Approach to Neonate with Respiratory Distress

Question 1

Manifestation of neonatal respiratory distress

Answer 1

Tachypnea

Question 2

Neonatal tachypnea

Answer 2

> 60 breaths/min

Question 3

T of F the presence of cyanosis necessarily means the newborn is respiratory distress

Answer 3

F

Question 4

Cessation of breathing for 20 seconds

Answer 4

Apnea

Question 5

Motor responses can be monitored and evaluated by measuring

Answer 5

EMG activity, intrathoracic pressure and lung function parameter

Question 6

Sensors of thoracic expansion and alveolar respiration

Answer 6

J-receptors, irritant receptors and stretch reeptors

Question 7

How can the baby conserve oxygen and energy

Answer 7

by not moving and not breathing

Question 8

Best strategy to control hypoxemia in utero

Answer 8

APNEA

Question 9

volume inspired above the tidal volume

Answer 9

Inspiratory reserve volume

Question 10

Volume of a normal breath

Answer 10

TIDAL volume

Question 11

Volume expired after expiration of tidal volume

Answer 11

ERV

Question 12

volume that remains after the maximal expiration

Answer 12

Residual volume

FRC-ERV

Question 13

volume expired after maximal inspiration

Answer 13

Vital capacity

TLC-RV

Question 14

volume that lung can maximally hold

Answer 14

TLC
TLC= TV+ERV +RV

200ml in newborn

Question 15

The tidal volume only uses __% or less of our TLC

Answer 15

10%

Question 16

Tidal volume can increase by?

Answer 16

modifying insoiratory and expiratory

Question 17

Ventilatory strategy of transient tachypnea

Answer 17

Increase frequency of breathing

Question 18

Suprasternal retractions and head bobbing

Answer 18

Recruit more alveoli by increasing the use of accessory muscles

Question 19

STrategy to recruit more functional respiratory units from ERV

Answer 19

Using inspiratory musles of laryngeal narrowing during expiration

Question 20

Due to poor compliance and attempt to improve oxygenation

Answer 20

Grunting

Question 21

only age group that exhibits grunting

Answer 21

Newborns

Question 22

Involves closing glottis to keep the lungs a little inflated

Answer 22

Grunting

Question 23

Observe in conditions with obstruction of airways and in most aspiration syndromes

Answer 23

Changing the size of alveolar gas reserve

Question 24

Cardiac causes of respiratory distress

Answer 24

Left to right shunt
Congestive cardiac faiure
Obstruction to pulmonary Venous Flow

Question 25

Neurologic causes of respiratory distress

Answer 25

Post asphyxia state Subarachnoid hemorrhage Infections

Question 26

Metabolic causes of respiratory distress

Answer 26

``` Metabolic acidosis Sepsis Hyperthermia/hypothermia Narcotic withdrawal Drugs ```

Question 27

Fastest way to correct acidosis

Answer 27

blowing off CO2 rapidly

Question 28

Pulmonary (Mechanical) causes

Answer 28

``` Ribcage anomalies Pneumothorax Pneumomediastinum Pleural effusion Chylothorax severe abdmonal distension ```

Question 29

Pulmonary (Developmental) causes

Answer 29

``` TEF CCAM CDH sequestration Pulmonary hypoplasia lobar emphysema congenital lung cyst ```

Question 30

Pulmonary (Airway abonarmalities)

Answer 30

``` Chonal stenosis, atresia Laryngeal web Laryngotracheomalacia Bronchomalacia Subglottic stenosis ```

Question 31

Pulmonary (Parenchymal) causes

Answer 31

``` Transient tachypnea of the newborn Hyaline membrane disease Pulmonary edema Aspiration syndromes Pneumonia pulmonary hemorrhage ```

Question 32

Persistent Pulmonary Hypertension of the newborn

Answer 32

Vascular disease - not parenchymal pulmonary vascular disease -> increased pulmonary vascular resistance

Question 33

Also known as Respiratory distress syndrome Type I

Answer 33

Hyaline Membrane disease (developmental disorder)

Question 34

conditions than can cause an even lower production of surfactant in an effort to decrease metabolic demand

Answer 34

Hypoxemia and hypercarbia

Question 35

Deficiency of surfactant

Answer 35

