1.3 MTB Step 3 - The Newborn (Respiratory Distress) Flashcards
Cards Complete: Day 1 - 5/9/2019 * Day 2 - 5/11/2019 * Day 3 - 5/19/2019 Day 4 - 6/18/2019 Day 5 - 7/18/2019
RESPIRATORY DISTRESS IN THE NEWBORN
What is the Best INITIAL Test for a Newborn in Respiratory Distress?
Chest X-Ray (CXR)
RESPIRATORY DISTRESS IN THE NEWBORN
What are (5) Diagnostic Studies, other than the best initial test, that should be done on a Newborn in Respiratory Distress?
- Arterial Blood Gas (ABG)
- Blood Cultures (Sepsis)
- Blood Glucose (Hypoglycemia)
- CBC (Anemia or Polycythemia)
- Cranial Ultrasound (Intracranial Hemorrhage)
RESPIRATORY DISTRESS IN THE NEWBORN
What is the Best INITIAL Treatment for a Newborn in Respiratory Distress?
Oxygen: Keep SaO2 > 95%
Give Nasal CPAP to prevent Barotrauma and Bronchopulmonary Dysplasia if the Neonate’s Oxygen requirement is High.
RESPIRATORY DISTRESS IN THE NEWBORN
When should you consider Empiric Antibiotics for a Newborn in Respiratory Distress?
Suspected SEPSIS
RESPIRATORY DISTRESS IN THE NEWBORN
If Oxygen Therapy does not improve Hypoxemia in a Newborn in Respiratory Distress, what other causes of hypoxemia should the patient be evaluated for?
Cardiac causes of Hypoxia (i.e., Congenital Heart Defects)
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What are (4) Clinical Features of Respiratory Distress Syndrome?
- Premature Neonate
- Tachypnea
- Nasal Grunting
- Intercostal Retractions within hours of Birth
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
- What is the Hallmark Diagnostic Finding in Respiratory Distress Syndrome (RDS)?
- What (2) Findings eventually follow the hallmark finding?
- Hypoxemia
- Hypercarbia & Respiratory Acidosis
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What is the Best INITIAL Test for Respiratory Distress Syndrome?
Chest X-Ray (CXR) = Atelectasis & Air Bronchograms
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What is the Best PREDICTIVE Test (eg, prior to birth) for Respiratory Distress Syndrome?
Lecithin-Sphingomyelin (L/S) ratio: on Amniotic Fluid prior to birth
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What Infection looks identical to Respiratory Distress Syndrome on Chest X-Ray (CXR)?
Pneumonia
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
- What is the Best INITIAL Treatment for Respiratory Distress Syndrome?
- What is the Most EFFECTIVE Treatment for Respiratory Distress Syndrome?
- Oxygen and Nasal CPAP
- Exogenous Surfactant administration (proven to decrease mortality)
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What is the First synthetic Peptide-containing Surfactant approved for treatment of Neonatal Respiratory Distress Syndrome?
Lucinactant
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What is the Mechanism of Surfactant?
- Prevents collapse of the Alveoli by decreasing Surface Tension.
- It is produced by Type II Pneumocytes, which start to develop around 24 weeks gestation. However, not enough surfactant is secreted until 35 weeks gestation.
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
Which (2) Medications should you give as Primary Prevention for Respiratory Distress Syndrome (RDS)?
- Antenatal Corticosteroid (e.g., Betamethasone): This is most effective if > 24 hours before delivery and < 34 weeks gestation.
- Tocolytics (e.g., Oxytocin, Nifedipine): Delays Birth to Avoid Prematurity.
RESPIRATORY DISTRESS IN THE NEWBORN
RESPIRATORY DISTRESS SYNDROME (RDS)
What are (3) Common Adverse Effects / Associated Disorders caused by both the Hypoxia from respiratory distress, as well as from the High-concentration Oxygen Treatment that follows the diagnosis?
- Retinopathy of Prematurity (ROP): Hypoxemia
- Intraventricular Hemorrhage.
- Bronchopulmonary Dysplasia: Prolonged high-concentration oxygen (prevent with CPAP).