Respiratory Distress in Neonates Respiratory Distress in Neonates Dr.Mohammad Saquib Mallick, FRCS Consultant Paediatric Surgeon, Consultant Paediatric.

Respiratory Distress Respiratory Distress in in

NeonatesNeonatesDr.Mohammad Saquib Mallick, Dr.Mohammad Saquib Mallick,

FRCSFRCS Consultant Paediatric Surgeon ,Consultant Paediatric Surgeon ,

King Fahd Medical City.King Fahd Medical City.

Riyadh Riyadh

Principles of Principles of Neonatal Surgery Neonatal Surgery

Types of Newborns:– Full-term: >38 weeks and weight >

2.5 kg – preterm infant: <38 weeks with

appropriate weight– SGA: >38 weeks and weight< 2.5 kg– VLBW: <32 weeks and <1.5 kg

There are physiologic differences between all these infants

Respiratory DistressRespiratory Distress The newborn suspected of having

respiratory distress should be studied in a logical step by step manner.

It is important to establish that the infant has a surgical problem before surgery is performed.

Resuscitation must be done before operation

Every condition will be dealt Every condition will be dealt accordinglyaccordingly

Respiratory DistressRespiratory Distress

Causes– Surgical

Upper airway obstruction Congenital diaphragmatic hernia Eventration of Diaphragm Esophageal atresia with TOF Pneumothorax Congenital lobar emphysema Congenital cystic adenomatoid

malformation Pulmonary Sequestration

Respiratory DistressRespiratory Distress

Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia

Incidence: 1:2000 to 5000,

female more affected,

prematurity and low BW,

Left side

Diaphragmatic Diaphragmatic HerniaHernia

SymptomsNone to severePolyhydramniosPresents birth to after many days

SignsScaphoid abdomenAudible bowel sound in the chest

Diaphragmatic Diaphragmatic HerniaHernia

Diagnosis:– Prenatal <25wks, prognosis

bad– Clinical– CXR– 10% >after neonatal period

Diaphragmatic Diaphragmatic HerniaHernia

Diaphragmatic Diaphragmatic HerniaHernia

Management– Reussciataion and

stabilization– Laparotomy

Primary Patch by silo or

muscle– Laparoscopic repair

Eventration of Eventration of DiaphragmDiaphragm

Def: Abnormal elevation of diaphragm Def: Abnormal elevation of diaphragm that results in paradoxical motion of that results in paradoxical motion of affected hemidiaphragm during affected hemidiaphragm during inspiration and expirationinspiration and expiration

Cause:Cause:– Congenital Congenital – AcquiredAcquired

Symptoms: Symptoms: – NoneNone– Resp. distressResp. distress– Wheezing, repeated URI, Wheezing, repeated URI,

Eventration of Eventration of DiaphragmDiaphragm

Diagnosis:Diagnosis:– CXRCXR– Fluoroscopy or Fluoroscopy or – Real time USReal time US

Eventration of Eventration of DiaphragmDiaphragm

Management:Management:–ConservativeConservative–plicationplication

Oesophageal atresia & TOFOesophageal atresia & TOF Incidence: 1: 5000 Incidence: 1: 5000 live births, 50% associated with live births, 50% associated with

anomaliesanomalies

Types: Types:

Symptoms and Signs:Symptoms and Signs:– Excessive salivation Excessive salivation – Respiratory DistressRespiratory Distress– Inability to pass NG tubeInability to pass NG tube– Choking and coughing on feedingChoking and coughing on feeding

VACTERLSyndrome

Oesophageal Oesophageal atresia & TOFatresia & TOF

Diagnosis Diagnosis – Clinical & CXR – Clinical & CXR Management: Management: ResuscitationResuscitation

– Common typeCommon type Right thoracotomyRight thoracotomy

Division and repair of TOFDivision and repair of TOF Primary anastomosisPrimary anastomosis

– Pure TOFPure TOF Division and repairDivision and repair

– Isolated atresiaIsolated atresia >3 vertebra>3 vertebra

Staged surgery (gastrostomy and Staged surgery (gastrostomy and followed in 3-6 months by delayed followed in 3-6 months by delayed repair. If fails then need esophageal repair. If fails then need esophageal replacement (stomach or colon)replacement (stomach or colon)

Respiratory DistressRespiratory Distress

Pneumothorax: The collection of air in the

pleural cavity in neonates.Causes: Hyaline membrane disease Meconium aspiration Pulmonary hemorrhage

Traumatic Rupture of cong.lung cyst

Respiratory DistressRespiratory Distress

Diagnosis: Clinical

Radiological

Respiratory DistressRespiratory Distress

Respiratory DistressRespiratory Distress Treatment: 1, Decompression by inserting chest tube

2, Treat the cause

Respiratory DistressRespiratory Distress

Congenital Lobar Emphysema:

“ massive over distension of a lobe or a segment of the lung that causes compression of normal lungs and medistinum“

Respiratory DistressRespiratory Distress

Etiology; air trapping due to abnormalities in

the bronchial cartilages.

bronchial cartilage may be

absent, hypoplastic, or dysplastic

Respiratory DistressRespiratory Distress

X-rays

Respiratory DistressRespiratory Distress CT Scan:

Respiratory DistressRespiratory Distress

Management:

Surgical excision of of the involved lobe or lobes is the treatment of choice.

QUESTIONS ?QUESTIONS ?