You are in Burma teaching Helping Babies Breathe – a newborn resuscitation curriculum for resource-limited settings. Your venue is a Burmese national hospital with an assembly of excited nurses and midwives. But your presentation is suddenly interrupted by an urgent call from the postpartum floor: “We have a baby who is not breathing.”
You scurry to the ward to find a full-term newborn just minutes since birth. He appears listless, cyanotic, and with grunting respirations. With each gasp his chest caves in. Your anxious learners watch as you palpate the umbilical cord and announce the pulse rate is over 120 beats per minute.
You anticipate that the most likely cause of this baby’s distress is:
A Diaphragmatic hernia
B Hypoglycemia
C Transient tachypnea of the newborn
D Pneumonia
E Pneumothorax
Transient tachypnea of the newborn (TTN) is the most common cause of neonatal respiratory distress, constituting more than 40 percent of cases throughout the world. TTN is a lung disorder characterized by pulmonary edema resulting from delayed resorption of fetal alveolar fluid. Diaphragmatic hernia, hypoglycemia, pneumonia and pneumothorax are potential but relatively uncommon causes of newborn distress among term infants. “C” is the correct answer.
You immediately instruct your students to aggressively dry the infant. You then call for oxygen, but are told that the O2 calendars along the wall are all empty. Borrowing a stethoscope, a quick auscultation of the chest reveals coarse but present lung sounds throughout.
Your next immediate step in the management of this infant is to:
A Begin an intravenous infusion of normal saline
B Provide artificial ventilation with a bag and mask apparatus
C Administer epinephrine subcutaneously
D Request a chest radiograph
E Begin gavage feedings
The immediate treatment for neonatal respiratory distress due to TTN or most any other cause is assurance of adequate ventilation, most commonly with a bag and mask apparatus. Room air or supplemental oxygen administered in this way usually results in rapid improvement in a newborn’s status. Less urgent interventions include chest radiography to differentiate causes of respiratory distress, and intravenous normal saline and gavage feeds for provision of fluids and nutrition. Epinephrine administer is rarely indicated in neonatal resuscitation. “B” is the correct answer.
Neonatal respiratory distress is one of the most devastating and preventable causes of death in the world’s poorest communities. In response, the American Academy of Pediatrics launched the Helping Babies Breathe educational program. Join us on June 1-2 at the Exploring Medical Missions Conference for Helping Babies Breathe instruction. You too could become a Helping Babies Breathe teacher, and transfer these life-saving skills to healthcare providers around the globe.