``` Decrease FRC Atelectasis Increased R to L shunt Increased work of breathing V/Q mismatch` ```

Question 36

collapse of an expanded lung especially in infants which is also a failure ofpulmonary alveolu to expand at birth

Answer 36

Atelectasis

Question 37

Increases R toL shunt because of pulmonary hypoperfusion

Answer 37

Atelectasis

Question 38

Potent vasodilators

Answer 38

high pH and low Co2 conditions

Question 39

Increased pressure due to vasoconstriction and may lead to capillary endothelial damage

Answer 39

Pulmonary hypertension

Question 40

composed of a high molecular weight proteinaceous substance

Answer 40

Hyaline membranes

Question 41

May cause the development of bronchopulmonary dysplasia

Answer 41

hyaline membrane

Question 42

Progressive atelectasis leads to worsening in the first ____hours

Answer 42

24 -28 hours

Question 43

End result of HMD

Answer 43

Capillary damage | Alveolar necrosis

Question 44

Radiologic findings of HMD

Answer 44

Reticulo-granular pattern Severe white lungs - semisolid Steepled appearance - some alveoli have air in it

Question 45

bronchi visible as black lines

Answer 45

Air bronchogram sign

Question 46

manangement of HMD

Answer 46

Continuous positive airway pressure Surfactant replacement therapy

Question 47

How do you give surfactant to a baby who is not intubated>

Answer 47

INSURE PROCEDURE

Question 48

Dosage for surfactant administration intrathecally

Answer 48

4 cc/kg (1cc/kg/quadrant)

Question 49

How do the surfactant enter the 4lung quadrants

Answer 49

Use gravity

Question 50

Also called respiratory distress syndrome type II

Answer 50

Transient tachypne of the newborn TTN

Question 51

Most common cause of respiratory distress in newborns

Answer 51

Transient tachypnea of the newborn

Question 52

Main pathology of the TTN

Answer 52

Delay in the resorption of fetal lung field

Question 53

Rate of production of fetal lung fluid

Answer 53

20 ml/kg of fluid in the fetal lungs

Question 54

What happens during labor?

Answer 54

there is plenty of beta adrenergic stimulation -> there is cessation of fetal lung fluid production

Question 55

How many fluid is removed during labor

Answer 55

2/3

Question 56

How many fluid is removed during baby's first breath

Answer 56

1/3

Question 57

Fluid resorption begins with

Answer 57

child's first breath

Question 58

Radiographic findings of TTN

Answer 58

Streaky linear hilar densities

Question 59

Management of TTN

Answer 59

self limiting disease and is managed conservatively with supportive care Fluid electrolytes thermoregulati Oxygen if needed

Question 60

Representative of all aspiration syndromes

Answer 60

Meconium Aspiration Syndrome

Question 61

MAS is non existent among

Answer 61

Preterm neonates

Question 62

MAS may result in

Answer 62

severe hypoxemia, acidosis, and respiratory failure

Question 63

Air leak syndromesL Allows air to enter but not exit

Answer 63

Ball Valve Effect

Question 64

Radiographic findings of MAS

Answer 64

cotton wool-like fluffy infiltrates or densities

Question 65

Classification of PPHN

Answer 65

PPHN associated with pulmonary parenchymal disease PPHN with radiographically normal lungs and no evidence of parenchymal disease PPHN associated with hypoplasia of the lungs

Question 66

Radiographic findings of PPHN

Answer 66

No vascular markings are observed because the vessels are constricted(oligemic x-ray)

Question 67

Manangement of PPHN

Answer 67

Vasodilators

Question 68

How to rule out pulmonary atresia

Answer 68

Passage of catheter through the nares