Approach to Neonate with Respiratory Distress Flashcards
Manifestation of neonatal respiratory distress
Tachypnea
Neonatal tachypnea
> 60 breaths/min
T of F the presence of cyanosis necessarily means the newborn is respiratory distress
F
Cessation of breathing for 20 seconds
Apnea
Motor responses can be monitored and evaluated by measuring
EMG activity, intrathoracic pressure and lung function parameter
Sensors of thoracic expansion and alveolar respiration
J-receptors, irritant receptors and stretch reeptors
How can the baby conserve oxygen and energy
by not moving and not breathing
Best strategy to control hypoxemia in utero
APNEA
volume inspired above the tidal volume
Inspiratory reserve volume
Volume of a normal breath
TIDAL volume
Volume expired after expiration of tidal volume
ERV
volume that remains after the maximal expiration
Residual volume
FRC-ERV
volume expired after maximal inspiration
Vital capacity
TLC-RV
volume that lung can maximally hold
TLC
TLC= TV+ERV +RV
200ml in newborn
The tidal volume only uses __% or less of our TLC
10%
Tidal volume can increase by?
modifying insoiratory and expiratory
Ventilatory strategy of transient tachypnea
Increase frequency of breathing
Suprasternal retractions and head bobbing
Recruit more alveoli by increasing the use of accessory muscles
STrategy to recruit more functional respiratory units from ERV
Using inspiratory musles of laryngeal narrowing during expiration
Due to poor compliance and attempt to improve oxygenation
Grunting
only age group that exhibits grunting
Newborns
Involves closing glottis to keep the lungs a little inflated
Grunting
Observe in conditions with obstruction of airways and in most aspiration syndromes
Changing the size of alveolar gas reserve
Cardiac causes of respiratory distress
Left to right shunt
Congestive cardiac faiure
Obstruction to pulmonary Venous Flow
Neurologic causes of respiratory distress
Post asphyxia state
Subarachnoid hemorrhage
Infections
Metabolic causes of respiratory distress
Metabolic acidosis Sepsis Hyperthermia/hypothermia Narcotic withdrawal Drugs
Fastest way to correct acidosis
blowing off CO2 rapidly
Pulmonary (Mechanical) causes
Ribcage anomalies Pneumothorax Pneumomediastinum Pleural effusion Chylothorax severe abdmonal distension
Pulmonary (Developmental) causes
TEF CCAM CDH sequestration Pulmonary hypoplasia lobar emphysema congenital lung cyst
Pulmonary (Airway abonarmalities)
Chonal stenosis, atresia Laryngeal web Laryngotracheomalacia Bronchomalacia Subglottic stenosis
Pulmonary (Parenchymal) causes
Transient tachypnea of the newborn Hyaline membrane disease Pulmonary edema Aspiration syndromes Pneumonia pulmonary hemorrhage
Persistent Pulmonary Hypertension of the newborn
Vascular disease - not parenchymal
pulmonary vascular disease -> increased pulmonary vascular resistance
Also known as Respiratory distress syndrome Type I
Hyaline Membrane disease (developmental disorder)
conditions than can cause an even lower production of surfactant in an effort to decrease metabolic demand
Hypoxemia and hypercarbia
Deficiency of surfactant
Decrease FRC Atelectasis Increased R to L shunt Increased work of breathing V/Q mismatch`
collapse of an expanded lung especially in infants which is also a failure ofpulmonary alveolu to expand at birth
Atelectasis
Increases R toL shunt because of pulmonary hypoperfusion
Atelectasis
Potent vasodilators
high pH and low Co2 conditions
Increased pressure due to vasoconstriction and may lead to capillary endothelial damage
Pulmonary hypertension
composed of a high molecular weight proteinaceous substance
Hyaline membranes
May cause the development of bronchopulmonary dysplasia
hyaline membrane
Progressive atelectasis leads to worsening in the first ____hours
24 -28 hours
End result of HMD
Capillary damage
Alveolar necrosis
Radiologic findings of HMD
Reticulo-granular pattern
Severe white lungs - semisolid
Steepled appearance - some alveoli have air in it
bronchi visible as black lines
Air bronchogram sign
manangement of HMD
Continuous positive airway pressure
Surfactant replacement therapy
How do you give surfactant to a baby who is not intubated>
INSURE PROCEDURE
Dosage for surfactant administration intrathecally
4 cc/kg (1cc/kg/quadrant)
How do the surfactant enter the 4lung quadrants
Use gravity
Also called respiratory distress syndrome type II
Transient tachypne of the newborn TTN
Most common cause of respiratory distress in newborns
Transient tachypnea of the newborn
Main pathology of the TTN
Delay in the resorption of fetal lung field
Rate of production of fetal lung fluid
20 ml/kg of fluid in the fetal lungs
What happens during labor?
there is plenty of beta adrenergic stimulation -> there is cessation of fetal lung fluid production
How many fluid is removed during labor
2/3
How many fluid is removed during baby’s first breath
1/3
Fluid resorption begins with
child’s first breath
Radiographic findings of TTN
Streaky linear hilar densities
Management of TTN
self limiting disease and is managed conservatively with supportive care
Fluid electrolytes thermoregulati
Oxygen if needed
Representative of all aspiration syndromes
Meconium Aspiration Syndrome
MAS is non existent among
Preterm neonates
MAS may result in
severe hypoxemia, acidosis, and respiratory failure
Air leak syndromesL Allows air to enter but not exit
Ball Valve Effect
Radiographic findings of MAS
cotton wool-like fluffy infiltrates or densities
Classification of PPHN
PPHN associated with pulmonary parenchymal disease
PPHN with radiographically normal lungs and no evidence of parenchymal disease
PPHN associated with hypoplasia of the lungs
Radiographic findings of PPHN
No vascular markings are observed because the vessels are constricted(oligemic x-ray)
Manangement of PPHN
Vasodilators
How to rule out pulmonary atresia
Passage of catheter through the nares
