respiratory distress syndrome of the preterm infant
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respiratory distress syndrome of the preterm infant,
Shortly after birth the preterm infant with RDS has a low Apgar score and obvious difficulty breathing. Tachypnea, tachycardia, retraction of the rib cage during inspiration, cyanosis, nasal flaring, and grunting during expiration are present. Blood gas studies reflect the impaired ventilatory function (abnormally low oxygen levels and respiratory acidosis).
Preterm infants with RDS require treatment in a specially staffed and equipped neonatal intensive care unit. Therapy is supportive: humdified oxygen is supplied, the airways are ventilated, and adequate hydration and electrolytes are administered. If necessary, assisted ventilation with PEEP or CPAP is used to open alveoli. Care is taken to prevent the barotrauma: traumatic formation of pulmonary air leaks that could cause pulmonary emphysema and tension pneumothorax. Instillation of surfactant into the respiratory tract via an endotracheal tube is essential in managing RDS.
To prevent RDS, as soon after birth as possible (preferably within 15 min), the health care professional administers neonatal lung surfactant intratracheally. The neonate's response to the medication is monitored carefully, and used to guide changes in ventilation, e.g., inspiratory pressures, tidal volume and oxygenation.
The skin and mucous membranes are frequently inspected and lubricated with a water-soluble lubricant to prevent irritation, inflammation, and perforation.
The newborn is maintained in a thermoneutral environment to stabilize body temperature at 97.6°F (36.5°C). The newborn requires gentle and minimal handling, with assessment and care procedures separated by rest periods. Caloric intake is provided orally or by gavage feeding in quantity to prevent catabolic breakdown. When her milk comes in, the infant's mother may want to pump her breasts as her infant can receive her milk through gavage feeding until the infant is strong enough to nurse.
The neonate also is at risk for multiple complications, including bronchopulmonary dysplasia, intracerebral bleeding, learning disabilities, pneumomediastinum, pneumothorax, retinopathy of prematurity, and sepsis among others. His or her parents require ongoing support of family, friends, or clergy to help them deal with familial, financial, and emotional stresses imposed by the illness. The parents are encouraged to ask questions and raise concerns. The parents' presence at cribside is encouraged to aid normal parent-infant bonding and they are shown ways to approach and be involved in the care of the infant (maintaining sterile technique) without adding to his or her stress.