The major respiratory signs are:
1. Tachypnea: Defined as the respiratory rate 60 breaths per minute. Indicates inadequate ventilation or oxygenation. The child responds to hypoxemia or hypercapnia, breathing faster.
2. Cyanosis: Reflects an increase of more desaturated hemoglobin 3-5 g / dl. It can occur in heart disease, respiratory, neurological and metabolic diseases.
3. Muscle Retractions: These occur in any muscle group of the chest may be intercostal, subxiphoid, supraclavicular … indicate inadequate ventilation that requires the use of accessory muscles. They are common to diseases which reduce alveolar ventilation, eg atelactasias.
4. Moan: An audible sound at the end of expiration. It is caused by the child’s respiratory effort against a closed glottis partially or completely. Represents a physiological response that seeks to increase the residual lung volume.
5. Apnea is defined as a respiratory pause of 15 seconds or more, or less than 15 seconds, if accompanied by bradycardia and / or arterial desaturation.
6. Nasal flaring: Movement of both wings of the nose that occurs during inspiration and an increase of respiratory work.


For objective assessment of respiratory distress syndrome (RDS) there is a “test” Silverman. Measures five parameters that contribute to the overall score of 0, 1 and 2 points. The higher the test score, the greater respiratory compromise. Silverman’s test with 0 points indicates no distress. The parameters measured are: nasal flaring, thoraco-abdominal separation, moan, xiphoid retraction and intercostal retractions.
It is considered a mild respiratory distress when there is a score on the test Silverman ≤ 3 points.


• It is considered a moderate respiratory distress when there is a score on the test Silverman in [4-6] points.
• It is considered severe respiratory distress when there is a score on the test Silverman ≥ 7 points.

SIGNS AND SYMPTOMS OF ALARM
Apnea (pauses in breathing) is the cessation of breathing for more than 20 seconds accompanied by bradycardia, cyanosis, pallor, hypotonia or metabolic acidosis. It is frequently in the premature, since 80% of those under 1000 gr. and 50% of those under 1500 gr. presented an episode of this type during its evolution. Must be differentiated from periodic breathing, a normal breathing pattern that affects some premature and that is recurrent breathing pauses 5-15 seconds followed by normal breathing movements or fast for another 10 to 15 seconds. In the RNT., By contrast, is a rare event and usually associated with serious illness.
Features:
• Lasts about 15-20 seconds.
• The newborn changes color: becomes pale or cyanotic (blue).
• It is associated with decreased heart rate (bradycardia).

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