Neonaates 2

Question 1

normal resp rate for an infant

Answer 1

40-60/min

Question 2

tachypnoea for a neonate

Answer 2

> 60/min

Question 3

common causes of respiratory distress in a newborn

Answer 3

• hyaline membrane disease/repsiratory distress syndrome
• transient tachypnoea of the newborn
• meconium aspiraation syndrome
• pnaumothorax
• pneumomediastinum

Question 4

hyaline membrane disease/respiratory distress syndrome is due to

Answer 4

surfactant deficiency
usually a disease of preterm infants
can occur even in late preterm infants

Question 5

presenting features of HMD

Answer 5

resp distress, grunting, tachypnoea, respiratory acidosis, hypoxia, apnoea

Question 6

required innvestigations for HMD

Answer 6

x-ray chest, full blood counts, CRP, blood culture, blood gas analysis

Question 7

aappearance of HMD in chest x-ray

Answer 7

ground glass

Question 8

what are the normal blood gas values

Answer 8

PH: 7.3 to 7.4; CO2: 35-45 mm Hg; Bicarb: 17-25 mmol/L; Base
excess: -1 to -2 mmol/L; Lactates: 1-3 mmol/L

Question 9

what happens to blood gasses in HMD

Answer 9

Predominantly respiratory acidosis: PH: 7.2, Co2: 70;
Bicarbonate: 23

Question 10

management of HMD

Answer 10

CPAP, Intubation and ventilation if required,
Surfactant, IV fluids, antibiotics

Question 11

what can be done to prevent HMD

Answer 11

avoid delivering babies before full term
in preterm deliveries before 34 weeks, give antenatal glucocorticoids to mother (betamethasone or dexamethasone)

Question 12

transient tachypnoea of the newborn is caused by

Answer 12

impaired fetal lung fluid clearance
more common in infants born by cesarean section

Question 13

presentation of transient tachypnoea of the newborn

Answer 13

chest x-ray reveals diffuse parenchymal infiltrates due to fluid in the interstitial, fluid in the interlobular fissure

Question 14

blood gasses of TTN

Answer 14

mild respiratory acidosis and hypoxaemia

Question 15

management of TTN

Answer 15

supportive, supplimentaal oxygen, CPAP
self limited disease

Question 16

how do you prevent TTN

Answer 16

avoid elective caesarean section before 39 weeks

Question 17

neonatal pneumonia

Answer 17

GBS is the most common organism
the orgnism is passed to the foetus from the mother whose vagina is colonised with GBS

Question 18

risk factors of neonatal pneumonia

Answer 18

prolonged rupture of membranes (PROM), materal infection, and prematurity

Question 19

presentation of neonatal pneumonia

Answer 19

repsiratory distress
chest x-ray: diffuse parenchymal infiltrates with air bronchogram
pneumonia usually occurs in association with sepsis

Question 20

treatment of neonatal pneomonia

Answer 20

IV antibiotics, CPAP, ventilation, supportive care

Question 21

what can be done to prevent GBS sepsis

Answer 21

routine rectal and vaginal-rectal swabs during pregnancy at 35-37 weeks
intrapartum antibiotics for those who are GBS positive

Question 22

meconium aspiration syndrome

Answer 22

respiratory distress in an infant born through meconium-stained amniotic fluid
meconium consists of salivary, gastric, pancreatic and intestinal juices, mucous, bile, vile acids, cellular debris, lanugo hairs, fetal wax and blood
meconium is a ppotent activator of inflammatory cascades

Question 23

aspirated meconium can cause

Answer 23

acute airway obstruction
patxhy atelectasis and over infiltration
surfactant dysfunction or inactivation
chemical pneumonitis
pulmonary hypertension

Question 24

diagnosis of meconium aspiration syndrome

Answer 24

chest radiograph and blood gas analysis
- x-ray: overexpansion of the lungs with widespread coarse, patchy infiltrates
severity of the x-ray pattern does not always correlate with the clinical picture

Question 25

investigations of MAS

Answer 25

blood gas shows repsiratory or mixed acidosis
hypoxaemia
low saturations
if PPHN: difefrence between saturations of upper and lower limb

Question 26

treatment of MAS

Answer 26

maintenance of adequate oxygenation
optimal blood pressure
correction of acidosis, hypoglycaemia
CPAP
adequate sedation, minimal handling
surfactant therapy
antibiotics, IV fluids
ECMO

Question 27

prevention of MAS

Answer 27

avoid post-term delivery (>41 weeks)

Question 28

suctioning of baby’s oropharynx nd tracheaa

Answer 28

not necessary
endotracheal suctioning may be considered to clear the airway if the baby is apnoeic at birth
rigorous electronic foetal monitoring durinf labour to detect early signs of foetal distress

Question 29

pneumothorax is

Answer 29

air in the pleural space

Question 30

penumothorax can occur in

Answer 30

HMD, MAS, spontaneous, or in any resp condition where the baby is on positive respiratory support

Question 31

presentation of pneumothorax

Answer 31

worsening of the respiratory distress in those who are already recieving CPAP or mechanical ventilation
spontaneous pneumothorax presents with sudden resp distress

Question 32

a pneumothorax needs

Answer 32

a chest drain insertion