Chapter 34 Neo/ped Disorders Flashcards by Ivy Anderson

How to differentiate ttnb and rds

Rds is in preemies, ttnb is in term

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Patho of rds

Decreased surfactant causes atelectasis, v/q mismatch and increased work of breathing.

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What happens to ABGs during rds

Acidosis

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Hypoxemia and acidosis cause increased or decreased pvr?

Increased

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Signs of rds

Tachypnea
Retractions 
Paradoxical breathing
Grunting
Nasal flaring

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Breath sounds with rds are

Fine inspiratory crackles

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How is rds diagnosed

Cxr with diffuse infiltrates, air bronchograms and low lung volumes

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Treatment for rds

Cpap
Surfactant
Hfo

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What causes ttnb

Delayed absorption of fetal lung fluid

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Pathophysiology of ttnb

Increased lung fluid causes decreased compliance. This can cause air trapping in some areas and hyperinflation in others

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Increased risk for ttnb

Cold c sections and prolonged labour

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Chest X-ray with ttnb

Perihilar streaking

Pleural effusions in costophrenic angles and fissures

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Treatment for ttnb

Cpap and frequent position changes

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Amniotic fluid consists of?

Fetal lung fluid, urine and transudate from uterine wall

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What is meconium

Thick, sticky substance contained in the fetal bowel

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What increases risk of mas?

Post term delivery

Lack of oxygen in utero

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What are the three primary problems with mas

Pulmonary obstruction
Lung tissue damage
Pulmonary hypertension

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Ball valve obstruction means

Gas can enter but not exit

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Type of obstruction that occurs with mas is

Ball valve obstruction

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What are common complications with mas

Pphn and right to left shunting

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Signs of mas

Fetal tachycardia
Presence of meconium in amniotic fluid
Gasping respirations

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Cxr with mas

Irregular densities with atelectasis and hyperinflation

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ABG with mas will show

Hypoxemia and metabolic acidosis

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Treatment for meconium

If vigorous. Warm dry and stim and suction

If not vigorous, intubate and suction ASAP

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Bpd pathophysiology

Caused atelectrauma and volutrauma and exposure to high levels of oxygen

Chest X-ray with bpd shows

Atelectasis emphysema and fibrosis

Treatment of bpd

Preventing vili Surfactant if needed Lowest o2 levels required

What is apnea of prematurity

Periods of apnea that last longer than 15 seconds or occur with bradycardia or cyanosis

Cause of apnea of prematurity

Immature control of resp drive

Treatment of apnea of prematurity

Caffeine Theophylline Flow

Causes of pphn

Oligohydraminos Cdh Lung Hypoplasia Total anomalous venous return

Treatmentfor pphn

``` Treat cause Oxygen if caused by hypoxia Surfactant for rds Intubation and mv if needed Can consider ino and ecmo if severe ```

What is laryngomalacia

Floppy larynx tissues that can cause partial obstruction of the airway

What is tracheal malacia

Soft, floppy larynx tissues that can collapse and block the airway

What is tracheal stenosis

Narrowing of the trachea

How does tef present

Difficulty swallowing Bubbling and frothing at the mouth Choking during feeding

What is the most common type of tef

Esophageal atresia with a distal fistula

What is cdh

A hole in the diaphragm

What does cdh frequently cause later in life

Scoliosis to side of cdh and severe gerd

What are other neonatal problems with cdh

``` Lung hypoplasia decreased alveoli, decreased pulmonary vasculature Pulmonary hypertension Unusual anatomy of the inferior vena cava ```

Signs and symptoms with cdh

Cyanosis Scaphoid abdomen Decreased breath sounds Muffled heart sounds

Treatment of cdh

Intubation Attaching stomach to suction to allow adequate ventilation Surgery at 7-10 days of life

What is omphalocele

When the infants intestine is outside of the body surrounded in tissue similar to umbilical cord

What is gastroschesis

When the bowel of an infant is outside the abdomen

4 defects with tetralogy of fallout

pulmonary stenosis Ventricular septal defect Right ventricular hypertrophy Overriding aorta

Symptoms of tof

Heart murmur | Intermittent severe cyanotic spells

What are cyanotic heart diseases

Transposition of the great arteries | Tetralogy of fallot

How do you close a pda

Indomethacin Ibuprofen Oxygen

How to keep pda open

Prostaglandin e

When does pda normally close

5-7 days after birth

What causes left ventricular outflow obstruction

Coarction of the aorta | Hypoplastic left heart syndrome

What increases risk of sids

Male gender Sga Prematurity Low apgar score

What is gerd

Regurgitation of stomach contents into esophagus

What respiratory problems can present with gerd

``` Reactive airway disease Aspiration pneumonia Laryngospasm Chronic cough Stridor Apnea ```

What virus causes bronchiolitis

Rsv

Patho of bronchiolitis

Inflammation and obstruction of small bronchi Commonly occurs after a viral upper resp infection Can cause wheezing and increased raw

Signs of bronchiolitis

Dyspnea Tachypnea Inspiratory and expiratory wheezing

Who is recommended to get a rsv vax

Infants less than 2 with history of Bpd Infants born at less than 32 weeks Infants with chd

Treatment for bronchiolitis

Humidity, oral decongestants and oxygen if needed

What is the ventilation strategy for bronchiolitis if required

Low resp rates and long expiratory time due to air trapping

What virus typically causes croup

Parainfluenza virus

What does croup cause

Subglottic swelling and obstruction

What does a X-ray with croup show

Subglottic narrowing, aka steeple sign

Symptoms of croup

Slow, progressive inspiratory and expiratory stridor | Barking cough

Treatment of croup

Corticosteroids and racemic epi for severe stridor

What is epiglottitis

Supraglottic swelling of epiglottis

What does X-ray of epiglottis show

Swelling of epiglottis or thumb sign

What typically causes epiglottitis

H. Influenzae b

Symptoms of epiglottis

``` High fever Sore throat Stridor Muffled voice Drooling ```

Treatment of epiglottis

Elective intubation done in the or by the most experienced provider

What is cystic fibrosis

A hereditary disease that causes production of thick mucous, respiratory digestive and reproductive problems

How is cf diagnosed

Sweat chloride test

Sweat chloride greater than __ confirms diagnosis of cf

60 meq

Treatment for cf

Airway clearance therapy Antibiotics Lung transplant