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Respiratory medicine > L5 - Neonatal lung disease > Flashcards

L5 - Neonatal lung disease Flashcards

1
Q

What is respiratory distress syndrome?

A
  • Usually caused by a deficiency in surfactant

- and often occurs in premature infants.

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2
Q

Effect of decreased surfactant

A

Lung compliance decreases.

Work of inflating stiff lung increases.

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3
Q

Administration of what may cause an increase in surfactant production?

A

Corticosteroids.

- stimulates lung development and surfactant production

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4
Q

Effect of decreased surfactant in a new born infant

A

Lung collapses with each successive breath.

So infant must work as hard with each successive breath.

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5
Q

What might progressive atelectasis and reduced lung compliance lead to…

A

Uneven perfusion and hypoventilation.

  • results in protein rich fibrin rich exudation
  • into the alveolar spaces
  • with the formation of hyaline membrane.
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6
Q

Problems associated with formation of hyaline membrane

A
  • Becomes barrier to gas exchange
  • leading to CO2 retention and hypoxemia.
  • Hypoxemia itself further impairs surfactant synthesis.
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7
Q

Babies with RDS may present with (3)

A
  • Tachypnoea
  • Laboured breathing with chest wall recession
  • Cyanosis (severe cases)
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8
Q

How might a pneumothorax be demonstrated on examination?

A

Transillumination into bright fibre optic light source applied to chest wall.

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9
Q

How might tension pneumothorax be treated

A

Treated urgently with decompression by inserting chest drain

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10
Q

Summarise the different stages in lung development of a neonate?

A
  1. Embryonic
  2. Psuedoglandular
  3. Canalicular
  4. Saccular
  5. Alveolar
  6. Post-natal
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11
Q

Embryonic stage of lung development

A

(4-7 weeks)

  • lung bud differentiation
  • trachea and bronchi forming
  • pulmonary vein and artery forming
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12
Q

Psuedoglandular stage of development

A

(7-17 weeks)

  • further division
  • conducting airways formed
  • terminal bronchioles
  • immature neural network
  • pre-acinar blood vessels
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13
Q

Canalicular stage of development

A

(17-26 weeks)

  • primitive alveoli
  • type I, type II cells
  • surfactant synthesis
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14
Q

Describe surfactant

A
  • lipoprotein
  • produced by type II cells
  • keeps surface tension low
  • prevents formation of water-air interface which has a high surface tension
  • maintains similar pressure in alveoli despite changes in diameter
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15
Q

Describe respiratory distress syndrome?

A
  • impaired surfactant and secretion leads to atelectasis
  • ventilation perfusion v/q inequality
  • hypoventilation with resultant hypoxemia and hypercarbia
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16
Q

What is the result of respiratory and metabolic acidosis?

A
  • causes pulmonary vasoconstriction
  • impaired endothelial and epithelial integrity
  • leakage of proteinaceous exudate
  • formation of hyaline membranes
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17
Q

Deficiency lung surfactant?

A
  • decrease in lung compliance
  • decrease in functional residual capacity
  • increase in deadspace
  • large v/q mismatch
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18
Q

Voltrauma

A
  • ultrastructural lung injury
  • due to overdistention
  • occurring during mechanical ventilation.
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19
Q

Barotrauma

A

Injuries caused by increased air and water pressure

20
Q

What sequence of events may lead to bronchopulmonary dysplasia?

A
  • oxygen toxicity with barotrauma,
  • voltrauma in the structurally immature lungs
  • causes an influx of inflammatory cells.
  • exacerbates the vascular injury.
  • leads to broncho pulmonary dysplasia
21
Q

Signs and symptoms of bronchopulmonary dysplasia in newborns

A
  • low birth weight

- significant weight loss during first 10 days of life.

22
Q

Management of Bronchopulmonary Dysplasia (3)

A
  • surfactant replacement with oxygen supplementation
  • continuous positive airway pressure
  • mechanical ventilation
23
Q

Bronchopulmonary dysplasia pathophysiology

A
  • overall reduction in SA for gas exchange
  • by alveolar septatum interferance
  • damage to developing pulmonary microvasculature
24
Q

Pulmonary interstitial emphysema (4)

A
  • Rupture of small airway, alveoli.
  • Air leaks out
  • due to high intra-alveolar pressure.
  • More frequently due to mechanically applied pressure
25
Q

How may changes in transpulmonary pressure cause damage to the respiratory epithelium?

A
  • if transpulmonary pressure exceeds the tensile strength of the non-cartillaginous terminal airway and alveolar saccules
26
Q

Summarise the different surfactant proteins

A

Hydrophillic
Immunity
- SP-A
- SP-D

Hydrophobic
Spread of surfactant
- SP-B
- SP-C

27
Q

Role of SP-A

A

‘immune system’

- protects surfactant transport

28
Q

Role of SP-B

A
  • essential for lung function

- absorption and spreading

29
Q

Role of SP-D

A

‘immune system’

- regulates surfactant balance

30
Q

Role of SP-C

A

Absorption

31
Q

What occurs during the saccular phase?

27-36 weeks

A
  • Formation of alveolar saccules, ECM.
  • Neural network maturation
  • More nerves and BV
32
Q

What occurs during the alveolar phase?

36 months - 2 years

A
  • expansion of gas exchange area, nerves and capillaries
33
Q

What occurs during the post natal phase

2-18 years

A
  • continued cellular proliferation

- lung growth and expansion

34
Q

What is required in order for lungs to develop properlly

A
  • fetal breathing
  • fetal lungs secrete lung fluid
  • pressure generated by amniotic fluid around fetus
35
Q

How do fetuses adapt at birth

A

Cut cord, baby will cry.

- babies filling lungs with oxygen and pushing out lung fluid

36
Q

How is the clearance of lung fluid controlled during labour?

A

Hormonally mediated :

  • catecholamines
  • ADH
  • thyroid hormones

Slow secretion and increase absorption.

37
Q

How is clearance of lung fluid controlled during delivery

A

‘thoracic squeeze’

- expels fluid and reduces lung volume

38
Q

Describe haemodynamic adaptation at birth?

A
  • fall in pulmonary vascular resistance
  • rise in systemic vascular resistance
  • increase in pulmonary blood flow
39
Q

Pulmonary hypoplasia

A

Small lungs that never develop properlly

40
Q

Congenital diaphragmatic hernia

A

Where bowel goes up into chest through hole in diaphragm and gets in way of lung.

41
Q

Congenital lobar emphysema

A

Hyperinflated lung on one side

Compression of adjacent lung

42
Q

Cystic adenomatoid malformation

A

Benign lung lesion that appears before birth as a cyst or mass in chest.

43
Q

What is given to mums at risk of pre-term labour?

A

Steroids

- increase surfactant production in baby, thus preventing possible RDS

44
Q

Hypoxic ischaemic encephalopathy

A
  • oxygen deprivation at birth

- septic

45
Q

RDS on CXR

A
  • granular appearnce of lungs

- umbilical lines, place canulla to provide antibiotics and nutrition

Respiratory medicine (16 decks)

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