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Abstract: The newborn was diagnosed with neonatal aspiration syndrome after delivery with Apgar score of 8, rapid and irregular respiration, visible nasal agitation and trigeminal sign, examination revealed a respiratory rate of 45 breaths/min, shortness of breath, oxygen saturation measured at 90%, and aspiration pneumonia manifested on chest X-ray. After timely treatment with oxygen, penicillin and anti-infection, the child’s condition improved and breathing resumed calmly.
Basic information】Male, 1 day
Type of disease】Neonatal aspiration syndrome
Hospital】Shanghai Sixth People’s Hospital
Date of Consultation】September 2021
Treatment plan】Oxygenation + medication (sodium penicillin for injection)
Treatment Period】1 week hospitalization
Treatment effect】normal temperature, no coughing and shortness of breath, calm breathing
I. Initial consultation
A 38-week pregnant mother had a decelerated fetal heart rate before delivery, and her amniotic fluid was cloudy and meconium-like in degree III at delivery. The newborn was born with an Apgar score of 8, with 1 point deducted for each of plantar reaction and respiration. At present, the child’s breathing was rapid and irregular, with nasal agitation and trigeminal signs. He was admitted to the hospital, and the relevant tests were completed, including blood and urine routine, liver and kidney function, arterial blood gas, chest X-ray, etc. The blood routine showed elevated C-reactive protein up to 20 mg/L, arterial blood gas showed mild respiratory acidosis, and chest X-ray showed thickened and blurred lung texture and a little exudation, so the diagnosis of neonatal aspiration syndrome was made.
II. Treatment history
A large part of neonatal aspiration syndrome is caused by meconium aspiration. The meconium was mixed with amniotic fluid in this child, and the chest X-ray showed coarse lung texture, blurring and exudation, and increased C-reactive protein. The child was admitted to the hospital in time, placed in a warm box, given oxygen by hood with an oxygen flow rate of 5L/min and intravenous penicillin sodium for injection, and paid attention to respiratory management. After active treatment, the child’s clinical manifestations improved significantly, and the respiratory symptoms of tachypnea disappeared, and he was discharged after 1 week of treatment.
III. Treatment effect
After 1 week of active care and treatment, the child’s mental status improved significantly, with calm breathing, no coughing and shortness of breath, normal milk intake, good appetite, normal urination and defecation, no drowsiness, and no screaming and convulsions. On physical examination, the child was clear and responsive, no more trigeminal signs and nasal agitation, strong heart sounds, soft abdomen without abdominal distention, flat and soft fontanelle, normal neurological reflexes, normal C-reactive protein. Parents are advised to bring the child back to the hospital for a review in 3 days to check whether there is any recurrence of the disease.
IV. Notes
As an attending physician, we are very pleased that the child’s condition has improved and healed after active treatment. The newborn’s body state is different from that of an adult, and the function of each system is not yet perfect, so the body is susceptible to diseases, especially respiratory diseases. Therefore, parents should pay close attention to the breathing condition, such as whether there is shortness or unevenness, and whether there is a blue face or nasal agitation. If there are similar cases, you need to go to the hospital in time, do not delay the treatment, and pay attention not to use the so-called folk remedies for treatment.
V. Personal insight
Newborns are relatively weak in disease resistance, parents should pay more attention, especially to observe the respiratory situation, for the early neonatal aspiration syndrome, as well as the later respiratory tract infections should have a certain understanding. If the newborn shows signs of shortness of breath, poor milk intake and poor mental status after discharge from the hospital, it is important to realize that it may be caused by the disease and should seek medical attention promptly. Parents should also be aware that if they are suffering from respiratory diseases such as influenza, they must pay attention to isolation and protection and try not to come into close contact with their children to avoid infection.