Neonatal Disorders

Question 1

Problems related to prematurity

Answer 1

• Temperature Regulation
• Infection
• Feeding
• Hypoglycaemia
• Apnoea
• Jaundice

Question 2

Complications of prematurity

Answer 2

Necrotising enterocolitis

• Patent ductus arteriosus
• Retinopathy of prematurity
• Damage dt immature CNS

Question 3

Respiratory stress syndrome causes

Answer 3

Due to surfactant deficiency of abnormality
•Usually due to prematurity
•Surfactant abnormality may be seen in babies born to diabetic mothers and those who have rhesus isoimmunisation.
•Elective caesarian exacerbates the condition.

Question 4

Presentation RDS

Answer 4

• Increased WOB
• Signs of respiratory distress.
• X-ray diffuse symmetrical reticular granular pattern with air bronchograms.
• Clinical signs present from 4 hours after delivery.
• Regardless of prematurity surfactant will be produced at 48 hrs post delivery, the condition is therefore self limiting as long as secondary

Question 5

Treatment of RDS

Answer 5

Supportive
•Exogenous surfactant
•Antibiotics

Prevention
•Beta-2 stimulants to mother if premature labour is expected (amonophylline, steroids, thyroxin and thyrotropic releasing hormone)
•Exogenous surfactant given to the baby at birth.

Question 6

Chronic lung Disease

Answer 6

Infants who are still oxygen dependent at one month are defined as having neonatal chronic lung disease (CLD I). A small proportion of these have cystic changes on x-ray and they are classified as having bronchopulmonary dysplasia (CLD II).
•Those with BPD remain oxygen dependent for many months and often require home oxygen

Question 7

Causes of CLD

Answer 7

Multi-factorial and includes prematurity, genetic predisposition and low antioxidant status.
•High inspired oxygen concentrations and ventilation at high pressures increase risk.
•Also associated with development of a PDA as well as with cytomegalovirus.

Question 8

CLD

Answer 8

Prevention
•High frequency oscillation ventilation may be helpful.

Management
•Wean infants ASAP
•Nebulise with caution as often get paradoxical deterioration in lung function with deoxygenation prior to bronchodilation. A metered dose inhaler with a spacer does not

Question 9

Physio mx of neonate

Answer 9

MINIMAL HANDLING
• No routine therapy
•Assess each infant individually
• Retention of secretions and lobar collapse due to plugging are the main indications for chest physio.

Question 10

Indications of PT

Answer 10

Meconium aspiration

• Aspiration of feed or vomit
• Chronic lung disease
• Postoperatively

Question 11

CI PHYSIO

Answer 11

• Unstable infant
• Pulmonary haemorrhage
• Respiratory distress syndrome

Question 12

Physiotherapy techniques

Answer 12

Positioning and postural drainage
•Percussion and vibration
•Manual hyperinflation
•Suction
•Saline installation