2.1.1 Acute Lung Injury Flashcards
What are some of the complications/factors that contribute to the respiratory issues associated with bronchopulmonary dysplasia?
- Abnormality in alveolar septation (reduced surface area)
- Dysregulation of pulmonary vasculature development
- Superimposed effects of hyperoxemia, hyperventilation, prematurity, inflammatory mediators
What is the most common cause of respiratory distress in premature infants?
Neonatal respiratory distress syndrome
What are 2 factors that increase surfactant production? Decrease surfactant production?
Increase: Glucocorticoids, Labor
Decrease: Insulin (infants of diabetic mothers), congenital surfactant deficiency (SFTBC genes)
A majority of infants gradually improve from bronchopulmonary dysplasia. What is the typical timeline for this gradual improvement?
2-4 months
What length of survival indicates an excellent chance of recovery in NRDS?
3-4 days
What are the two phases of retrolental fibroplasia?
Phase I: hyperoxic phase of therapy
- Reduced VEGF
- Endothelial apoptosis
Phase II: w/ hypoxic room air ventilation
- VEGF levels recover
- Retinal vessel proliferation
Describe the pathophysiological progression of neonatal RDS starting with prematurity and finishing with hyaline membrane.
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What are some of the causes of ARDS?
Infections, Gastric aspiration, Sepsis, Trauma, inhalants, chemicals/drugs, shock, metabolic, hypersensitivity reactions
What are two possible complications of oxygen therapy?
Bronchopulmonary dysplasia
Retrolental fibroplasia (retinopathy of prematurity)
A congested, atelectatic lung (prior to first breath) has the gross appearance of what organ? Does it sink or float?
Liver; sink
What is a histological characteristic of neonatal RDS?
hyaline membrane in peripheral airspaces
What are some of the ways to manage neonates at risk of and/or experiencing neonatal RDS?
Assess maturity using amniotic fluid phospholipids
Delay labor
Induce lung maturity w/ corticosteriods
Surfactant replacement therapy
Oxygenation/ventilation
What is the composition of surfactant?
Lecithin, phosphatidyl glyceral, hydrophobic glycoproteins (SP-B, SP-C)
What are some potential sources of microvascular injury that results in pulmonary edema?
Infection: pneumonia, septicemia
Inhaled gases
Liquid aspiration
Drugs and chemicals
Shock, trauma
Radiation
Transfusion related
What are the brown-tinged cells?
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Hemosiderin-laden macrophages - “heart failure cells”
What changes occur b/t 22 and 32 wks of gestation that allow for better respiratory outcomes for a neonate?
Lungs continue to develop and divide. The epithelium transitions from cuboidal to squamous. The alveoli become more closely apposed to surrounding capillaries.
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