A 1.5 Kg child born at 32 weeks through LSCS, presents with moderate respiratory difficulty. Which of the following is the appropriate management -?
CPAP The symptoms suggests neonatal respiratory distress syndrome / hyaline membrane disease. Respiratory distress syndrome / hyaline membrane disease occurs because of inadequate production of surfactant. - Since surfactant deficiency is the basis of RDS, exogenous surfactant is now recommended as the treatment of choice in neonates with RDS. - It is given to all neonates less than 28 weeks irrespective of presence or absence of RDS (Rescue treatment). -Beyond this age surfactant therapy is given according to the clinical condition of the patient. - If the distress is severe surfactant is required. - In the question the neonate is 32 weeks old and presents with moderate respiratory distress. - Surfactant is not necessary in such patient. Remember "Surfactant is not universally indicated in all cases of respiratory distress syndrome". Management of Respiratory distress syndrome Management of respiratory distress syndrome begins with administration of warm humidified oxygen. - This should maintain the aerial levels between 50 and 70 mm Hg (85-95% saturation) to maintain normal tissue oxygenation. If Pa02 cannot be maintained above 50 min Hg at inspired 02 concentration of 60% or greater CPAP should be applied. - If the patient is VLBW (very low bih weight) then CPAP is used early (t/t begins with CPAP instead of oxygen). - Another approach in VLBW infant is to intubate the infant, administer intracheal surfactant, then extubutate the patient and put him on CPAP. (In the question the infant is 1.5 kg at 32 weeks, his weight for age is adequate). Infants with severe RDS require mechanical ventilation.
CPAP
Mechanical ventilation
Warm oxygen
Surfactant and ventilation