Neonatal Clinical Manifestations of Respiratory Diseases
History
Inspection
Objective Data
Auscultation
ABGs/Pulse Ox
Prematurity
Maternal diabetes
C-section
Multiple births
Sibling w/ RDS
Prematurity
Hx of RDS
Mechanical Vent
Retractions
Nasal Flaring
Paradoxical respirations
Cyanosis/pallor
Expiratory grunting
Poor air entry
May have crackles
Decreased chest
movement
Low birth weight
RDS
Prolonged mechanical O2
Slow growth
CXR
Assessment
Common causes
Plan
Reticulogranular,
Ground glass
appearance w air
bronchograms
RDS
Surfactant deficiency
atelectasis
O2 therapy
Hyperinflation therapy
Mechanical Ventilation
Surfactant administration
Diminished/Distant
BS
Decrease PO2
Decrease SpO2
Avoid SpO2 >95
Note: preemies need PO2 in
60-80 range
Further decrease PO2/SpO2
while on FiO2
Small cystic areas w
possibly flattened
diaphragm
Pulmonary Interstitial
Emphysema (PIE),
Air trapping
Cyanosis if off O2,
Barrel chest
Wheezes
Crackles
Rhonchi
Increase PCO2
Normal pH
Decrease PO2/SpO2
Cystic pattern
Bronchopulmonary
Dysplasia (BPD),
Air trapping,
Bronchospasm
Usually full term
Possibly C-section
Perinatal complications
Stress and/or asphyxia in utero,
Meconium noted in amniotic
fluid,
Usually full term to post term
Tachypnea
Retractions
Crackles
Decrease PCO2
Decrease PO2/SpO2
Dyspnea,
Meconium-stained
umbilical cord or
fingernails
Crackles
Rhonchi
Decrease PCO2
Decrease PO2/SpO2
Perihilar streaking w/
enlarged cardiac
silhouette
Hyperaeration
Transient Tachypnea of the
Newborn,
Airway fluid
Meconium Aspiration
Syndrome (MAS),
Airway secretions
Air trapping
O2 therapy,
Decrease Vent pressure,
Permissive hypercapnia,
Monitor for barotrauma,
Possibly high frequency vent
and/or selective mainstream
intubation
O2 therapy
Bronchodilator therapy
Bronchial hygiene therapy
Permissive hypercapnia
Fluid management
Increased calorie intake
O2 therapy
Possible underlying problem w/
meconium aspiration,
CHF,
Perinatal asphyxia,
Minimal increase PO2 w/ 100%
O2 challenge
May have normal pregnancy
and delivery,
May have dusky/cyanotic
episodes,
Minimal increase PO2 w/ 100%
O2 challenge
Problems w breathing,
Difficulty w eating and
breathing,
Noisy breathing
Persistent cyanosis
disproportionate to
degree of pulmonary
disease on CXR,
Tachypnea
Corresponds to
underlying
cardiopulmonary
disorder
Fluctuation in PO2/SpO2
Normal to mild
pulmonary parenchymal
disease
May be normal in
appearance if left-Right
shunt is present,
Cyanotic if right-left
shunt is present
Heart murmur may
be present
PO2 may vary widely
depending on heart lesion:
Low=right-left shunt
More normal =left-right
shunt
May have irregular heart
shape depending on
lesion
Persistent Pulmonary
Hypertension of the
Newborn (PPHN),
Pulmonary vasoconstriction,
Reopening of fetal
circulation pathways
Congenital Heart Disease
Pulmonary shunting
Varies w/ lesions,
Respiratory distress,
Drooling,
Gastric distention
Varies w/ lesions
Decrease PCO2
Decrease PO2
Extent of which varies w/
lesions
Normal to highly
irregular depending on
lesion
Congenital Anomalies of the
respiratory system
Airway obstruction
Suction oropharynx and trachea
before delivery,
O2 therapy,
Bronchial hygiene therapy,
Possible hyperventilation if
hypertension is likely,
May need to consider ECMO, HFV,
etc.
Monitor for barotrauma
O2 therapy,
Mechanical Ventilation,
Treat underlying cause
May need to consider ECMO, HFV,
nitric oxide
Evaluation to identify problem,
Cardiac catheterization,
Surgery (Pre and Post Op care)
Evaluation to identify problem,
Radiographic
procedures/operative procedures
to diagnosis and treat
Pre and post-op supportive care