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Paediatrics > 1: Neonatology- Respiratory Distress Syndrome, Transient Tachypnoea of the Newborn > Flashcards

1: Neonatology- Respiratory Distress Syndrome, Transient Tachypnoea of the Newborn Flashcards

1
Q

What is respiratory distress syndrome also called

A

Surfactant deficiency lung-disease

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2
Q

What causes respiratory distress syndrome

A

Insufficient surfactant production

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3
Q

What does insufficient surfactant lead to

A

Atelectasis. Baby has to work harder with each breath to force alveoli open causing respiratory failure

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4
Q

What % of neonates born 26-28W will have respiratory distress syndrome

A

50

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5
Q

What % of neonates born 30-31W will have respiratory distress syndrome

A

25

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6
Q

What causes respiratory distress syndrome

A

Surfactant deficiency

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7
Q

What is the single-biggest risk factor for respiratory distress syndrome

A

Pre-maturity

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8
Q

Give 5 risk factors for respiratory distress syndrome

A
  • Prematurity
  • Second-born of premature twins
  • Maternal diabetes
  • Male
  • Elective C-section
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9
Q

Why does C-Section causes respiratory distress syndrome

A

Vaginal delivery uterine contractions stimulates corticosteroid production that aids lung development

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10
Q

Why does maternal diabetes cause surfactant deficiency

A

insulin inhibits surfactant development

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11
Q

What is main feature of respiratory distress syndrome

A

Increased work of breathing after delivery

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12
Q

How does neonatal respiratory distress syndrome present clinically

A
  • Breathlessness
  • Nasal flaring
  • Grunting
  • Intercostal recessions
  • Cyanosis
  • Jugular retractions
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13
Q

Why does grunting occur

A

Infant partially closes epiglottis to try and increase intra-pulmonary pressure

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14
Q

Why does cyanosis occur

A

Peripheral hypoxic vasoconstriction

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15
Q

How will respiratory distress syndrome present on auscultation

A

Decreased breath sounds due to atelectasis

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16
Q

What produces surfactant in the lungs

A

Type II pneumocystes

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17
Q

When is surfactant initially produced

A

20W

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18
Q

When is surfactant distributed around the lungs

A

28-32W

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19
Q

When does surfactant reach sufficient concentration and what does this mean

A

36W - premature infants at increased risk of respiratory distress syndrome

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20
Q

What investigations are ordered in respiratory distress syndrome

A

ABG

CXR

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21
Q

How may an ABG present in respiratory distress syndrome

A
  • Hypoxia
  • Hypercapnia
  • High lactate
22
Q

How may CXR present in respiratory distress syndrome

A

Diffuse fine reticulogranular densities = ground-glass appearance. Air bronchograms

23
Q

What is given to prevent respiratory distress syndrome

A

Glucocorticoids (23-35W)

24
Q

Explain doses of glucocorticoids to prevent respiratory distress syndrome

A

In women expected to deliver 23-35W 2 doses of glucocorticoids are given 24h before delivery

25
Q

What is done regarding cord clamping to manage respiratory distress syndrome

A

In pre-mature infants delay cord clamping by 3-minutes

26
Q

Explain oxygen delivery to neonates with respiratory distress syndrome

A
  • 21% oxygen is delivered by an air blender
27
Q

What SpO2 are aimed for in neonates during first 5-10 minutes of life

A

SpO2 of 85% is normal in first 5-10 minutes of babies life. If these sats persist beyond then, increase by 10% each-time.

28
Q

What should oxygen be increased by

A

10%

29
Q

If neonate is spontaneously breathing, what ventilation should they be offered

A

CPAP

30
Q

What SpO2 are aimed for in respiratory distress syndrome

A

85-93%

31
Q

If a neonate less than 26-weeks gestation has respiratory distress syndrome how are they managed

A

Intubate and given endotracheal surfactant

32
Q

Summarise management of respiratory distress syndrome

A
  • Delayed cord clamping
  • Oxygen via air-blender or CPAP
  • Endotracheal glucocorticoids if under 26W
33
Q

What fluids may be given in respiratory distress syndrome

A

IV 10% Dextrose

34
Q

What is inositol and it’s use in respiratory distress syndrome

A

Stimulates surfactant production. Given as supplement to formula in pre-mature infants

35
Q

What are 3 risks of respiratory distress syndrome

A
  1. Patent DA: as the duct closes when certain sPO2 is reached which is not in RDS
  2. Cardiac arrest
  3. Hypoxia
36
Q

What is a risk of ventilation in neonates

A

Pneumothorax

37
Q

What can prolonged neonatal ventilation result in

A

Bronchopulmonary dysplasia

38
Q

What % of neonates under 1Kg with RDS experience bronchopulmonary dysplasia

A

40

39
Q

When does bronchopulmonary dysplasia occur

A

If infants are mechanically ventilated for more than 28-days

40
Q

How does bronchopulmonary dysplasia present on CXR

A

Granular densities and lung hyper-inflation

41
Q

What are 3 early symptoms of bronchopulmonary dysplasia

A
  • Desaturating during feeds
  • RSV bronchiolitis
  • Feeding difficulties
  • Reflux
42
Q

What are 4 late-features of bronchopulmonary dysplasia

A
  • Low IQ
  • CP
  • Asthma
  • Exercise limitation
43
Q

How is bronchopulmonary dysplasia prevented

A

Glucocorticoids

44
Q

What is the most common cause of respiratory distress in neonates

A

Transient tachpneoa newborn

45
Q

What causes transient tachypnoea of the newborn

A

Delayed reabsorption fluid into lungs

46
Q

What is a major risk factor for TTN and why

A

C-Section

47
Q

What are symptoms of TTN

A

Tachypnoea
Nasal flaring
Grunting
IC Recessions

48
Q

What will be heard on auscultation in TTN

A

Diffuse crackles

49
Q

What will be seen on CXR in TTN

A

Hyperinflation

Fluid in horizontal fissure

50
Q

How is TTN managed

A

Oxygen

51
Q

What time frame does TTN resolve

A

Resolves in 1-2 days

Paediatrics (61 decks)

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