Central nervous IVH, drugs, seizures, hypoxic injury system
Respiratory Pneumonia, obstructive airway lesions, atelectasis, extreme prematurity (<1000 g), laryngeal reflex, phrenic nerve paralysis, severe RDS, pneumothorax
Infectious Sepsis, necrotizing enterocolitis, meningitis (bacterial, fungal, viral)
Gastrointestinal Oral feeding, bowel movement, gastroesophageal reflux, esophagitis, intestinal perforation
Metabolic ↓ Glucose, ↓ calcium, ↓ PO2, ↓↑ sodium, ↑ ammonia, ↑ organic acids, ↑ ambient temperature, hypothermia
Cardiovascular Hypotension, hypertension, heart failure, anemia, hypovolemia, change in vagal tone
Idiopathic Immaturity of respiratory center, sleep state, upper airway collapse
IVH, Intraventricular hemorrhage; RDS, respiratory distress syndrome.
a distending pressure of 8 to 10 cm H2O. If respiratory failure ensues (Pco2 >60 mm Hg, pH <7.20, and Pao2 <50 mm Hg with 100% oxygen), assisted ventilation using a ventilator is indicated. Conventional rate (25 to 60 breaths/min), high-frequency jet (150 to 600 breaths/min), and oscillatory (900 to 3000 breaths/min) ventilators all have been successful in managing respiratory failure caused by severe RDS. Suggested starting settings on a conventional ventilator are fraction of inspired oxygen, 0.60 to 1.0; peak inspiratory pressure, 20 to 25 cm H2O; positive end-expiratory pressure, 5 cm H2O; and respiratory rate, 30 to 50 breaths/min.
In response to persistent hypercapnia, alveolar ventilation (tidal volume − dead space × rate) must be increased. Ventilation can be increased by an increase in the ventilator’s rate or an increase in the tidal volume (the gradient between peak inspiratory pressure and positive end-expiratory pressure using a pressure-controlled ventilator). In response to hypoxia, the inspired oxygen content may be increased. Alternatively, the degree of oxygenation depends on the mean airway pressure. Mean airway pressure is directly related to positive end-expiratory pressure, flow, and inspiratory time. Increased mean airway pressure may improve oxygenation by improving lung volume, enhancing ventilation-perfusion matching. Because of the difficulty in distinguishing sepsis and pneumonia from RDS, broad-spectrum parenteral antibiotics (ampicillin and gentamicin) are administered for 48 to 72 hours, pending the recovery of an organism from a previously obtained blood culture.
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PDA is a common complication that occurs in many low birth weight infants who have RDS. The incidence of PDA is inversely related to the maturity of the infant. In term newborns, the ductus closes within 24 to 48 hours after birth. However, in preterm newborns, the ductus frequently fails to close, requiring medical or surgical closure. The ductus arteriosus in a preterm infant is less responsive to vasoconstrictive stimuli, which, when complicated with hypoxemia during RDS, may lead to a persistent PDA that creates a shunt between the pulmonary and systemic circulations.