NeonatalPeds Respiratory Care

1
Neonatal/Peds Respiratory Care
2
Development of RespiratorySystem

• 22 wks Lecithin appears Type I II
  pneumonocytes appear- immature surfactant
• 24 wks Respiratory bronchioles and alveoli
  appear
• 26-28 wks alveolar-capillary surface area
  development for extrauterine life
• 35 wks phosphocholine transferase system for
  lecithin synthesis

3
Maternal-Fetal Circulation

• Maternal uterine tissues and blood vessels (fetal
  chorionic villi or finger like projections) make
  up the placenta
• Maternal blood flows into spaces called
  intervillous space (1)
• Umbilical cord is made up of the umbilical vein
  and arteries, and filled with Whartons jelly, a
  white gelatinous substance (2)

4
Fetal Circulation

• Fetuss PO2 is normally about 30 torr
• HbF has a high affinity for O2 (a left shift of
  the oxyHb curve)
• HbF converts to HbA(adult) in 5 to 6 months

5
Fetal Circulation

• Oxygenated blood from the mother via the placenta
  ?umbilical vein ?fetal circulation via hepatic
  system ? 1/3 lower trunk ? 2/3 ductus venosus ?
  inferior vena cava ? right atrium ? 50 shunted
  from right atrium to left atrium through foramen
  ovale ?left ventricle ? body (brain,
  brachiocephalic trunk, descending aorta) (1)

6
Birth

• Lungs clear of liquid as the baby squeezes
  through the birth canal
• Air fills lungs at gt40 cm H2O transpulmonary
  pressure gradient to overcome forces that keep
  lungs deflated
• Pulmonary vascular pressure decreases that
  results in ?PO2, ?PCO2, ?pH and constricts ductus
  arteriosus (1)
• Umbilical blood flow ceases ?increased SVR
  ?increased left heart pressure gt right heart
  pressure ?closure of the foramen ovale (2)

7
General Assessment

• Maternal factors related to health of the fetus
• Mothers age
• High risk lt 16 gt 40 years of age
• Parity or pregnancies
• Hx of prior births
• Hx of maternal disease (1)
• Use of drugs, alcohol, and tobacco during
  pregnancy (2)

8
Fetal Assessment

• Ultrasonography
• Position of the fetus and placenta
• Gestational age and growth development
• Anatomic abnormalities
• Amniocentesis
• Meconium or blood
• Genetic abnormalities
• Lung maturation (1)

9
Fetal Assessment

• Fetal heart monitor
• Normal heart rate 120-160 beats/minute
• Contractions
• Type I decreased HR immediately after
  contractions
• Type II decreased HR 10-30 secs after
  contractions ? impaired maternal-placental blood
  flow
• Type III HR variable ? cord compression

10
Newborn Assessment

• APGAR score
• Taken 1st minute and 5th minute after birth
• 7 or higher is normal
• 3-6 after one minute need stimulation and O2
• lt 6 after five minutes needs CMV and NICU

11
Signs of Respiratory Distress

• Silverman Score
• Nasal flaring (reflect ? Raw)
• Cyanosis (may be masked by bilirubin)
• Retractions (reflect ? compliance)
• Expiratory grunting
• Paradoxical breathing

12
General Inspection (Skin)

• Infants skin is an indicator of intravascular
  volume and/or perfusion status
• Capillary refill time should be lt 3 secs
• Acrocyanosis
• Central (true) cyanosis
• Mottled skin
• Jaundice
• Lanugo
• Vernix caseosa

13
Gestational Age

• Dubowitz scale
• 10 physical signs
• 11 neurological signs
• Ballard scale
• 6 physical signs
• 6 neurological signs