DISTRESS-SYNDROME respiratory — the heavy respiratory insufficiency which is followed by a respiratory and metabolic acidosis, arising at newborns during the first hours after the birth.
D. - page is observed at malformations of a diaphragm, lungs and heart, pre-natal infections, a birth trauma and noninfectious pneumopathies (polysegmented and scattered atelectases of lungs, hyaline membranes, an edematous and hemorrhagic syndrome). If the reason of respiratory insufficiency is not clear, it is accepted to speak about a so-called idiopathic syndrome of respiratory frustration.
D. is especially frequent - the page develops at premature children (to 80% of all sick D. - page). The factors contributing to D.'s emergence - page, are the viral infection, a diabetes mellitus, anemia at the pregnant woman and bleeding in labor, Cesarean section prior to patrimonial activity, prematurity at durations of gestation less than 38 weeks, a condition of newborns — less than 7 points on a scale Apgar (see. Apgar method ).
- page is of Great importance in D.'s emergence anatomic and functional immaturity of lungs with insufficient production of so-called anti-atelectatic substance — surfactant (see). At the same time permeability of vessels increases (a plasmorrhagia, and sometimes and a hemorrhage). In transudate under the influence of high concentration of thromboplastin of an amniotic fluid, aspirirovanny a fruit, fibrinogen passes into fibrin. It is promoted by the insufficient level of plasminogen. Hyaline membranes cause obstruction of distal alveoluses with development of the alveolar and capillary block. Hypostasis, hemorrhages and hyaline membranes cork pneumatic ways that leads to secondary atelectases (see. Hyaline and membrane disease of newborns ).
A clinical picture
In D. - pages allocate several stages. The early stage is shown later 1 — 2 hour after the birth by signs respiratory insufficiency (see). Breath becomes frequent to 80 — 160 in 1 min., the configuration of a thorax changes, there is a sonorous «snoring» exhalation, cyanosis accrues. At auscultation sometimes it is possible to catch the crepitation which is not disappearing during the crying. At rentgenol, a research reveal gentle, scattered dot shadows of pulmonary fields.
The late stage is characterized by increase of slackness, drowsiness, an adynamia with decrease in physiological reflexes, a loss of consciousness. Heavy respiratory insufficiency is observed, the paradoxical breath (at a breath intercostal spaces sink down) is noted. Respiratory noise are not listened, there is no effect of an oxygenotherapy (see. Oxygen therapy ). Right-ventricular joins heart failure (see). On an ECG the signs of disturbance of conductivity caused by a hypoxia come to light. Later there are widespread hypostases of hypodermic cellulose; ability to maintenance of standard temperature of a body is lost.
From laboratory control methods major importance has a research of indicators of acid-base equilibrium. For definition of extent of shunting of lungs the research of blood gases is conducted after the 20-minute period of inhalation by pure oxygen. Predictively arterial pO is adverse in similar conditions 2 it is lower than 50 mm of mercury., and pH of blood lower than 7,2.
Treatment is directed first of all to fight against respiratory insufficiency and its effects, elimination of hyaline membranes and maintenance of a homeostasis.
Maintenance of temperature and humidity of the environment is essential (the couveuse with t ° 32 — 34 °). It is desirable to provide humidity of inhaled air by means of a finely divided aerosol suspension, 20% include solution of glycerin, lecithin in structure a cut for stabilization of surfactant and to Streptasum or plasmin for dissolution of a fibrinous matrix of hyaline membranes.
At an apnoea (pCO 2 blood more than 75 mm of mercury., pO 2 blood are lower than 40 mm of mercury. with the progressing decrease in pH lower than 7,2) against the background of breath by pure oxygen artificial ventilation of the lungs is effective. The oxygenotherapy is shown in all cases of D. - page, however the percent of oxygen in the inhaled mix is regulated thus to support arterial pO 2 within 50 — 70 mm of mercury. If this indicator cannot be defined, then the oxygen content in inhaled air daily decreases until the patient does not have a cyanosis then concentration 02 in air increases by 10%. In some cases recommend to resort to an oxygenobarotherapy (see. Hyperbaric oxygenation ), and at disturbance of passability of respiratory tracts — to inhalation of kislorodogeliyevy mixes. Administration of sodium bicarbonate without laboratory control is possible only at persistent bradycardia, a cardiac standstill or against the background of artificial ventilation of the lungs (3 — 5 ml of 5% of solution of sodium bicarbonate for 1 kg of weight intravenously).
The homeostasis is supported by transfusion of solutions of salts, by glucose, amino acids in the volumes corresponding to the daily needs for them.
Heparin in combination with fibrinolitic drugs — plasmin, streptazy is applied to prevention of intravascular coagulation, prevention of hyaline membranes. At suspicion of a pre-natal infection and for the purpose of prevention of bacterial pneumonia appoint courses of antibiotics.
Forecast at modern methods of treatment favorable.
events for antenatal protection of the child Are held, including: fight against toxicoses of pregnant women, prevention of not wearing out, pre-natal hypoxia, asphyxia, pre-natal infection.
Bibliography: Kravtsov V. I. Resuscitation and treatment of respiratory insufficiency of newborns in the conditions of hyperbaric oxygenation, Vopr. okhr. mat. also it is put., t. 17, No. 7, page 45, 1972; P and N about in N. A. Radiological aspects of pneumopathies at newborn children, Pediatrics, No. 6, page 39, 1974; Blind A. S., Kostin E. D. and Kuchinsky Yu. P. Treatment of the newborns having dysfunction of external respiration, oxygen-helium mixes in the conditions of supertension, Vopr. okhr. mat. also it is put., t. 19, No. 7, page 33, 1974; Morels A. P. Sindr of respiratory frustration at newborn children, Pediatrics, No. 6, page 80, 1974, bibliogr.; Sotnikova K. A., B at V. B. rakov and Poddub-n and I A. E. Sindr of respiratory frustration at children of the first days of life, Vopr, okhr. mat. also it is put., t. 20, N» 5, page 46, 1975, bibliogr.; Ballard R. And. and. lake of Idiopatic respiratory distress syndrome, Amer. J. Dis. Child., v. 125, p. 676, 1973, bibliogr.; F a vara B., Franciosi R. A. a. Butterfield L. J. Disseminated intravascular and cardiac thrombosis of the neonate, ibid., v. 127, p. 197, 1974; L a 1-lemandD. et SauvergrainJ. Diagnostic radiologique des detresses res-pkatoires neo-natales, Rev. Pediat., t. 10, p. 395, 1974; Outerbridge E. W. a. o. Idiopathic respiratory distress syndrome, Amer. J. Dis. Child., v. 123, p. 99, 1972.
A. V. Papayan, E. K. Tsibulkin.