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Pediatrics > Case 7 - Newborn with respiratory distress > Flashcards

Case 7 - Newborn with respiratory distress Flashcards

1
Q

WHat are some major perinatal and birth complications to ask about when coming up with a differential for newborn respiratory distress?

A 
maternal diabetes?
prematurity?
maternal GBS infection?
C-section or vaginal?
premature rupture of membranes > 18 hrs?
Meconium in amniotic fluid?
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2
Q

What is the main risk factor for respiratory distress syndrome?

A

prematurity (born before 38 wks) because they don’t have surfactant

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3
Q

What type of delivery predisposes a baby to having transient tachypnea of the newborn?

A

c-section (because baby needs the stress response from being squeezed out of the vaginal canal to really clear those secretions early on)

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4
Q

Why is maternal group B strep and premature rupture of membranes important to consider for newborn respiratory distress?

A

they increase risk for neonatal sepsis, which should alwways be on your differential for neonatal respiratory distress

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5
Q

What’s counted in the APGAR score?

A 
Appearance (color)
Pulse
Grimace (reaction to pain)
Activity (tone)
Respiration
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6
Q

You can call a baby large for gestational age if their birth weight is above what percentile?

A

90th

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7
Q

What is the most common cause of large for gestational age-ness?

A

maternal diabetes

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8
Q

What are potential complications for babies that are large for gestational age?

A 
difficult delivery (section, forceps, vacuum)
birth injuries (fractured clavicle, brachial plexus injury, facial nerve palsy)
Hypoglycemia (if born to diabetic mom)
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9
Q

You can call a baby small for gestational age if their birth weight is between what percentiles?

A

3-10th

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10
Q

How are SGA and intrauterine growth restriction technically different?

A

SGA cant be diagnosed until birth, while IUGR is diagnosed in-utero.

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11
Q

What are some unique problems specific to SGA babies?

A

temperature instability (hypothermia)
inadequate glycogen stores (hypoglycemia)
polycythemia and hyperviscosity

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12
Q

In utero, oxygenated blood is carried from the placenta to the fetus by what vessel?

A

umbilical bein

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13
Q

A portion of the oxygenated blood in the umbilical vein perfuses the liver and the rest passes through what structure to enter the IVC?

A

ductus venosus

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14
Q

One-third of the vena caval blood crosses what structure to the left atrium to be pumped to the coronary, cerebral and upper body circulations?

A

PFO

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15
Q

THe remaining two-thirds of blood is combined with venous blood from the upper body in what chamber of the heart?

A

right atrium through pulmonary artery

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16
Q

Why does only 8-10% of the blood in utero to through the pulmonary vasculature?

A

because vasoconstriction of the pulmonary arterioles produces high pulmonary vascular resistance in utero

17
Q

The remaining 90-92% of blood is shunted from the pulmonary artery through what structure to the descending aorta?

A

patent ductus arteriosus

18
Q

What events need to happen for the newborn to successfully transition to extrauterine life in terms of oxygenation and circulation?

A
  1. need to cut the cord
  2. initiation of air breathing
  3. reduction of pulmonary arterial resistance by vasodilation
  4. closure of the PFO and PDA
19
Q

How does the amniotic fluid leave a newborn’s lungs?

A
  1. squeezed out during uterine contractions

2. absorbed through pulmonary lymphatics

20
Q

If you have delayed absorption of pulmonary fluid, what develops?

A

transient tachypnea of the newborn (or persistent postnatal pulmonary edema)

21
Q

What should happen to the respiratory and heart rates in babies during the first and second hour of life?

A

first hour: HR 160-180 and RR 60-80

second hour: HR 120-160 and RR 40-60

22
Q

What are the classic signs of respiratory distress in a newborn?

A

tachypnea
retractions
grunting

23
Q

Why do infants born to diabetic moms have a risk for hypoglycemia after birth?

A

Because mom’s high sugars trigger insulin secretion in the baby and then when they’re born that insulin makes their sugars drop

24
Q

Babies born to mom’s with an A1c>12% have a __-fold increase of major malformations

A

12-fold…how convenient

25
Q

What are some reasons why breast milk is generally better than formula?

A
  1. provides a lower renal solute load then formula
  2. has anti-infective and anti-allergic properties, including mom’s antibodies
  3. fosters mother-infant bonding
26
Q

What are some of the risk factors for hip dysplasia?

A 
breech position (30-50% of DDH cases occur in breech infants)
gender (female 9:1 predominance)
family history
27
Q

How often should a breastfed newborn typically feed?

A

every 2-4 hours, feeding 10-15 minutes per breast

28
Q

How many wet diapers should a newborn have in a day?

A

at least 6

29
Q

What vitamin should all exclusively breastfed infants be given?

A

At least 400 IU of Vitamin D a day

30
Q

What type of car seat is necessary for an infant?

A

rear-facing in the backseat

31
Q

How and where should a baby sleep to avoid suffocation?

A

on his or her back, in her own crib/basinette (no co-sleeping)

32
Q

What should be on your differential in a newborn with tachypnea?

A 
RDS
TTN
pneumothorax
hypoglycemia
CHF (from congenital heart defect)
neonatal sepsis (usually GBS)
congenital diaphragmatic hernia
severe coarctation of the aorta
meconium aspiration
maternal drug exposure
hypothermia
33
Q

What diagnostics should you obtain in a newborn with cyanosis?

A 
ABG
CSF cultures
CBC with diff
CXR
Echo
Oxygen challenge test
Pulse ox
34
Q

What can an oxygen challenge test give you?

A

helps differentiate between a cardiac cause and a pulmonary cause

osygen will increase the PaO2 of an infant with a respiratory cndition, but will not significantly increase the PaO2 if a cardiac lesion causes the cyanosis (because it doesn’t fix the shunt)

35
Q

What will a CXR look like in TTN?

A

“wet” looking lungs without consolidation and no air bronchograms

36
Q

What will a CXR look like in RDS?

A

diffuse reticulogranular appearance of lung fields (ground glass) WITH air bronchograms

37
Q

Most diaphragmatic hernias develop on which side?

A

left

38
Q

Why don’t we usually give D5 to a hypoglycemic infant?

A

because the glucose water only raises the serum glucose transiently and then you get rebound hypoglycemia

so just do milk feeding

39
Q

What is considered a normal glucose range for an infant?

A

over 40 mg/dL

Pediatrics (11 decks)

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