitoring..

ventilate if:
a) significant respiratory distress
b) associated hypoxemia, hypercarbia or acidosis
c) inability to maintain PaO2 > 50 mm of Hg with FiO2 0.5-0.8 or PaCO2 < 50 mm of Hg

Oxygen therapy:

Warm & humidified O2 therapy in concentration of 35-40% under positive pressure
CPAP(Continuous Positive Airway Pressure) of 10-12 cm of water for moderate disease
IMV(Intermittent Mandatory Ventilation) for severe disease
HFJV(High Frequency Jet Ventilation) & Oscillatords for very severe disease who do not respond to conventional ventilators

(HFJV- 150-600 pulses of gas/min, can cause gas trapping, necrotizing tracheal damage..
Oscillators- 300-1800 pulses/ min, can cause gas trapping, air leaks, intraventricular haemorrhage, periventricular leucomalacia..)

Sodium bicarbonate 8.4% 1 mEq/kg in 1:1 dilution with 5% glucose for acidosis

Surfactant therapy is given as rescue treatment in all neonates with RDS or prophylactically in those <28 wks..

Direct tracheal instillation is done via endotracheal tube every 6-12 hours for 2-4 doses

Exosurf- synthetic surfactant
Survanta- modified natural bovine surfactant
Curosurf
Infasurf
ALEC- Artificial Lung Expanding Compound

However, these preparations can cause transient hypoxia & hypotension, pulmonary haemorrhage & blockage of ET..

Experimental therapies:

>Partial liquid ventilation with O2-carrying perflubron
>Inhaled nitric oxide

Complications:

a) Intraventricular haemorrhage
b) Pulmonary haemorrhage
c) Pneumothorax, pneumomediastinum, pneumopericardium
d) Bronchopulmonary displasia
e) Retrolental fibroplasia
f) Neurological abnormalities
g) PIE- Pulmonary Interstitial Edema

zolt · Credits: 9181 My Scrapbook My Reading List 40 Books

Indeed Parin has provided a nice informative piece about HMD.Thanks Parin.

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