RESPIRATORY PROBLEMS AND

INFECTION

ASPHYXIA NEONATORUM

Asphyxia neonatorum means non establishment of satisfactory pulmonary respiration at birth.

or Clinically defined as failure to initiate

and maintain spontaneous respiration following birth.

Etiopathology

continuation of intra uterine hypoxia

Prenatal and intranatal medication

Birth trauma

Postnatal

Clinical features Low Apgar score PaO2 80-95 mmHg PaCO2 35-45 mmHg HCO3 24-26 mEq/L

PATHOPHYSIOLOGY Hyperapnea primary apnea gasping attempt

secondary apnea

bradycardia and shock

diminished cerebral flow Cerebral haemorrhage

Hypoxic ischemic encephalopathy

Death or handicapped

MANAGEMENT

RESPIRATORY DISTRESS SYNDROME

Termed as Hyaline membrane disease It occurs due to diminished surfactant

production Pathologic feature is a hyaline like

membrane formed from an exudate of an infants blood that begin to line the terminal bronchioles, alveolar ducts and alveoli.

RISK FACTORS

Preterm babies Infants of diabetic mothers Ceaserian section Breech delivery

PATHOPHYSIOLOGY

deficient surfactant production

hypoinflation of the alveoli

pulmonary resistance increased

poor oxygen exchange

release of lactic acid

CLINICAL FEATURES

Low body temperature Nasal flaring Sternal subcostal retraction Tachypnea Cyanotic mucus membrane Expiratory grunt Seesaw respiration

Pale gray skin Periods of apnea pneumothorax

MANAGEMENT

Surfactant therapy Oxygen administration Ventilation prevention

MECONIUM ASPIRATION SYNDROME

Management include proper intrapartum

monitoring amino infusion pulmonary toileting liberal oxygen supply antibiotic coverage

OPTHALMIA NEONATORUM

Inflammation of conjunctiva during first three weeks oflife

Causes- bacterial chemical viral

Mode of infection is by contaminated vaginal discharge

Clinical pictures include watery discharge, muco purulent to frank purulent in one or both eye,sticky or markedly swollen eyelid and cornea may involve

PREVENTION

Treat in antenatal period Obstetrical asepsis Newborns eyelid is thoroughly cleaned

and dried Investigation include gram stain smear,

c@s,scraping material from lower conjunctiva and culture in special viral media

TREATMENT

Bacterial: irrigate with sterile isotonic solution, topical gentamycin eye drops, in severe culture positive cases ceftriaxone and cefotaxime

Chlamydia: erythromycin suspension and ophthalmic ointment

Herpes simplex: acyclovir, topical use of Idoxuridine

SKIN INFECTION

Due to staphylococcus aureas Superficial pustules, singleor scattered

form on face, axilla and scalp 1% gentian voilet

Pemphigus neonatorum It is a serious form of skin infection

caused by staphylococcus Causes septicemia and pyaemia Superficial blisters occurs at any part of

the skin becomes pustules and then burst

Kept in isolation Avoid baby bath in hospital Blisters are pricked by sterile needles 1% gentian violet Erythromycin and cloxacillin

ORAL THRUSH

Infection of the buccal mucos membrane and the tongue by the fungus candida albicans

Milky white patches resembling milk curd

Spread to GI and Respiratory tract 1% gentian violet Nystatin oral suspension

UMBILICAL SEPSIS

Staphylococcus, e coli and other pyogenic organs

Serous purulant umbilical discharge may offensive

Stump looks moist Periumbilical area become red and

swollen Delay in falling of cord

TETANUS NEONATORUM

Clostridium tetani 5-10 days after birth Inable to suck followed by marked

trismus,rigidity of the body, Pyrexia Convulsions opisthotonus

TREATMENT

Isolation Tetanus immunoglobin Anti tetanus serum Antibiotics Sedation Antiepileptic Intubation and ventilation Nutrition by intragastric feed