Neonatal Respiratory Care Julia Petty
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1 Neonatal Respiratory Care Julia Petty
2 Respiratory conditions EXAMPLES.. Respiratory Distress Syndrome (RDS) Chronic lung disease Transient Tachypnoea of the Newborn Meconium Aspiration Pneumonia Apnoea of prematurity Air leaks e.g. pneumothorax Persistent Pulmonary Hypertension of the Newborn (PPHN)
3 Assessing the normal respiratory system Rate Pattern / rhythm Sounds Chest movement Colour Blood gases Good saturations / transcutaneous O2 in air Heart rate
4 Assessing the compromised respiratory system Rate - Tachypnoea Pattern / rhythm dyspnoea / gasping Sounds - grunting Chest movement - recession and nasal flaring Colour cyanosis / pallor Blood gases -? Acidosis /? High CO2 Poor saturations in air & requiring oxygen Heart rate tachycardia (late. bradycardia)
5 Respiratory care Different levels of dependency (from healthy up to intensive care) Self ventilating in air Oxygen ambient in incubator Oxygen via nasal cannula Oxygen via head box High flow oxygen (Vapotherm ) CPAP continuous positive airway pressure BiPhasic CPAP (2 levels) Ventilation
6 Oxygen therapy High flow oxygen Different ways of giving oxygen highlighted on previous slide Remember oxygen at high levels can be harmful Reduce/remove oxygen as soon as possible Monitor oxygen saturations continuously
7 What is CPAP? Continuous Positive Airway Pressure The application of positive pressure to the airways of a spontaneously breathing patient throughout the respiratory cycle Spontaneous breathing possible but with difficulty maintaining airway patency / when there is poor compliance and collapse Thompson, 2006
8 Binasal CPAP Delivered by nasal prongs in both nostrils OR via a mask over the whole nose (see next picture) Based on a linear relationship between flow and pressure (i.e.- increase flow to increase pressure) Designed to provide accurate and easily controlled CPAP by a non-invasive means Continuous flow, a constant seal is vital, A unique fluidic flip mechanism in the tubing near the nose ensures this pressure delivered is in tune with inspiration and expiration of the neonate (flow driver)
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10 BiPhasic CPAP ( SiPAP ) Two fluctuating levels of pressure Changes in pressure can be set by the nurse / clinician OR set according to the baby (i.e. trigger ) Increases of pressure referred to as pulses rather than breaths See next picture
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12 Nursing care issues Fixation ensure good seal, c/o nostrils, nose care Correct bonnet size and prong Support of tubing positioning tubes and the baby (?prone), correct angle Humidity Feeding & observe abdomen Observation of respiratory status Petty (2013a)
13 Ventilation Full mechanical ventilation is only given when non-invasive interventions have been attempted and are ineffective Neonate is intubated and put onto ventilator support with a given selected mode guided by their individual condition and assessment Protective lung strategies mean that the lowest possible pressure, volume & oxygen must be given to prevent damamge to fragile neonatal lungs Bellettato et al, 2011; Sweet et al, 2013; Petty, 2013b
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15 Other areas Surfactant therapy for preterm neonates administered early (Sweet et al, 2013) Other related drug areas are use of caffeine & steroids (maternal antenatal use to prevent RDS and the use of post-natal steroids to et neonate off ventilation) Weaning ventilation. Conventional verses non-conventional modes & adjuncts - e.g. high frequency oscillation, nitric oxide therapy. NON-invasive strategies always best if condition allows
16 Further Reading Bellettato B, Carlo W, Rosenkrantz T, Carter BS and Windle. ML. Assisted Ventilation of the Newborn Dewhurst, C., Harigopal, S., Subhedar, N (2007) Recent advances in inhaled nitric oxide therapy in neonates: A review of the evidence Infant 3(2): Fallon A (2012) Fact Sheet Oxygen Therapy. Journal of Neonatal Nursing. 18 (6), Halliday, H.L. (2007) Postnatal steroids for chronic lung disease Infant 3(2): Mayell S.J., Harrison G., Shaw N.J. (2006) Management of infants on home oxygen. Infant 2(4): Petty, J. (2013a). Understanding neonatal non-invasive ventilation Journal of Neonatal Nursing 19, Petty, J. (2013b) Understanding Neonatal Ventilation: Strategies for Decision Making in the NICU. Neonatal Network. 32, 4, Pramanik, AK, & Rosenkrantz, T. (2012) Respiratory Distress Syndrome. Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Saugstad O, Simeoni U, Speer CP, VallsiSoler A and Halliday H (2013) European consensus guidelines on the management of neonatal respiratory distress syndrome 2013 Update. Neonatology. 103: DOI: / pdf Thomson, M. (2006) The prevention of bronchopulmonary dysplasia. Is there syngergy between early nasal CPAP and surfactant? Infant 2(2):
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