Neonaates 2 Flashcards
normal resp rate for an infant
40-60/min
tachypnoea for a neonate
> 60/min
common causes of respiratory distress in a newborn
- hyaline membrane disease/repsiratory distress syndrome
- transient tachypnoea of the newborn
- meconium aspiraation syndrome
- pnaumothorax
- pneumomediastinum
hyaline membrane disease/respiratory distress syndrome is due to
surfactant deficiency
usually a disease of preterm infants
can occur even in late preterm infants
presenting features of HMD
resp distress, grunting, tachypnoea, respiratory acidosis, hypoxia, apnoea
required innvestigations for HMD
x-ray chest, full blood counts, CRP, blood culture, blood gas analysis
aappearance of HMD in chest x-ray
ground glass
what are the normal blood gas values
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
what happens to blood gasses in HMD
Predominantly respiratory acidosis: PH: 7.2, Co2: 70;
Bicarbonate: 23
management of HMD
CPAP, Intubation and ventilation if required,
Surfactant, IV fluids, antibiotics
what can be done to prevent HMD
avoid delivering babies before full term
in preterm deliveries before 34 weeks, give antenatal glucocorticoids to mother (betamethasone or dexamethasone)
transient tachypnoea of the newborn is caused by
impaired fetal lung fluid clearance
more common in infants born by cesarean section
presentation of transient tachypnoea of the newborn
chest x-ray reveals diffuse parenchymal infiltrates due to fluid in the interstitial, fluid in the interlobular fissure
blood gasses of TTN
mild respiratory acidosis and hypoxaemia
management of TTN
supportive, supplimentaal oxygen, CPAP
self limited disease
how do you prevent TTN
avoid elective caesarean section before 39 weeks
neonatal pneumonia
GBS is the most common organism
the orgnism is passed to the foetus from the mother whose vagina is colonised with GBS
risk factors of neonatal pneumonia
prolonged rupture of membranes (PROM), materal infection, and prematurity
presentation of neonatal pneumonia
repsiratory distress
chest x-ray: diffuse parenchymal infiltrates with air bronchogram
pneumonia usually occurs in association with sepsis
treatment of neonatal pneomonia
IV antibiotics, CPAP, ventilation, supportive care
what can be done to prevent GBS sepsis
routine rectal and vaginal-rectal swabs during pregnancy at 35-37 weeks
intrapartum antibiotics for those who are GBS positive
meconium aspiration syndrome
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
aspirated meconium can cause
acute airway obstruction
patxhy atelectasis and over infiltration
surfactant dysfunction or inactivation
chemical pneumonitis
pulmonary hypertension
diagnosis of meconium aspiration syndrome
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
investigations of MAS
blood gas shows repsiratory or mixed acidosis
hypoxaemia
low saturations
if PPHN: difefrence between saturations of upper and lower limb
treatment of MAS
maintenance of adequate oxygenation
optimal blood pressure
correction of acidosis, hypoglycaemia
CPAP
adequate sedation, minimal handling
surfactant therapy
antibiotics, IV fluids
ECMO
prevention of MAS
avoid post-term delivery (>41 weeks)
suctioning of baby’s oropharynx nd tracheaa
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
pneumothorax is
air in the pleural space
penumothorax can occur in
HMD, MAS, spontaneous, or in any resp condition where the baby is on positive respiratory support
presentation of pneumothorax
worsening of the respiratory distress in those who are already recieving CPAP or mechanical ventilation
spontaneous pneumothorax presents with sudden resp distress
a pneumothorax needs
a chest drain insertion
