Neonatal Diseases Flashcards
Assessment and stabilization of the neonate immediately following delivery
Delivery Room Care
Primary assessment for Delivery Room Care
Clear airway first with bulb syringe
Dry infant and keep warm
APGAR score- Performed at 1 min and then again at 5 mins
Secondary assessment for Delivery Room Care
As neonate’s condition allows, evaluate
- History: family, mother, pregnant, delivery
- Gestational age
- Weight
- General appearance: color, chest configuration
- Breath Sounds
APGAR score of 0 to 3
- Resuscitate
- CPR
APGAR score of 4 to 6
- Stimulate
- Warm
- Administer oxygen
- Assist ventilation
APGAR score of 7 to 10
- Monitor
- Routine care
Apnea caused by immature neurologic control of ventilation resulting in death
Apnea of Prematurity
Etiology of Apnea of Prematurity
Immature central nervous system
Past medical history: premature, episodes fo central apnea
- Respiratory pattern: periodic apnea, irregular breathing
- Color: periodic cyanotic spells
- Vital Signs: periods of bradycardia, variations of thermal regulation
Primary assessment for Apnea of Prematurity-
Secondary assessment - Apnea of Prematurity
- Basic Lab Tests: help rule out other causes
- Special tests
Special tests for Apnea of Prematurity
Polysomnogram
Treatment and management for Apnea of Prematurity
- Oxygen therapy 30 to 50 % as indicated by oximetry
- Methylxanthines (caffeine)
- MV if necessary
- Teach parents/family CPR
- Send infant home with an apnea monitor
Condition in which a fetus aspirates a mix of fetal stool (meconium) and amniotic fluid during episodes of fetal hypoxemia
Meconium Aspiration Syndrome
- Past medical history: most common in post term infants (more than 42 wks)
- Respiratory pattern: grunting, substernal retractions/abdominal distention (seesaw movement), nasal flaring, asphyxia, gasping with tachypnea
- Color: cyanosis
- Physical appearance: Low Apgar score, stained with meconium
- Heart Rate: tachycardia, elevated BP
Primary assessment for Meconium Aspiration Syndrome
Secondary assessment for Meconium Aspiration Syndrome
CXR
ABG
Irregular densities throughout the lungs with atelectasis and consolidation
CXR findings in Meconium Aspiration Syndrome
Treatment and management for Meconium Aspiration Syndrome
-Suction the nasopharynx and oropharynx throughly when amniotic fluid stained
-Follow NRP guideline
Stabilize infanta and transfer to ICU
Meconium Aspiration Syndrome
- Infant is not vigorous,
- Pulse < 100
- Limp
- Depressed RR
- Poor tone
- Absent or gasping respirations
- No positive pressure ventilation
- Visualize vocal cords with laryngoscope
- Intubated with a meconium aspirator and suction the trachea
- Repeat until airway is clear- even if pulse is low
- Intubate and provide airway
Meconium Aspiration Syndrome
- Vigorous, active and crying,
- Pulse > 100
- Strong RR
- Good muscle tone
- Suction mouth and nose to clear pharynx
- Warm, dry, and observe
- Blow by oxygen as needed
Once patient is in ICU - Meconium Aspiration Syndrome
- Vigorous pulmonar hygiene
- Oxygen therapy
- Mechanical ventilation for ventilatory failure
- Drug therapy
- -Antibiotics
- -Steroids
Structural abnormality of the heart present at birth
Congenital Heart Defects
Etiology of Cyanotic - Congenital Heart Defects
Right to left shunt (Hypoxemia)
- Tetralogy of Fallot
- Transposition of the Great Vessels
Etiology of Acyanotic Congenital Heart Defects
Left to Right shunt (pulmonary congestion)
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
Primary assessment for Congenital Heart Defects
- Color: cyanosis
- Breath Sounds: normal breath sounds, heart murmur
- Physical appearance: respiratory distress
Secondary assessment for Congenital Heart Defects
CXR: Possibly and enlarged or abnormal shaped heart
Congenital Heart Defects - Egg shaped heart
With transposition of the Great vessels
Congenital Heart Defects - Boot shaped heart
With tetralogy of Fallot
Most important test to ID cardiac defects
Echocardiogram
Overriding aorta, pulmonary stenosis, ventricular septal defect, and right ventricular hypertrophy
Tetralogy of Fallot
Aorta is switched with pulmonary artery (aorta arises from the right ventricular and the pulmonary artery arises from the left ventricle)
Transposition of the Great Vessels
Failure of the ductus arterioles to close.
