Neonatal Nursing: Respiratory Distress Syndrome Essay

Baby X, a male infant, was born on 21/4/2011 to a primigravida mother at 35 weeks of gestation through spontaneous normal vaginal delivery. The birth weight was 2832 grams. The mother conceived after in vitro fertilization. The baby was born in a good condition. APGAR Score at 1 minute was 9/10 and at 5 and 10 minutes was 10/10. Heart rate was more than 100 per minute. At 12 minutes of life, baby X was noticed to have a sternal recession, nasal flaring and grunting because of which he was transferred to the neonatal unit. A diagnosis of respiratory distress, prematurity and ?sepsis was made. The baby was kept in an incubator for warmth. The intravenous cannula was inserted and blood samples sent for routine investigations and blood culture.Neonatal Nursing: Respiratory Distress Syndrome Essay .  The bay was started on 10 % dextrose solution intravenously at 60ml/kg/day. Chest X-ray was taken after 4 hours of life. CPAP was initiated. The chest X-ray was suggestive of respiratory distress syndrome. The CPAP requirement on the first day of life was CPAP 6 cm/h2o and 21 percent oxygen (air). The aim of saturation was at least 94 percent. The baby was kept nil by mouth and broad-spectrum intravenous antibiotics were started. On the second day, the baby was weaned from CPAP to nasal cannula oxygen. The intravenous fluids were increased to 90ml/kg/day with 10 percent dextrose. Intravenous antibiotics were continues while awaiting blood culture reports. The baby was continued to be Nil by Mouth and in an incubator. Cranial ultrasound done on the third day of life was normal. Neonatal Nursing: Respiratory Distress Syndrome Essay .

This assignment describes my own reflective experience while caring for a sick neonate with Respiratory Distress Syndrome (RDS) in the neonatal unit. This has enabled me to explore the meaning and significance of my clinical practice and to recognise the complexities within it. The experience raises a number of issues frequently encountered in daily nursing practice. Within this assignment, I will be discussing a particular pre term baby with RDS and critically analyse the use of nasal continuous positive airways pressure (NCPAP) and surfactant therapy and possible effects on baby’s outcome. Pseudonyms will be used to maintain patient confidentiality in order to keep in with the nursing and midwifery council code of conduct. (NMC 2004)The
Due to the lack of adequate surfactant in miniature lungs the alveoli collapses and cause inadequate gaseous exchange with hypoxemia and hypercarbia, resulting acidosis. In some babies pulmonary vasoconstriction leads to persistent hypertension and right to left shunts resulting more severe hypoxemia. (Rodriguez 2003)
Management of RDS include both prevention and active management before during and after birth. Prevention of preterm delivery is very important as the vast majority of babies who develop RDS do so because they are born preterm. Late or lack of antenatal care, smoking, alcohol consumption, illegal drug use, domestic violence, lack of social support, high levels of stress and long working hours with lengthy periods of standing can all increase the risk of premature birth( Johnson et al, 2003). Current medical approaches to preventing preterm labour include the use of tocolytic drugs, antibiotic treatment and cervical cerclage. Neonatal Nursing: Respiratory Distress Syndrome Essay .Tocolytic drugs such as ritodrine can delay the progress of preterm labour in the short term which may allow enough time to give the women antenatal steroids or to arrange her transfer to a perinatal centre with neonatal intensive care facilities if needed (Murphy et al, 2004). A systematic review of randomised controlled trials (including large ORACLE 1 trial,) indicated that the antibiotics for preterm pre-labour membrane rupture prolong pregnancy and reduce the incidence of neonatal infection 

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