2 - Respiratory Distress (Miller)

Question 1

Ojectives: List physical exam findings associated with respiratory distress in the newborn

Answer 1

Tachypnea

Grunting

Nasal Flaring

Retractions (chest)

Cynaosis

Question 2

Objectives: Describe the pathophysiology of Transient Tachypnea of the Newborn (TTN)

Symptoms

Signs

Cause

Risk Factors

Diagnosis/Treatment

Answer 2

• Aka “Retained Fetal Lung Fluid”
• Symptoms: Grunting, nasal flaring, retractions, tachpneic, crackle in lungs
• Signs: Fluid in fissue of lungs on xray
• Causes: Failure of fetal lung fluid to be reabsorbed at time of delivery
  
  • Labor drives hormonal changes, which cause reversal of Na⁺ channels in lung tissue
  • Failure of channel reversal leads to retained lung fluid and increased effort to maintain adequate gas exchange
• Risk Factors:
  
  • Elective C-Section w/out Labor
  • Males
• Diagnosis/Treatment: Chest X-ray
  
  • Oxygen / Nasal CPAP

Question 3

Objectives: Identify risk factors for surfactant deficiency at birth

Answer 3

• Risk Factors:
  
  • Prematurity (<32-35 weeks)
  • Wimpy White Boy
  • Previous Baby with RDS
  • Perinatal Asphyxia/Cold Stress
  • Infection
  • Multiple Gestation
  • Diabetic Mother
  • Patent Ductus Arteriosis

Question 4

Objectives: Describe the pathophysiology of Respiratory Distress Syndrom (Hyaline Membrane Disease)

Symptoms

Signs

Cause

Risk Factors

Diagnosis/Treatment

Answer 4

• Symptoms: Grunting, Nasal Flaring, Subcostal retractions, Nacypneic, Lung crackls, Perioral cyanosis
• Signs: Reticulo-Cranial Pattern of chest x-ray
• Cause: Surfactant Deficiency (released by Type II Pneumocytes ~ 24 wks)
  
  • ​Lack of surfactant→Alveolar Collapse→Protein Accumulation→Hyaline Membrane Formation
  • Impaired Gas Exchange
• Risk Factors: Prematurity, Wimpy White Boy
• Diagnosis/Treatment: Give Surfactant, Ventilate
  
  • Artificial Surfactant: Lacks complete proteins
  • Natural Surfactant (best): Porcine, Bovine
  • NCPAP / Mech. Ventilation

Question 5

Objectives: Describe the pathophysiology of Congenital Pneumonia

Symptoms

Signs

Cause

Risk Factors

Diagnosis/Treatment

Answer 5

• Symptoms: Grunting, Nasal flaring, retractions, tachpneic, crackles/reduced air entry, perioral cyanosis
• Signs: CXR, 10% will have positive blood culture, indicating systemic infection (most deadly) (still treat); usually isolated to pulmonary system
• Cause:
  
  • Infections: E. Coli, Group B Strep, U. urealyticum
  • Non-infectious: Aspiration of blood, aspiration of meconium
• Risk Factors:
  
  • Prolonged rupture of membrane
  • Maternal fever
  • Uterine tenderness
  • Foul smelling amniotic fluid
• Diagnosis/Treatment:
  
  • Antiobiotics
  • O₂
  • NCPAP/Mech. Ventilation
  • Surfactant (natural inactived by infection, blood, meconium)

Question 6

Objectives: Describe the pathophysiology of Spontaneous Pneumothorax

Symptoms

Signs

Cause

Risk Factors

Diagnosis/Treatment

Answer 6

• Symptoms: Decreased breath sounds on one side, + other respiratory issues
• Signs: CXR will have black lung on one side (air)
• Cause: See risk factors
• Risk Factors:
  
  • Difficult deliveries, large baby, diabetic mom
  • Positive Pressure Ventilation during resuscitation
  • Connective tissue disease
• Diagnosis/Treatment:
  
  • NCPAP / Mech Ventlation (avoid + pressure)
  • Needle Chest
  • Chest Tube (left in place until no bubbles)
  • No future risk of pneumothorax

Question 7

Objectives: Describe the pathophysiology of Congenital Diaphragmatic Hernia

Symptoms

Signs

Cause

Risk Factors

Diagnosis/Treatment

Answer 7

• Symptoms: Respiratory symptoms, retractions, decreased lung sounds on left side
• Signs: CXR
• Cause: Abnormal diaphragm formation
• Risk Factors
• Diagnosis/Treatment:
  
  • Supportive First: Mech. Ventilation, Replogis to LIS (keep air out of intestines)
  • Surgery Second