Most often results in a left to right shunt (increased pulmonary blood flow)
However, if the pressure in the right ventricle is greater than the pressure in the left ventricle, blood will flow from right to left across the ductus (shunt effect)
Patent Ductus Arteriosus
A constriction in the aorta.
Demonstrates as hypertension in the upper extremities and hypotension in lower extremities
Coarctation of the Aorta
Opening in the atrial septum
Atrial Septal Defect (ASD)
Opening in the ventricular septum
Ventricular Septal Defect (VSD)
Combined pulmonary artery and aorta
Truncus Arteriosus
Pre and Post ductal blood gas studies
-If the pre ductal (right radial artery) PO2 is >15 torr higher than the post ductal (umbilical artery) PO2, then the patient has a right to left shunt
Treatment and management for Congenital Heart Defects
- Oxygen therapy: maintain PaO2 levels between 60 to 80 torr
- Mechanical ventilation for ventilatory failure
- Supportive care prior to surgery to correct defect
- Prostaglandin E, may be helpful to maintain a PDA
Primarily associated with prematurity or high risk infants
-Caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia
Infant Respiratory Distress Syndrome (IRDS)
- Past medical history: gestational age < 38 wks, low APGAR score, onset present at brith or within a few hours after delivery, L:S ratio < 2:1
- Appearance of the chest: intercostal retractions
- Respiratory pattern: tachypnea and possible apnea
- Color: cyanosis
- Breath sounds: bronchial or harsh, fine crackles/rales, expiratory grunting
- Physical appearance: nasal flaring, grunting, retractions
- Vital signs: increased HR, BP, QT
Primary assessment for Infant Respiratory Distress Syndrome
Secondary assessment for Infant Respiratory Distress Syndrome
CXR
ABG
- Increased opacity
- Ground glass appearance
- Air bronchograms
CXR findings for Infant Respiratory Distress Syndrome
Treatment and management for Infant Respiratory Distress Syndrome
- Correct hypoxemia
- Maintain neutral thermal environment
- Surfactant replacement therapy
- Mechanical ventilation for ventilatory failure (time cycled ventilation) with PEEP
How to correct hypoxemia for Infant Respiratory Distress Syndrome
- Oxygen via oxyhood or nasal cannula
- CPAP 4 to 6 cmH2o
- Maintain PaO2 between 60 to 80 torr
How to give surfactant therapy for Infant Respiratory Distress Syndrome
- Administer immediately after birth (prophylactic) in neonates <35 weeks or once IRDS has bee diagnosed
- Instill directly into the trachea though 5 fr catheter placed into the ETT
- Solution is administered in 4 portions, one at a time
- Catheter is removed after each administration
- Infanta is manually ventilated for 30 seconds
- Change patient position to increase distribution
- Observe for adverse reactions
Surfactant Replacement Drugs for IRDS
Survanta (beractant)
Infasurf (calfactant)
Curosurf (poractant alfa)
Surfaxin (lucinactant)
Chronic lung disorder characterized by bronchiolar metaplasia and interstitial fibrosis.
