Neonatal and Pediatric Respiratory Care
Neonatal physiology and RDS
Fetal hemoglobin shifts the oxygen dissociation curve left. Surfactant appears around 24–28 weeks; deficiency causes RDS with grunting, retractions, and ground-glass CXR. Antenatal steroids accelerate surfactant. Target SpO2: preterm 90–95%, term 94–99%, avoiding hyperoxia. Apnea of prematurity is treated with caffeine citrate.
Resuscitation and devices
Newborn resuscitation: warm, dry, stimulate; if apneic/gasping or HR <100, start PPV within 60 seconds. Initial PIP 20–25 cmH2O, PEEP 5 cmH2O; increase oxygen only as guided by preductal SpO2. Uncuffed ETT size ≈ (age/4) + 4; neonate 3.0–3.5 mm. Pediatric bag-valve masks 250 mL for neonates, 500 mL for children.
Worked example
A 3.0-kg newborn has HR 70, apnea, and central cyanosis. Start PPV with a T-piece or self-inflating bag at 20–25 cmH2O and PEEP 5, using air initially if term and blending to target SpO2. Reassess HR every 30 seconds; if HR remains <60, begin chest compressions at 3:1 with ventilations.
Traps
Do not give 100% oxygen routinely to preterm infants. Do not use adult-sized ETT or bag. Do not mistake croup's barking cough for epiglottitis, which presents with drooling, tripod posture, and muffled voice; avoid agitating the child.