Neonatal Medicine: CPAP and Ventilation in Neonatal Respiratory Distress

You argon reviewing Nathan, a 12 hour old neonate with respiratory distress. He is 37 weeks maternity and was natural by caesarean section section following failure to progress. The atomic number 8 fecundation is 94% in 50% FiO2, the respiratory tread is 80. There is mode stray intercostal recession and an infrequent grunt. Your hospital participated in the bubbles for babies essay and you have still started to use CPAP in your unit now the trial is finished. Your registrar suggests using CPAP on this neonate, but the care for staff have called you to arrange transfer.QuestionsWould you use CPAP or ventilate and transfer this neonate?Please lend oneself reasons for your choice with reference to the current literature.In your closure you should too consider the following main points the benefits of CPAP e verywhere ventilation, particularly with reference to your current practice environs the potential complications of CPAP reasons why ventilation whitethorn be requisi te even though CPAP is in situ.The minor Nathan is paroxysm from neonatal respiratory distress syndrome, which is a embodiment most often seen in newborn despoil babies and is characterized by a difficulty in breathing. The curb more frequently raises in prematurely born babies as their lungs are not fully developed. The lubricating substance that lines the inner membranes of the lungs (known as bed wetter) is deficient, thus make difficulty in inflating the lungs and resolutenessing in the strip sacs collapsing. wetting agent helps to sink the surface tension of water that is personate on the alveoli, thus helping to thwart the lung sacs from collapsing. Usually, the condition develops in childs born before the 38 week. The baby is cyanosed and has difficulty in breathing. The accessory muscles of cellular respiration are active and a frequent grunting sound is heard. The different symptoms that may be observed include hard up flaring, shallow breathing, swollen legs, unusual movement of the bureau wall, etc.The infant may be hypoxic and the carbonic acid hired gun levels in the blood rise. The symptoms usually develop at birth, or a little while afterward birth. The symptoms tend to worsen and may progress to respiratory failure and death. As the prematurity increases, so does the demote of developing this condition. This is be reasonableness surfactant is produced only during the later stages of gestation in the infant. The diagnosis of RDS in babies is made ground on the history, presence of certain risk factors, toilet table X-ray, Blood tests, CSF studies, lung tests, blood gas analysis, etc (Greene, 2007 & Merck, 2005).When a neonatal is born, certain signs are observed which include-a heart rate between 110 to one hundred fifty beats per minutea respiratory rate between 40 to 70 breathes per minute absence of cyanosis, os wastede flaring, grunting sounds, forceful use of accessory muscles during respiration, etc atomic numbe r 8 saturation which is about 95 %the P ao2 is high than 50 %the FiO2 is about 40 to 50 % (CCM, 2007, NGC, 2008, & Millar et al, 2004)Previously, for the interference of RDS, ventilatory support was apply. This may be employ if the blood carbon dioxide levels are high, the blood oxygen levels are low, and if acidosis sets in. To some extent ventilation helps to conquer the infant mortality rate arising from RDS, but the unwholesomeness to develop Bronchopulmonary dysplasia (a condition characterized by oedema of the air sacs and of the connective tissues due to persistent inflammation) is high as the young neonatal lungs are damaged from ventilation. iodine of the treatments that have been developed in order to overtake the limitations of ventilation is Continuous Positive Airway pull (CPAP). This is an advanced form of therapy in which the upper and the lower airways receive a continuous distending pressure by means of the infants pharynx and/or nose throughout the respir atory cycle. An endotracheal tube clear also be utilized. The device is connected to a gas source that provides humidified warm air continuously (NGC, 2008, Millar et al, 2004, Tidy, 2007).CPAP has several(prenominal)(prenominal) benefits including-helps to maintain a normal breathing condition helps to arrive at normal functional balance capacity helps to lower any airway immunity in the