A chronic lung disease that developed in newborns as a consequence of treatment of IRDS with oxygen and positive pressure ventilation for primary lung disorder
Bronchopulmonary Dysplasia
Common factors of Bronchopulmonary Dysplasia
- Low gestational age and low birth weight
- Mechanical ventilation with high airway pressures
- High oxygen concentrations
- History of IRDS
- Past medical history: prematurity
- Appearance of the chest: intercostal retractions
- Respiratory pattern: > 60/min
- Color: cyanosis
- Breath sounds: wheezes, rhonchi, crackles, expiratory grunting
- Physical appearance: nasal flaring, substernal retractions/abdominal distention (seesaw movement)
- Vital signs: increased HR, BP, QT
Primary assessment of Bronchopulmonary Dysplasia
Secondary assessment of Bronchopulmonary Dysplasia
CXR
ABG
-Initially resembles IRDS, then progresses to atelectasis, followed by cyst like areas of hyperlucency which increase in later stages
CXR findings in Bronchopulmonary Dysplasia
Treatment and management for Bronchopulmonary Dysplasia
- Oxygen therapy
- Pulmonary hygiene
- Mechanical ventilation
- Ventilation and oxygenation should be maintained at the lowest possible level
- Drug therapy: bronchodilators
- Monitor fluid balance
- Surgical ligation of PDA for infants that are difficult to wean
- Supportive care to relieve symptoms
- Minimize mean airway pressure
- Extubation can be done at ventilator rates between 5 and 15
- Avoid endotracheal CPAP
- Maintain ABG values PaO2= 55-70, PaCO2 45-60, pH 7.25 -7.40
Respiratory distress that begins 4-6 hrs after brith and produces symptoms similar to the early stages of IRDS
Transient Tachypnea of the Newborn/Type II RDS
Primary assessment of Transient Tachypnea of the Newborn/Type II RDS
- Past medical history: good APGAR score at brith then develops respiratory distress in next 12 hrs
- Cough: depressed effort, excessive secretions and mucus
- Appearance of the chest: intercostal retractions, nasal flaring
- Respiratory pattern: increased rate > 60/min
- Color: cyanosis
- Breath sounds: wheezes, rhonchi, crackles, expiratory grunting
- Vital signs: increased HR, BP, QT
Secondary assessment of Transient Tachypnea of the Newborn/Type II RDS
CXR
ABG
- Initially appears normal, sign of pulmonary congestion developed 12 hours after birth
- Patchy infiltrates
- Cardiomegaly and pleural effusion may be present
CXR findings in Transient Tachypnea of the Newborn/Type II RDS
Treatment and management for Transient Tachypnea of the Newborn/Type II RDS
- Support care to relieve symptoms
- Oxygen therapy
- CPAP to offset pulmonary congestion and interstitial edema
- Pulmonary hygiene
- -Increased bronchial hydration
- -Postural drainage and percussion
- -Suctioning
- Mechanical ventilation
Occurs when the diaphragm does not completely form.
Causes the abdominal contents to be in direct contact with the thoracic cavity
Congenital Diaphragmatic Hernia
Primary assessment of Congenital Diaphragmatic Hernia
Past medical history: respiratory distress at birth, may be detected on prenatal ultrasound
Appearance of the chest: intercostal and substernal retractions, nasal flaring, expiratory grunting
Respiratory pattern: increased > 60/min
Color: cyanosis
Breath sounds: Absent on affected side, bowel sounds on the affected side
Physical appearance: Scaphoid abdomen, barrel chest
Vital signs: increased HR, BP, QT
- Fluid and air filled loops of intestine in the chest
- Shift of the heart and mediastinum toward unaffected side
- Atelectasis and complete lung collapse
- Hypoplastic left lung
CXR findings in Congenital Diaphragmatic Hernia
Treatment and management of Congenital Diaphragmatic Hernia
- Always an emergency
- Prompt surgical repair is crucial
- Insert an oral gastric tube to decrease gas in the bowel
- Immediate oxygen therapy
- Place infant on affected side
- Do not ventilate with a mask
- May require intubation and mechanical ventilation
- -use low PIP <30 cmH2O and higher RR
- -High frequency ventilation
-ECMO for severe cases
