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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
What is done regarding cord clamping to manage respiratory distress syndrome
In pre-mature infants delay cord clamping by 3-minutes
26
Explain oxygen delivery to neonates with respiratory distress syndrome
- 21% oxygen is delivered by an air blender
27
What SpO2 are aimed for in neonates during first 5-10 minutes of life
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
What should oxygen be increased by
10%
29
If neonate is spontaneously breathing, what ventilation should they be offered
CPAP
30
What SpO2 are aimed for in respiratory distress syndrome
85-93%
31
If a neonate less than 26-weeks gestation has respiratory distress syndrome how are they managed
Intubate and given endotracheal surfactant
32
Summarise management of respiratory distress syndrome
- Delayed cord clamping - Oxygen via air-blender or CPAP - Endotracheal glucocorticoids if under 26W
33
What fluids may be given in respiratory distress syndrome
IV 10% Dextrose
34
What is inositol and it's use in respiratory distress syndrome
Stimulates surfactant production. Given as supplement to formula in pre-mature infants
35
What are 3 risks of respiratory distress syndrome
1. Patent DA: as the duct closes when certain sPO2 is reached which is not in RDS 2. Cardiac arrest 3. Hypoxia
36
What is a risk of ventilation in neonates
Pneumothorax
37
What can prolonged neonatal ventilation result in
Bronchopulmonary dysplasia
38
What % of neonates under 1Kg with RDS experience bronchopulmonary dysplasia
40
39
When does bronchopulmonary dysplasia occur
If infants are mechanically ventilated for more than 28-days
40
How does bronchopulmonary dysplasia present on CXR
Granular densities and lung hyper-inflation
41
What are 3 early symptoms of bronchopulmonary dysplasia
- Desaturating during feeds - RSV bronchiolitis - Feeding difficulties - Reflux
42
What are 4 late-features of bronchopulmonary dysplasia
- Low IQ - CP - Asthma - Exercise limitation
43
How is bronchopulmonary dysplasia prevented
Glucocorticoids
44
What is the most common cause of respiratory distress in neonates
Transient tachpneoa newborn
45
What causes transient tachypnoea of the newborn
Delayed reabsorption fluid into lungs
46
What is a major risk factor for TTN and why
C-Section
47
What are symptoms of TTN
Tachypnoea Nasal flaring Grunting IC Recessions
48
What will be heard on auscultation in TTN
Diffuse crackles
49
What will be seen on CXR in TTN
Hyperinflation | Fluid in horizontal fissure
50
How is TTN managed
Oxygen
51
What time frame does TTN resolve
Resolves in 1-2 days

Paediatrics (61 decks)

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