Newborn breathing disorder syndrome - a common problem of premature babies

Neonatal respiratory distress syndrome most often affects babies born prematurely, but sometimes also those born on time. The occurrence of respiratory distress syndrome is influenced by a number of factors, most of them related to respiratory or cardiovascular diseases. How is the neonatal respiratory distress syndrome manifested?

Respiratory Disorder Syndrome( ZZO ) is the most common he alth problem seen in newborns. There are mild or more severe breathing disorders.

ZZO mainly affects premature babies, because the lungs of such a small child are not sufficiently developed to allow them to breathe independently. However, the disorder may have other causes and affect older children as well.

The first is the so-calledtransient tachypnoe of the newborns(TTN -transient tachypnoe of the newborns ) that resolve spontaneously within a few hours after birth and within 3 days at most. They are found in 1-2% of full-term babies and about 15% of premature babies. On the other hand, respiratory disorders of moderate and moderate course occur in half of premature babies born before 28 weeks of pregnancy, in 20-30% of babies born between 32 and 28 weeks of pregnancy and in approx. 15% of so-called late premature babies, i.e. those born between 32 and 36 weeks.

Reasons for the occurrence of ZZO

Neonatal respiratory distress syndrome usually occurs because of problems with the respiratory or circulatory system.

• among the respiratory causes are the aforementioned fluid retention in the lungs, but also perinatal hypoxia, congenital pneumonia (which in turn can be caused by childbirth lasting more than 18 hours, frequent infections of the mother's urinary tract, or some other infection, mother's fever before labor, contaminated amniotic fluid), meconium aspiration syndrome (MAS), but also congenital defects of the respiratory system - such as surfactant deficiency, which results in the collapse of the alveoli and leads to atelectasis.
• circulatory causes include congenital heart defects, congestive heart failure or persistent pulmonary hypertension

The causes of IBD can also include metabolic disorders, body temperature disorders (both fever and hypothermia),infections and diseases of the nervous and muscular systems. The newborn's respiratory disorders are also favored by the male sex, the second twin, maternal diabetes, caesarean section.

Worth knowing

When the baby is still in the womb, he begins to draw amniotic fluid into the bronchi and lungs and remove it back. In this way, it teaches the lungs to breathe air. Just before giving birth, this activity stops. As the baby passes through the birth canal, the remnants of the amniotic fluid are pressed out of the lungs and removed from the baby's body (therefore, caesarean section is one of the factors that increase the risk of developing an OCD, especially in women who have not had labor). Within a few hours after birth, any remaining fluid should evaporate through breathing.

Symptoms of Newborn Respiratory Disorder Syndrome

A child who has breathing problems has:

• rapid breathing (over 60 / minute - normally it should be around 40 / minute). It is especially difficult for a child to exhale. The symptoms worsen between the first and second day of life. If no measures are taken to support the child's breathing at this point, the oxygen saturation in the blood will decline with time, and this will result in hypoxia. Metabolic acidosis appears, as well as acute respiratory failure.
• grunting
• apnea or slowing down of the breathing rhythm - in severe forms of ZZO
• cyanosis, i.e. a bluish discoloration of the skin and oral mucosa
• increased, visible work of the muscles of the respiratory system (tightening of the sternum, cervical notch, intercostal spaces, movements of the nasal wings)
• tachycardia
• feeding problems

Recognition of IBD

In premature babies, HRD is diagnosed fairly quickly. An experienced doctor recognizes the disorder at the very first breath of a child. If the disorder occurs later, the specialist will conduct a detailed interview and carefully examine the child for symptoms typical of an IBD. In addition, he should pay attention to the mother's he alth condition, whether she had a cold before childbirth, or had gestational diabetes - because this disease may cause a deficiency of surfactant in the child. The doctor should also ask about the course of the delivery, how long did it last, whether there were any complications, whether the amniotic fluid was clean, whether it had the right volume (a small amount of amniotic fluid promotes lung underdevelopment), as well as the child's behavior - e.g. whether he chokes while eating if he has any asymmetrical reflexes. Then the doctor orders a series of tests:

• arterial blood gas measurement - an increase in the concentration of dioxide will indicate an HRDcarbon (>45 mm Hg) with reduced oxygen concentration (<60 mm Hg)
• blood count - it may show anemia, infection
• blood glucose concentration
• Chest X-ray
• Brain transthral ultrasound - if there is a suspicion of intracranial bleeding
• echo of the heart - in case of suspicion of a heart defect or persistent pulmonary hypertension
• bronchoscopy

A microbiological test is also performed to help diagnose pneumonia or sepsis.

Treatment of the newborn's respiratory distress syndrome

After the diagnosis of ED, the child should be provided with specialist hospital care. It is necessary to ensure that his respiratory tract is unblocked and, if necessary, to activate the respiratory and circulatory system support, and to ensure the appropriate ambient temperature. Treatment depends on the form of the disease, its severity and cause.

Surgery should be considered in cases where the respiratory distress syndrome is caused by a congenital heart defect.

Passive oxygen therapy is the simplest, non-invasive method. A newborn baby is placed in an oxygen booth or a device (CPAP air pump) is installed above it, forcing oxygen into the air it breathes. Nasal cannulae or masks can also be used. A special respirator, in addition to supplying the child with oxygen, gives it under pressure, thanks to which the alveoli do not collapse.

More severe cases of IBD require mechanical ventilation, in which an endotracheal tube is inserted into the child's trachea, through which the machine conducts replacement breathing. If the cause of ED is already known, pharmacological treatment is also started:

• surfactant - if ZZO causes a deficiency of this factor
• antibiotics - if ZZO causes pneumonia or meconium aspiration syndrome
• cardiac medications - if a heart defect is the cause of the IBD.

The prognosis for the respiratory distress syndrome depends on the cause and course of the disease. The mildest cases pass spontaneously and do not require treatment at all - such as, for example, transient tachypnea in newborns. Congenital pneumonia also gives a good prognosis. However, the prognosis is worse if HRDs cause severe birth defects. Perinatal hypoxia can also significantly interfere with the later development of the baby. Every child with a respiratory distress syndrome as a newborn should be regularly tested for psychomotor development. It is worth knowing that oxygen in high concentration is a powerful drug and can have a toxic effect. It is especially dangerousoxygen therapy in the first 14 days of a child's life. When used at such an early stage of development, it increases the risk of lung damage, the central nervous system, and oxidative stress. In the following years, however, the child may suffer from various disorders of the central nervous system. They can cause mental retardation, motor problems, hearing and vision impairments.