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- Linking the elements of this baby's history at delivery, develop a concept map which links the pathophysiological disease processes that have led to his deterioration in hospital
- Explain the underlying pathophysiological disease processes that lead to the observed signs, symptoms and test results found in this patient over the subsequent days following delivery.
Despite the advancements in medical care, Neonatal Respiratory Distress Syndrome (RDS) continues to be a persistent and risky problem in infants born before the gestational age of 37 weeks (Pickerd and Kotecha, 2009). The condition predominately is seen with respect to the pulmonary surfactant deficiency in the child that assists in the filings of lungs (Reuter et al. 2014). In their review, Kaplan et al. (2011) countered that there is a need to ensure that the surfactants-based limitation of the lung deflation in such patients must be overcome through the use of external surfactants, maternal steroids and oxygen balance maintenance through high pressure. However, some practices such as artificial surfactants have given rather inconclusive results, and the process has been restricted for its intricacies on the basis of the inconsistency in the measurement of the concentration of the surfactants to the RDS severity (Kaplan et al. 2011). Hence, a need to follow an inexpensive, effective and optimized solution in the form of CPAP has been advocated in most cases (Dewez and de Broek, 2016). Through the present case, the pathophysiology of the ailment is studied to understand the disease process.
The present case is that of a preterm 33 weeks' boy delivered at Cohuna Hospital, Victoria, to a 36-year-old female. The child born under caesarean section had an APGAR score of 8 (one minute) and 9 (5 minutes) with a birth weight of 2.3 kg. The mother with a history of multigravida, diabetes, and UTI (Urinary tract infection) and was normal post-delivery. Meanwhile, the child also established rhythmic breathing patterns and normal colour in few minutes postnatal. The mother had previously been admitted to the hospital in her 3rd trimester due to preterm labour and UTI with continuous watery vaginal discharge. The labour was postponed, and the infection was treated with Amoxicillin 500mg TDS for 4 days. The child started showing signs of respiratory distress during the visit and faced challenges with anuria, hypoxia, dysphagia and cyanosis. In addition, the body showed signs of diffused intercostal spaces and increased unevenness in the breath sounds.
To further confirm the diagnosis and overcome challenges associated with regurgitations, a nasogastric tube was inserted in the patients, and gastric contents were aspirated (NooriShadkam et al. 2014). The arterial oxygen level for SpO2 was 91% on CPAP (continuous positive airway pressure), with FiO2 level at 0.6. PaO2 was 64 mmHg, and PaCO2 was at 48 mmHg, which was reflective of low oxygen in the body fluids. The body acidic content (pH) was found to be 7.32. Since post ventilation, the baby’ heart rate improved, this line of treatment was continued. However, in the face of the significant intercostal and soft tissue retraction with inhalation, a decision was made to admit the child for observation and conclusive treatment at a neonatal ICU.
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