Definition: Rapid breathing in the early days of life
due to immaturity of the lungs or
decreased absorption of fetal lung fluid.
1. What caused this condition?
Rapid breathing (tachypnea) is a sign of an abnormality in the lungs.
Causes for the rapid breathing can be lung fluid that did not clear
quickly (transient tachypnea of newborn), inadequate levels of a
substance (surfactant) in the lungs that prevents them from collapsing
(respiratory distress syndrome), or infection (pneumonia).
2. What is actually taking place in the lungs?
The lungs are stiffer than normal and have a decreased ability to get
oxygen into the bloodstream and carbon dioxide out. In some cases,
there may be gradual collapsing of the small air sacs that, as it
progresses, makes the condition worse.
3. How does it differ from pneumonia?
Pneumonia is caused by an infection. This condition is caused by
either too much fluid in the lungs after delivery or decreased amounts
of a chemical that stops the air sacs in the lungs from collapsing.
4. What tests are needed to further define this condition?
Chest X rays are the main test, but many of these conditions can
appear the same on chest X ray. Often the way the baby acts after
several hours will determine whether there is just fluid or if there is
collapse occurring. Since infection is always a concern, a blood count
and blood culture are also almost always done. A blood gas to deter-
mine how well the lungs are functioning is also frequently performed.
5. How dangerous is this condition, and can we
expect a complete recovery?
If there is extra fluid only, the condition is mild, and the baby gener-
ally starts to get better several hours after treatment. If there are
decreased amounts of surfactant present, then the baby will most
likely need some type of breathing support. Decreased surfactant is a
more significant condition with potentially more complications and a
longer need for treatment. In both conditions the affected newborn
generally makes a complete recovery.
6. What kind of treatment will be needed, and are there
any potential negative side effects from the treatment?
In most cases either additional oxygen support and/or breathing
support with a machine will be needed. An artificial form of the
chemical to prevent lung collapse, surfactant, will be given to babies
meeting levels of support to warrant its use. If artificial surfactant replacement is needed, then a breathing tube will be placed into the
baby’s airway (trachea), and the chemical will be given directly into
the lungs. The breathing tube may then be removed or kept in place
and a form of breathing support will be started. This breathing support
can either be through prongs that go in the baby’s nose or by a
breathing machine (ventilator) attached to the breathing tube.
As with any abnormality in the lungs and need for breathing assis-
tance, a hole can develop in the lung(s) that allows air to escape from
the lung into the chest cavity (pneumothorax). As this air accumulates, it may compress the lungs and cause further worsening of the
breathing condition. Many of these leaks require a drainage tube
(chest tube) placed into the chest to remove this trapped air.
Occasionally, these leaks can also occur within the lungs (pulmonary
interstitial emphysema), under the skin, or around the heart. These
may require different drainage tubes or special ventilators to treat.
7. How long will my baby need to stay in the hospital?
Depending on the severity and whether it is excess fluid or low levels of
surfactant, the baby may stay in the hospital from three days to several
weeks. Infants with excess fluid and mild surfactant shortage respond
quickly and will have shorter stays. In all cases, the breathing concerns
have to be resolved and the baby feeding by mouth prior to going home.
8. Will the treatment or the disorder weaken the
lungs in the future and predispose my baby to
future respiratory tract problems?
In most babies that are close to their due date or at their due date
there are minimal long-term effects on the lungs. The majority of
these babies will have no further respiratory concerns.
9. Will I be able to stay in the hospital until my baby
is fully recovered?
The usual hospital stay for a mother is two to four days, depending
on the type of delivery. Babies with excess fluid have a better chance
of being able to be discharged with the mother. Mothers of infants
with surfactant immaturity will most likely be discharged prior to the
baby’s recovery.
10. Will any treatment be needed at home following
discharge, and, if so, who will help me
administer it?
It is unusual for babies that are not very premature to require any
treatments after discharge. More premature babies may require
supplemental oxygen, intermittent breathing treatments, or rarely,
additional breathing support. Parents of babies with these needs will
be trained prior to discharge and often spend one to two days and
nights in the hospital with their baby prior to discharge. Sometimes
a home nurse may assist or check in regarding the care of the baby
after discharge.
11. Do we need to consult with a neonatologist
(newborn specialist) or a pulmonary (lung)
specialist?
Most babies with breathing issues that require them to be transferred
to the neonatal intensive care unit will be cared for by a neonatologist. Pulmonary specialists are generally consulted near discharge if
the baby is going to require breathing support at home.
12. Is this hospital capable of dealing with this
disorder, or does my baby need to be
transferred to another hospital that is more
capable of dealing with difficult illnesses?
This depends on each hospital’s capabilities and pediatrician’s comfort
level in treating sick newborns. Many smaller hospitals will attempt to
take care of babies with excess fluid that just need additional oxygen
and are stable or improving. If the baby’s condition is getting worse
and breathing support is needed, that is generally done at larger hospitals that have special areas called neonatal intensive care units
(NICUs) and neonatologists (newborn specialists).
13. After discharge from the hospital, what kind of
follow-up will be needed?
This is dependent on the age of the baby at birth. If the baby was near
its expected birth date, then usually care with the pediatrician is
needed. The more premature the baby was will increase the potential
need for pulmonology and developmental specialty care.
|
Respected Readers:
|
