Respiratory System in the Newborn
Wednesday, February 25, 2015
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The respiratory tract consists of a complex of structures that function under neural and hormonal control. At birth the respiratory system is relatively small, but after the first breath the lungs grow rapidly. The shape of the chest changes gradually from a relatively round configuration at birth to one that is more or less flattened in the antero-posterior diameter in adulthood. In severe obstructive lung disease the antero-posterior measurement approaches the transverse measurement; Periodic measurements provide clues to the course of lung disease or the efficacy of therapy.
Physiologicoanatomical structure of the infant's respiratory system
Changes take place in the air passages that increase respiratory surface area. For example, during the first year the alveoli in the terminal units rapidly increase in number. In addition, the early globular alveoli develop septa that cause them to become more lobular. They continue to increase steadily until, at the age of 12 years, there are approximately nine times as many as were present at birth. In later stages of growth the structures lengthen and enlarge.
After the early weeks of life the respiratory tract follows the general growth curve. However, the respiratory apparatus grows faster than the vertebral column, resulting in alterations in the relationships between these structures. The bifurcation of the trachea lies opposite the third thoracic vertebra in the infant and gradually descends to a position opposite the fourth vertebra in the Adults; the cricoid cartilage descends from the level of the fourth cervical vertebra in the infant to that of the sixth in the adult. These anatomic changes produce differences in the angle of access to the trachea at various ages and must be considered when the infant or child is to be positioned for purposes of resuscitation and airway clearance. The larynx grows slowly until puberty, when its accelerated growth produces changes in the voice that are particularly marked in boys.
Respiratory movements are first evident at approximately 20 weeks gestation, and throughout fetal life there is an exchange of amniotic fluid in the alveoli. In the neonate the respiratory rate if rapid to meet the needs of a high metabolism. During growth, the rate steadily decreases in both boys and girls until levels off at maturity. The volume of air inhaled increases with the growth of the lings and is closely related to the body size. In addition, there is a qualitative difference in expired air at difference ages. The amount of oxygen in the expired air gradually decreases and the amount of carbon dioxide increases during growth. Other important aspects of the respiratory function are discussed as they relate to prenatal life and perinatal adjustments, the newborn infant, and acute and chronic respiratory problems of infants and children.
Physiologicoanatomical structure of the infant's respiratory system
Changes take place in the air passages that increase respiratory surface area. For example, during the first year the alveoli in the terminal units rapidly increase in number. In addition, the early globular alveoli develop septa that cause them to become more lobular. They continue to increase steadily until, at the age of 12 years, there are approximately nine times as many as were present at birth. In later stages of growth the structures lengthen and enlarge.
After the early weeks of life the respiratory tract follows the general growth curve. However, the respiratory apparatus grows faster than the vertebral column, resulting in alterations in the relationships between these structures. The bifurcation of the trachea lies opposite the third thoracic vertebra in the infant and gradually descends to a position opposite the fourth vertebra in the Adults; the cricoid cartilage descends from the level of the fourth cervical vertebra in the infant to that of the sixth in the adult. These anatomic changes produce differences in the angle of access to the trachea at various ages and must be considered when the infant or child is to be positioned for purposes of resuscitation and airway clearance. The larynx grows slowly until puberty, when its accelerated growth produces changes in the voice that are particularly marked in boys.
Respiratory movements are first evident at approximately 20 weeks gestation, and throughout fetal life there is an exchange of amniotic fluid in the alveoli. In the neonate the respiratory rate if rapid to meet the needs of a high metabolism. During growth, the rate steadily decreases in both boys and girls until levels off at maturity. The volume of air inhaled increases with the growth of the lings and is closely related to the body size. In addition, there is a qualitative difference in expired air at difference ages. The amount of oxygen in the expired air gradually decreases and the amount of carbon dioxide increases during growth. Other important aspects of the respiratory function are discussed as they relate to prenatal life and perinatal adjustments, the newborn infant, and acute and chronic respiratory problems of infants and children.
Peculiarity of the nose in the newborn
The nose is usually flattened after birth, and bruises are common. Patency of the nasal can be assessed by holding the hand over the infant's mouth and one canal and noting the passage of air through the unobstructed opening. If nasal patency is questionable, is should be reported because newborns are obligatory nose breathers.
Thin white mucus is very common in the newborn, but thick, bloody nasal discharge without sneezing may suggest the snuffles of congenital syphilis. Sneezing is very common in the newborn. Flaring of the nares is always noted because it is a serious sign of air hunger from respiratory distress.
Peculiarity of the neck in the newborn
The newborn's neck is short and covered with folds of tissue. Adequate assessment of the neck requires allowing the head to fall gently backward in hyper-extension while the back is supported in a slightly raised position. The doctor observes for range of motion shape, and any abnormal masses.
Insignificant or no deviation to these clinical features indicates a healthy newly welcomed "fresh-man"
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The nose is usually flattened after birth, and bruises are common. Patency of the nasal can be assessed by holding the hand over the infant's mouth and one canal and noting the passage of air through the unobstructed opening. If nasal patency is questionable, is should be reported because newborns are obligatory nose breathers.
Thin white mucus is very common in the newborn, but thick, bloody nasal discharge without sneezing may suggest the snuffles of congenital syphilis. Sneezing is very common in the newborn. Flaring of the nares is always noted because it is a serious sign of air hunger from respiratory distress.
Peculiarity of the neck in the newborn
The newborn's neck is short and covered with folds of tissue. Adequate assessment of the neck requires allowing the head to fall gently backward in hyper-extension while the back is supported in a slightly raised position. The doctor observes for range of motion shape, and any abnormal masses.
Insignificant or no deviation to these clinical features indicates a healthy newly welcomed "fresh-man"
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