Distress syndrome of respiratory newborns

Respiratory distress syndrome (respiratory distress syndrome) is a non-infectious pathological process (primary atelectasis, hyaline membrane disease, edematous hemorrhagic syndrome) that form in the prenatal and early neonatal periods of a child's development and are manifested by breathing disorders. The incidence of respiratory distress depends on the degree of miscarriage and averages 60% in children born less than 28 weeks of gestation, 15-20% at 32-36 above and 5% at 37 weeks or more. At rational nursing of such children lethality comes nearer to 10%.

Etiology, pathogenesis. It develops mainly in premature babies from mothers with a burdened obstetric anamnesis (cardiovascular diseases, diabetes, nephropathies, placental pathology, uterine bleeding). Intrauterine hypoxia, asphyxia and hypercapnia in labor are important in the presence of immaturity of the lung tissue. Under the influence of hypoxia and hypercapnia, there is a violation of pulmonary circulation, impregnation of interalveolar septa with serous fluid occurs, with the exit into the lumen of the alveoli of the constituent parts of the plasma, in particular fibrin. The formation of hyaline membranes is also possible as a result of a decrease in fibrinolytic activity of the blood. There is also a lack or a sharp decrease in the activity of the anti-teleleptic factor (surfactant), which promotes atelectasis. Deficiency of plasminogen, alpha2-macroglobulin and the development of local or disseminated intravascular coagulation are of definite importance. There are underdevelopment of the elastic tissue of the lung, immaturity of the alveoli, aspiration of the amniotic fluid and mucus, especially in the case of deep-seated children.

Clinical picture. Most babies are born in a state of asphyxia and congenital hypoxia, but breathing disorders may not appear immediately, but several hours after birth. Typical are the marked signs of respiratory failure: dyspnea with a respiratory rate of 60 or more per 1 min (often with aperiodic respiration), cyanosis (perioral, acrocyanosis, generalized), pale skin, participation in the act of respiration of the auxiliary musculature (nostril tension, Compliant places of the chest - intercostal spaces, xiphoid process of the sternum, retraction of the supraclavicular pits), rigidity of the thorax, sometimes foam at the mouth, hampered breathing (spasm of the glottis fissure), swelling of the cheeks. There is a decrease in motor activity, hyporeflexia, muscle hypotension. For early detection and evaluation of the severity of respiratory disorders in newborns, use the Silverman scale (Table 13). The assessment is made in dynamics every 6 hours for 2-3 days.

As the disease progresses, respiratory disorders and symptoms of nervous system depression increase, cyanosis increases, apnea appears, a "grunting" exhalation and paradoxical breathing (with exhalation the anterior chest sections are drawn in, and the stomach protrudes), absent crepitus. Often there are local and generalized edema; Foamy, sometimes spotting from the mouth. The cardiovascular system is affected, tachycardia, deaf heart sounds are observed, fruit communication with the right shunt is preserved, signs of pulmonary hypertension grow, cardio and hepatomegaly develop.

The diagnosis of respiratory distress is based on the clinical picture. It can be predicted on the basis of the study of the content of lecithin or thromboplasty of amniotic fluid.

If the ratio of sphingomyapin-lecithin levels in the amniotic fluid is more than 2.0, the probability of developing respiratory distress is 2%, if less than 2.0-50%, if less than 1.0-100%. A simple lung maturity test can also be used - Clements's "foamy test" with the contents of the stomach obtained by probing.

Differential diagnosis is carried out with pneumonia, malformations of the lungs and heart, intracranial birth trauma, diaphragmatic hernia.

Treatment. First of all, this is the prevention of cooling (the latter reduces or stops the synthesis of the surfactant). The child immediately after birth is wrapped and placed under a radiant heat source, and then to a kuvez. Carry out activities to revitalize and restore breathing. Good anti-acid therapy results. The main indication for the correction of sodium bicarbonate is the general severe condition of the child (less than 6 points in Apgar) and the development of decompensated acidosis (pH <7.3). Sodium bicarbonate solution is re-introduced in the next 2-3 days to normalize the acid-base state (pH 7.35-7.4). Widely used are the administration of vitamins, cardiac agents (0.05-0.1 ml of a 0.06% solution of a corglicon), euphyllin, and others.

Infusion therapy should be carried out slowly in a small volume at a rate of 3-5 drops per minute. The composition of the injected fluid is determined by the goal: delivering calories to the body, reducing catabolism and the degree of acidosis, improving water-salt metabolism, preventing hypo- or hyperkalemia and hyperaminoacidemia. In case of shock and blood loss, blood transfusion is indicated (10 ml of fresh blood). Permanent inhalation of 30% oxygen-air mixture is necessary. Indication for artificial ventilation is p02, equal to 40-50 mm Hg. Art. When inhaled 100% oxygen, and pCO2, equal to 70-80 mmHg. Art.

The use of oxygen-helium mixtures (70% helium and 30% oxygen) is effective. Of great importance is the care: peace, content in the kuveze. The time of the beginning of the feeding is determined individually, taking into account the functional state of the child and the degree of prematurity. In severe conditions, especially when the coordination of swallowing, sucking and breathing is disturbed, feeding through the probe is prescribed. As they recover, the children are transferred to the breast for expressed breastfeeding and then applied to the mother's breast.

The prognosis for the development of edematous hemorrhagic syndrome and hyaline membranes is severe, in other cases it is favorable.