FINAL EXAM

Question 1

Relate a deficit of surfactant to RDS.

Answer 1

Etiology of RDS is lack of surfactant.

Question 2

List pathophysiological, clinical, radiologic and laboratory findings associated with RDS

Answer 2

Atelectasis
Hyaline membranes
Grunting
Retracting
Flaring
Tachypnea
Ground glass appearance with air bronchograms
L:S ratio less than 2:1.

Question 3

Discuss treatment of RDS, including the importance of thermoregulation and typical initial ventilator parameters.

Answer 3

Steroids (dexamethasone) given to mother at least 24 hours prior to delivery.
Terbutaline to stop premature delivery.
Maintain neutral thermal environment, instill surfactant, oxyhood (mild hypoxemia; O2 via hood with PO2 60-80 torr); change to CPAP if PO2 < 50 & FIO2 of 0.60 or less. Mechanical ventilation if Ph 60 torr.
Vent parameters: PIP: 20; Rate: 30-60; FIO2: Set to keep SpO2 90-92%; PEEP: 3-5; Insp. time: .3 sec.; Flow: 6-8.

Question 4

State the point at which RDS is likely to begin improving.

Answer 4

After 48 - 72 hours

Question 5

Define PIE and discuss its treatment.

Answer 5

Pulmonary interstitial emphysema.
If on CMV lower pressure and peep.
May need to switch to HFOV.
Place affected lung down.

Question 6

Relate asphyxia in utero and postmaturity to MAS.

Answer 6

Fetal stress in utero causes asphyxia and the release of meconium.
Release of meconium also common with postmaturity.

Question 7

List pathophysiological, clinical, and radiologic findings associated with
MAS.

Answer 7

Areas of atelectasis and areas of hyperinflation. X-ray described as irregular densities. Clinical signs include meconium staining and dry flaky skin.

Question 8

List complications associated with MAS.

Answer 8

Pneumonia

PPHN

Question 9

Discuss treatment of MAS, including the importance of suctioning and ventilator parameters associated with pulmonary hypertension.

Answer 9

Oxygen Therapy; Surfactant replacement therapy (SRT); Nasal continuous positive airway pressure (Nasal CPAP) Heated high humidity nasal cannula (HHHNC) Conventional mechanical ventilation (CMV); HFOV; INO; ECMO.

Question 10

List the factors associated with the development of BPD.

Answer 10

Prematurity plus severe hmd requiring High FIO2 and high ventilatory pressures.

Question 11

List pathophysiological, clinical, and radiologic findings associated with
BPD.

Answer 11

Stage 1 x-ray – ground glass appearance and air bronchograms. Stage II x-ray – becomes more opaque (white out). Stage III x-ray - development of small cystic formations in the lungs with visible cardiac silhouette. Stage IV of BPD CXR - Increased lung density and the formation or larger, irregular cysts. Pathophysiology - as abnormal development or growth (dysplasia) of the lungs and air passages. Clinical findings – extreme prematurity, need for supplemental O2 at 36 weeks corrected gestational age. Chronic lung disease. Discharged home on O2 via cannula.

Question 12

Contrast transient tachypnea of the newborn and neonatal pneumonia with RDS.

Answer 12

Transient tachypnea is a milder condition with delayed absorption of lung fluid. Compare case studies.

Question 13

Describe the diagnosis and treatment of pneumothorax.

Answer 13

Transillumination
Chest x-ray
Chest tube.

Question 14

Compare the typical x-ray of pneumomediastinum to that of pneumopericardium.

Answer 14

Pneumomediastinum has sail sign. Air does not surround heart.
Pneumopericardiem – air surrounds the heart.

Question 15

Describe the diagnosis and treatment of apnea of prematurity.

Answer 15

Central apnes, cessation of breathing > 20 seconds with bradycardia. Treated with theophylline, caffeine or aminipholline.

Question 16

Discuss the diagnosis and treatment of each of the following and indicate if it is a cyanotic or acyanotic type and if it requires bypass. Refer to power point.

Answer 16

a. Patent ductus Arteriosus – acyanotic and does not require bypass
b. Ventricular septal defect – acyanotic and requires bypass
c. Tetralogy of Fallot –cyanotic and requires bypass
d. Complete Transposition – cyanotic and requires bypass
e. Coarctation of the aorta – cyanotic or acyanotic
f. Hypoplastic left heart syndrome – cyanotic and requires transplant

Question 17

Therapy for PPHN.

Answer 17

PPHN has a wide etiological diversity which means that no single treatment may be uniformly effective. Mechanical hyperventilation, high frequency oscillatory ventilation, vasodilators such as tolazoline and prostaglandins, muscle relaxants, and sedatives have all been advocated.
Extracorporeal membrane oxygenation has been used to treat severe cases of PPHN with various success, but is not available in most neonatal centers.