Neonatal Diseases Flashcards
What is the technical definition of apnea of prematurity?
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
What causes apnea of prematurity?
Physiological immaturity of the neurological and chemical receptor systems of the body
What are the 2 types of apnea of prematurity?
Central
Obstructive
What is the most common form of apnea of prematurity?
Central
Due to the immaturity of the central respiratory drive
At what gestational age(s) is apnea of prematurity most common?
54% of 30-31 weekers
80% <30 weekers
What are options for management and treatment of apnea of prematurity?
- Positioning
- Methylxanthines
- blood transfusion
- Nasal cannula/CPAP/HHFNC
How do methylxanthines and caffeine treat apnea of prematurity?
stimulates the CNS and respiratory drive
How do nasal cannula/CPAP/HHFNC treat/manage apnea of prematurity?
the tactile stimulation reminds the neonate to breath
Define transient tachypnea of the newborn
a parenchymal lung disease caused by pulmonary edema resulting in a delay of clearance and reabsorption of fetal lung fluid
What can cause transient tachypnea of the newborn?
- Maternal diabetes
- Maternal Asthma
- C section births without active labor
- Precipitous deliveries
- multiple gestations, twins
How does vaginal birth prevent transient tachypnea of the newborn?
- Fetal adrenaline released during labor inhibits type 2 cells and decreases fetal lung fluid amounts and begins reabsorption process
- Thorax compression during contractions and delivery push out 25-35% of remaining lung fluid
Describe the effect that fetal adrenaline has on fetal lung fluid levels
- Fetal adrenaline inhibits chloride channels inhibiting fetal lung fluid production
- Fetal adrenaline activates sodium channels which stimulate absorption of fetal lung fluid
How does transient tachypnea of the newborn present?
- Initial APGARs are normal
- Increasing signs of respiratory distress within several hours of birth
- tachypnea
- hypoxemia/hypercapnia
- Retractions
- Nasal flaring
- Expiratory grunting
Describe how an xray of an infant with TTN would present
- Initial xray would be normal
- progress to “wet” CXR
Describe how a wet CXR would present in a neonate with TTN
- increased pulmonary congestion
- increased pulmonary markings
- bulging intercostals
- Flattened diaphragms
- peripheral lucency
How can TTN be managed?
- Oxihood
- HHFNC
- CPAP
- Mechanical ventilation
- frequent changes of position
What are risk factors for neonatal pneumonia?
- Prolonged rupture of membranes
- maternal fever
- Meconium stained fluid
- Positive group B strep for mom
If a neonate develops PNA within 7 days of life, what is the most likely pathogen?
Group b strep
If a neonate develops PNA after 7 days, what is the most likely pathogen?
E coli
What etiologies can result in neonatal pneumonia?
- Intrauterine
- Intrapartum-aspiration of infected amniotic fluid
- Postnatal-environmental/healthcare acquired PNA
What is the concern for neonates with group B strep related PNA?
GBS may rapidly progress to sepsis
How could a neonate with sepsis present?
- Tachypneic
- Lethargic
- poor feeding
- apnea
- tachy/bradycardia
- poor perfusion
- temp instability
- abdominal distension
- metabolic acidosis
How is sepsis in a neonate diagnosed?
- CBC
- blood cultures
- tracheal aspirate gram stain
What would a CBC of a neonate with sepsis look like?
- Decreased WBC
- Left shift of neutrophils
- increase in bands
What would the chest xray of a neonate with pneumonia generically look like?
- atelectasis
- pleural effusion
- relative over expansion of uninvolved areas
What does the chest xray of a neonate with GBS look like?
RDS
What does the CXR of a neonate with staph PNA look like?
lobar consolidation/infiltrates
pneumatoceles (air cavities)
What does klebsiella PNA look like in neonates?
lobar consolidation
infiltrates
bulging fissures
What are respiratory approaches to treating neonatal patients with PNA?
- Chase good enough blood gases
- CPT?PD for bronchial hygeine
- antibiotics
- ECMO if unresponsive to therapy
What conditions qualify as air leak syndrome?
- Pneumothorax
- Pneumomediastinum
- Pneumopericardium
- Pulmonary interstitial emphysema
What are risk factors associated with air leak syndrome?
- surfactant deficiency
- aspiration of foreign contents (blood, meconium and amniotic fluid)
- pulmonary hypoplasia
What signs would indicate air leak syndrome?
- Abrupt decrease in cardiac output
- sudden oxygen desaturate
- Increased heart rate
- Decreased blood pressure
How do you diagnose air leak syndrome?
transillumination
1. healthy lung = small halo of light
2. pneumothorax = large light illumination
What is choanal atresia?
Defined as unilateral or bilateral obstruction of the choanal plate within the posterior nasal passage
What can choanal atresia cause?
- Severe respiratory distress
- Feeding problems
How do you test for choanal atresia?
attempt to pass a / french suction catheter through each nare to see if obstruction is felt
How is choanal atresia treated?
surgical stent placement
