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Pediatrics > Neonatal Diseases > Flashcards

Neonatal Diseases Flashcards

1
Q

What is the technical definition of apnea of prematurity?

A

sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia or oxygen desaturation in an infant younger than 37 weeks

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2
Q

What causes apnea of prematurity?

A

Physiological immaturity of the neurological and chemical receptor systems of the body

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3
Q

What are the 2 types of apnea of prematurity?

A

Central
Obstructive

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4
Q

What is the most common form of apnea of prematurity?

A

Central
Due to the immaturity of the central respiratory drive

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5
Q

At what gestational age(s) is apnea of prematurity most common?

A

54% of 30-31 weekers
80% <30 weekers

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6
Q

What are options for management and treatment of apnea of prematurity?

A
  1. Positioning
  2. Methylxanthines
  3. blood transfusion
  4. Nasal cannula/CPAP/HHFNC
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7
Q

How do methylxanthines and caffeine treat apnea of prematurity?

A

stimulates the CNS and respiratory drive

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8
Q

How do nasal cannula/CPAP/HHFNC treat/manage apnea of prematurity?

A

the tactile stimulation reminds the neonate to breath

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9
Q

Define transient tachypnea of the newborn

A

a parenchymal lung disease caused by pulmonary edema resulting in a delay of clearance and reabsorption of fetal lung fluid

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10
Q

What can cause transient tachypnea of the newborn?

A
  1. Maternal diabetes
  2. Maternal Asthma
  3. C section births without active labor
  4. Precipitous deliveries
  5. multiple gestations, twins
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11
Q

How does vaginal birth prevent transient tachypnea of the newborn?

A
  1. Fetal adrenaline released during labor inhibits type 2 cells and decreases fetal lung fluid amounts and begins reabsorption process
  2. Thorax compression during contractions and delivery push out 25-35% of remaining lung fluid
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12
Q

Describe the effect that fetal adrenaline has on fetal lung fluid levels

A
  1. Fetal adrenaline inhibits chloride channels inhibiting fetal lung fluid production
  2. Fetal adrenaline activates sodium channels which stimulate absorption of fetal lung fluid
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13
Q

How does transient tachypnea of the newborn present?

A
  1. Initial APGARs are normal
  2. Increasing signs of respiratory distress within several hours of birth
  3. tachypnea
  4. hypoxemia/hypercapnia
  5. Retractions
  6. Nasal flaring
  7. Expiratory grunting
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14
Q

Describe how an xray of an infant with TTN would present

A
  1. Initial xray would be normal
  2. progress to “wet” CXR
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15
Q

Describe how a wet CXR would present in a neonate with TTN

A
  1. increased pulmonary congestion
  2. increased pulmonary markings
  3. bulging intercostals
  4. Flattened diaphragms
  5. peripheral lucency
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16
Q

How can TTN be managed?

A
  1. Oxihood
  2. HHFNC
  3. CPAP
  4. Mechanical ventilation
  5. frequent changes of position
17
Q

What are risk factors for neonatal pneumonia?

A
  1. Prolonged rupture of membranes
  2. maternal fever
  3. Meconium stained fluid
  4. Positive group B strep for mom
18
Q

If a neonate develops PNA within 7 days of life, what is the most likely pathogen?

A

Group b strep

19
Q

If a neonate develops PNA after 7 days, what is the most likely pathogen?

A

E coli

20
Q

What etiologies can result in neonatal pneumonia?

A
  1. Intrauterine
  2. Intrapartum-aspiration of infected amniotic fluid
  3. Postnatal-environmental/healthcare acquired PNA
21
Q

What is the concern for neonates with group B strep related PNA?

A

GBS may rapidly progress to sepsis

22
Q

How could a neonate with sepsis present?

A
  1. Tachypneic
  2. Lethargic
  3. poor feeding
  4. apnea
  5. tachy/bradycardia
  6. poor perfusion
  7. temp instability
  8. abdominal distension
  9. metabolic acidosis
23
Q

How is sepsis in a neonate diagnosed?

A
  1. CBC
  2. blood cultures
  3. tracheal aspirate gram stain
24
Q

What would a CBC of a neonate with sepsis look like?

A
  1. Decreased WBC
  2. Left shift of neutrophils
  3. increase in bands
25
Q

What would the chest xray of a neonate with pneumonia generically look like?

A
  1. atelectasis
  2. pleural effusion
  3. relative over expansion of uninvolved areas
26
Q

What does the chest xray of a neonate with GBS look like?

A

RDS

27
Q

What does the CXR of a neonate with staph PNA look like?

A

lobar consolidation/infiltrates
pneumatoceles (air cavities)

28
Q

What does klebsiella PNA look like in neonates?

A

lobar consolidation
infiltrates
bulging fissures

29
Q

What are respiratory approaches to treating neonatal patients with PNA?

A
  1. Chase good enough blood gases
  2. CPT?PD for bronchial hygeine
  3. antibiotics
  4. ECMO if unresponsive to therapy
30
Q

What conditions qualify as air leak syndrome?

A
  1. Pneumothorax
  2. Pneumomediastinum
  3. Pneumopericardium
  4. Pulmonary interstitial emphysema
31
Q

What are risk factors associated with air leak syndrome?

A
  1. surfactant deficiency
  2. aspiration of foreign contents (blood, meconium and amniotic fluid)
  3. pulmonary hypoplasia
32
Q

What signs would indicate air leak syndrome?

A
  1. Abrupt decrease in cardiac output
  2. sudden oxygen desaturate
  3. Increased heart rate
  4. Decreased blood pressure
33
Q

How do you diagnose air leak syndrome?

A

transillumination
1. healthy lung = small halo of light
2. pneumothorax = large light illumination

34
Q

What is choanal atresia?

A

Defined as unilateral or bilateral obstruction of the choanal plate within the posterior nasal passage

35
Q

What can choanal atresia cause?

A
  1. Severe respiratory distress
  2. Feeding problems
36
Q

How do you test for choanal atresia?

A

attempt to pass a / french suction catheter through each nare to see if obstruction is felt

37
Q

How is choanal atresia treated?

A

surgical stent placement

Pediatrics (10 decks)

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