Respire: A Breath for Life

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MANAGEMENT OF RDS -
1. Surfactant Replacement Therapy

2. Correction of hypoxia with oxygen. The concentration of inspired oxygen should maintain the infant's arterial oxygen tension at 50-70 mm Hg.

3. If the infant is having recurrent apnea, persistent respiratory acidosis or if the PaO2 is inadequate in 50% or more oxygen with usage of nasal CPAP, the infant should be intubated.

4. To minimize both barotrauma and BPD, peak inspiratory pressures should be decreased as tolerated to keep the pCO2 between 40 and 60 mm Hg as long as the pH > 7.25.

5. The infant is placed in an incubator or on a radiant heater bed.

6. Intravenous fluids are given.

7. Metabolic acidosis is corrected by a slow infusion of sodium bicarbonate.

8. Shock is corrected by use of normal saline or Plasmanate R.

surface-active lipoprotein complex (phospholipoprotein) formed by type II alveolar cells.
-Why is Surfactant necessary?
The proteins and lipids that make up the surfactant have both hydrophilic and hydrophobic regions. By adsorbing to the air-water interface of alveoli, with hydrophilic head groups in the water and the hydrophobic tails facing towards the air, the main lipid component of surfactant, dipalmitoylphosphatidylcholine (DPPC), reduces surface tension

An unborn baby starts to make surfactant at about 26 weeks of pregnancy. If a baby is premature (born before 37 weeks of pregnancy), he or she may not have made enough surfactant yet.

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Effective screening and prevention of PTB varies between the different pregnancy populations.

Progesterone- It has been proposed that progesterone administration can prevent preterm cervical ripening.
Pessary- It prevents premature dilatation of the cervix and preterm rupture of the membranes.
Cerclage- The cervical cerclage is a securing suture around the cervix to prevent cervical shortening and opening.

Precautions:
KANGAROO TECHNIQUE 🦘 is a technique where the premature baby is placed in an upright position on its mother’s bare chest allowing tummy to tummy contact that positions the baby between the mother’s breasts. The baby’s head is turned so that its ear is positioned above the mother’s heart.
Many studies have shown that Kangaroo Care offers significant benefits. ✨

While not all premature babies experience complications, being born too early can cause SHORT TERM & LONG TERM complications.

A) Short-term Complications:

1. BREATHING PROBLEMS- Caused by an immature respiratory system.
Immature lungs in premature babies often lack SURFACTANT and ALVEOLAR COLLAPSE may occur.
Sometimes a more severe complication called as BRONCHOPULMONARY DYSPLASIA (BPD) may occur.

2. HEART PROBLEMS- Like PATENT DUCTUS ARTERIOSUS (PDA) can be seen due to depression in respiration.
If not supported properly, it can also lead to HEART MURMUR & even HEART FAILURE

3. BRAIN PROBLEMS- Like INTRAVENTRICULAR HEMORRHAGE which may lead to brain injury.

4. HYPOTHERMIA- A preterm-baby has LOW STORED FAT as compared to a fullterm-baby.
The preterm-baby is more susceptible to losing body heat in the form of radiation.
Hence such babies are supported with the help of an INCUBATOR or RADIANT WARMER.

5. GASTROINTESTINAL PROBLEMS- A serious complication called as NECROTISING ENTEROCOLITIS (NEC) is often seen because of the weakened state of intestine due to the lack of oxygen resulting in BACTERIAL INFILTRATION and subsequent NECROSIS.
However preterm babies recieving BREASTMILK are less prone to such complications (BREASTFEEDING 101).

B) Long-term Complications: (Generally due to the developmental anomalies)

1. CNS ASSOCIATED PROBLEMS- Like CEREBRAL PALSY due to inadequate blood supply can lead to impared muscle tone and posture related problems. Also, impared learning, behavioural and psychological problems are precipitated.

2. IMPARED VISION in preterms (reffered as RETINOPATHY OF PREMATURITY) due to scarring and pulling out of position of retina leads to BLINDNESS.

3. DENTAL PROBLEMS such as DELAYED tooth eruption , DISCOLORATED and MIS-ALIGNED TEETH can also be seen.

***However, if the baby is supported properly with proper medical assistance, better prognosis is seen and even a early preterm baby can show FULL RECOVERY.***