upper respiratory tract helps to prevent development of apnea prevents the airways and the air sacs from collapsing helps stimulate release of surfactant helps to increase the lung volume and lung function After expiration, CPAP helps to extend the air sacs open The chances of developing lung trauma such as barotrauma and atelectotrauma are lesser (CCM, 2007, Sehgal, 2003, NGC, 2008, Millar et al, 2004). CPAP is required in several situations that arise from RDS including-When it is difficult to maintain the Pa02 above 50 %.When the respiratory rate is above 70 breathes per minuteExcessive u se of the accessory muscles of respirationThe oxygen saturation falls to between 90 to 95 %The presence of apneaIt preempt be utilized along with administration of surfactant that develops out of the conduct to treat RDS (CCM, 2007, Sehgal, 2003, NGC, 2008, Millar et al, 2004).As the patient role is not suffering from a mischievous form of RDS and the oxygen saturation levels have not dropped to a serious extent, ventilatory support is not required, and the patient can be treated with CPAP. Besides, the findings do not suggest that the patient is suffering from a cardiovascular complication, an upper respiratory tract abnormality or intractable apnoeic episodes. Along with CPAP, several other measures are required such as using larger nasal prongs, ensuring that the baby is in a prone determine and keeping a towel below the neck. This helps to date that the certain areas are aerated better (CCM, 2007, Sehgal, 2003, NGC, 2008, Millar et al, 2004).CPAP has several complications i ncluding-mucous from the upper respiratory tract may block the nasopharyngeal tube that delivers CPAP Sometimes blockages may result in the pressure rising to higher(prenominal) levels in the tube If the peak pressure is very high, then gastric complications can develop The nasopharyngeal tube has to be derriered in lead position. Any deviation from the position can result in fluctuation of the air pressure The nasal devices may be swallowed or aspirated resulting in severe complications Sometimes harnesses may be utilized to place the head and the neck in position. This may cause serious dermatological and musculoskeletal complications in the infant Air leakage problems in the lungs Abdominal distention Decrease in the cardiac output higher(prenominal) working of breathing pneumothoraces and air embolism can also develop Cardiac monitoring unavoidably to be performed more closely in the mooring of CPAP compared to ventilation often air leaks from the nose and the gumshield it may be very difficult to ascendence the air pressure in the lower airways If CPAP is utilise to an infant with normal lungs, several problems can develop Several respiratory complications such as pneumothorax, pneumomediastinum, and pneumopericardium can develop (CCM, 2007, Sehgal, 2003, NGC, 2008, Millar et al, 2004, Halamek et al, 2006) ReferencesCalifornia College of Midwives (20080, Guidelines for Assessing the Neonate, Online, gettable http//www.collegeofmidwives.org/Standards_2004/Standards_MBC_SB1950/Assess_HealthyNeonate_Oct2004_OOO.htm Retrieved on 2008, April 2.Greene, A. (2007), Neonatal respiratory distress syndrome, Online, open http//www.nlm.nih.gov/medlineplus/ency/article/001563.htm Retrieved on 2008, April 2.Halamek, L. P. Et al (2006), Continuous Positive Airway printing press During Neonatal Resuscitation, Clin Perinatol, 33, pp. 83-98. http//www.mdconsult.com/das/article/body/91421747-3/jorg= ledger&source=MI&sp=16080552&sid=690389052/N/525142/s009551080500 1235.pdf?issn=0095-5108Millar, D., & Kirpalani, H. (2004), Benefits of Non Invasive Ventilation, Indian Pediatrics, 41, pp. 1008-1017. http//www.indianpediatrics.net/oct2004/oct-1008-1017.htmNGC (2008), Complete Summary, Online, functional http//www.guideline.gov/summary/summary.aspx?ss=15&doc_id=6516&nbr=4085, Retrieved on 2008, April 2.Sehgal A. Et al (2003), Improving Oxygenation in Preterm Neonates with Respiratory Distress, Online, Available http//www.indianpediatrics.net/dec2003/1210.pdf, Retrieved on 2008, April 2.The Merck Manual (2005). Respiratory Distress Syndrome, Online, Available http//www.merck.com/mmpe/sec19/ch277/ch277h.html, Retrieved on 2008, April 2.Tidy, C. (2006), Infant Respiratory Distress Syndrome (RDS), Online, Available http//www.patient.co.uk/showdoc/40000462/, Retrieved on 2008, April 2.