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Pediatrics > Full term neonatal disease > Flashcards

Full term neonatal disease Flashcards

1
Q

How does PPHN cause hypoxemia?

A

Pulmonary vasculature remains constricted after birth despite clearance of amniotic fluid from lungs and decrease in PVR

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2
Q

Define persistant pulmonary hypertension of the newborn

A
  1. Abnormal transition from fetal to extrauterine life
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3
Q

Is persistent pulmonary hypertension a right to left shunt or left to right shunt?

A

Right to left shunt, blood continues to flow through the ductus arteriosus despite clearance of fluid from the infants lungs

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4
Q

what are the risk factors associated with PPHN?

A
  1. Oligohydramnios
  2. high maternal BMI
  3. Maternal diabetes
  4. pre-eclampsia
  5. smoking
  6. SSRIs
    NSAIDS
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5
Q

What are the proposed etiologies for PPHN?

A
  1. repeated intrauterine closure of ductus with redirection of blood flow into the high resistance fetal pulmonary vasculature
  2. repeated intrauterine hypoxia which stimulates hypertrophy of medial smooth muscle which surround pulmonary arterioles
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6
Q

When does PPHN typically present?

A
  1. Full or post term infant
  2. Dystocia (difficult labor)
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7
Q

How does PPHN present?

A
  1. Refractory hypoxemia
  2. Low APGARS
  3. Mild respiratory distress to moderate tachypnea
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8
Q

How is PPHN diagnosed?

A
  1. Cardiac echocardiogram
  2. Clear CXR
    3 Normal heart
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9
Q

What should you try to rule out before diagnosing PPHN?

A
  1. Meconium aspiration
  2. Congenital heart disease
  3. Group Be strep PNA
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10
Q

What would indicate the presence of PPHN after reviewing the echocardiogram and CXR?

A
  1. Severe hypoxemia
  2. No parenchymal disease
  3. Evidence of left to right shunting
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11
Q

What are the 3 categories of PPHN physiology?

A
  1. Maladaption
  2. excessive muscularization
  3. Hypoplastic vasculature
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12
Q

Describe how PPHN can be caused by maladaption?

A

structurally normal but abnormally constricted vasculature caused by lung parenchymal disease such as MAS, group b strep or RDS

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13
Q

Describe how excessive muscularization can cause PPHN

A

normal parenchyma but increased smooth muscle cell thickness and extension of smooth muscle to distal ends of pulmonary vessels

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14
Q

How does hypoplastic vasculature contribute to PPHN?

A

underdevelopment of the pulmonary vasculature may result in vessels that are small and incapable of carrying the appropriate volume of blood

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15
Q

What IV medications may be used on infants with PPHN?

A
  1. Sedatives-fentanyl
  2. Paralytics - vecuronium
  3. Magnesium - muscle relaxers
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16
Q

What strategies is employed when mechanically ventilating infants with PPHN?

A

mild hyperventilation

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17
Q

What respiratory medications can be given to infants with PPHN?

A

Inhaled Nitric oxide
Flolan

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18
Q

What is the formula for the oxygenation index?

A

OI = (Paw x FiO2) / PaO2

19
Q

What is the oxygenation index used for?

A

Used to measure the disease severity

20
Q

What is a normal Oxygenation index value?

A

Normal < 10

21
Q

What oxygenation index supports the initiation of HFOV or iNO?

A

> 20

22
Q

What oxygenation index score supports the initiation of ECMO?

A

> 40 on conventional ventilation supports ECMO
60 on HFOV supports ECMO

23
Q

Describe the 20-20-20 rule for initiation of nitric oxide

A

When OI is 20
Dose 20 ppm
Response if the P/F ration increases by greater than 20 mmhg

24
Q

What is the 60-60-60 rule for weaning iNO?

A

When? 60 minutes after demonstrating response if FiO2 is less than 60% and PaO2 is greater than 60 mmHg

25
Q

What are the risks associated with severe PPHN?

A
  1. Inadequate systemic blood pressure
  2. Cardiac dysfunction
  3. inability to oxygenate
26
Q

What is meconium?

A

meconium is a sterile green tinged bowel content of an infant typically passes within 48 hours of life

27
Q

What are the risk factors for meconium aspiration?

A

Post term deliveries

28
Q

Why do post term deliveries carry and increased risk of MAS?

A

Fetus passing meconium is thought to be a vagal response due to stress and hypoxia

29
Q

What physiologic response does meconium aspiration cause?

A
  1. Airway inflammation
  2. Mucus production
  3. bacterial proliferation
  4. Surfactant washout
30
Q

How can the pulmonary vasculature react to MAS?

A

Pulmonary vasculature may be hyperreactive and vasoconstrict resulting in PPHN

31
Q

Meconium aspiration can cause something called the ball valve effect. What does this result in?

A
  1. Air trapping
  2. Alveolar hyperinflation
  3. Air leak syndrome
32
Q

Describe how MAS may present?

A
  1. Green or brown stained amniotic fluid
  2. Yellow stained skin, nails and umbilical cord
  3. Difficult delivery
  4. Depressed at birth
  5. Low APGARS
  6. Respiratory distress
  7. Cyanosis
  8. Hypoxia
33
Q

Is endotracheal suctioning an appropriate response to suspected MAS?

A

research has not been able substantiate improved outcomes in neonates that were endotracheally suctioned vs those who were not

34
Q

How can MAS be diagnosed?

A
  1. Stained amniotic fluid
  2. respiratory distress at birth
  3. ruling out other causes such as GBS PNA, PPHN, CHD
  4. CXR
35
Q

How does MAS present on a CXR?

A

heterogenous pulmonary infiltrates in associated with hyperinflated lungs

36
Q

How can MAS be managed?

A
  1. Oxygen
  2. Mechanical ventilation
  3. Surfactant administration
  4. iNO but only if PPHN is present
  5. ECMO (last resort)
37
Q

Define congenital diaphragmatic hernia

A

Condition resulting from inability of the pleura and peritoneal spaces to close during the first trimester of pregnancy leading to the displacement of abdominal organs within the chest cavity

38
Q

What can result from a congenital diaphragmatic hernia?

A

Lung hypoplasia and altered pulmonary vascular development

39
Q

What causes congenital diaphragmatic hernias?

A
  1. Cause is unknown
  2. Multiple potential factors at plays such as genetics, environment and nutrition are suspected
40
Q

What chromosomal abnormalities is CDH associated with?

A

Trisomy 13, 18
Turner syndrome

41
Q

When are most case of CDH found?

A

at the 2o week anatomy scan

42
Q

How does CDH present?

A
  1. Respiratory distress
  2. Severe WOB
  3. Concave abdomen
  4. decreased breath sounds
  5. Bowel sounds in abdomen
  6. low APGARs
43
Q

How is CDH managed?

A
  1. Resuscitation team in delivery room
  2. orogastric tube to decompress stomach
  3. intubation
  4. permissive hypercapnia allow
  5. ECMO
44
Q

What are complications associated with CDH?

A
  1. Chronic lung disease
  2. Pulmonary hypertension
  3. Aspiration risks
  4. Feeding issues
  5. Developmental delays
  6. Re-herniation

Pediatrics (16 decks)

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