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Respiratory 2 > Neonatal Lung Diseases > Flashcards

Neonatal Lung Diseases Flashcards

1
Q

Neonatal respiratory distress syndrome is also known as…

A

Surfactant deficiency disorder

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2
Q

Neonatal respiratory distress syndrome

A

NRDS is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs.

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3
Q

Outline surfactant

A

Lipoprotein produced by type 2 pneumocytes.

Reduces surface tension in the alveoli preventing alveolar collapse.

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4
Q

What is the treatment for respiratory distress syndrome?

A

Treatment is to provide babies with the surfactant lipoprotein via a tracheal tube covering the lungs with surfactant.
Provide oxygen and IV fluid with antibiotics.

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5
Q

What are the two components of surfactant?

A

Hydrophillic component and a hydrophobic component.

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6
Q

What does the hydrophillic component of surfactant do?

A

Has a role in immunity.

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7
Q

What does the hydrophobic component of surfactant do?

A

Spreads surfactant across the lung surface.

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8
Q

What is the role of surfactant?

A

Reduces surface tension preventing alveolar collapse and increasing lung compliance.

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9
Q

How do the alveoli change in the alveolar stage of respiratory development?

A

1-2 years most alveoli are formed.

3-8 years alveoli increase in size.

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10
Q

How is amniotic fluid cleared from the babies lungs?

A
  1. During labour hormones such as catecholamines, ADH and thyroid hormones decrease secretion and increase absorption of ling fluid.
  2. The thoracic squeeze during delivery expels fluid and reduces lung volume.
  3. Post natal hydrostatic gradient within the lung.
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11
Q

What causes the onset of regular post natal breathing?

A
  1. Increased arousal and brainstem activity.
    - catecholamines
    - sensory input
  2. Umbilical cord occlusion.
  3. Increased arterial oxygenation.
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12
Q

What is the benefit of functional residual capacity?

A

Increases compliance and prevents alveolar collapse.

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13
Q

What are the heamodynamic changes that allow blood to flow to the lungs?

A

Fall in pulmonary vascular resistance.

Clamping of the umbilical cord increases systemic vascular resistance.

Increase in pulmonary bloodflow.

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14
Q

What is the normal respiratory rate of a baby at birth?

A

30-60 breaths per minute.

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15
Q

Pulmonary hypoplasia

A

Pulmonary hypoplasia is incomplete development of the lungs, resulting in an abnormally low number or size of bronchopulmonary segments or alveoli.

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16
Q

What can cause pulmonary hypoplasia?

A

Bilateral renal agenesis
Congenital diaphragmatic hernia
Oligohydraminos

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17
Q

Explain what bilateral renal agenesis and oligohydraminos are and how this causes pulmonary hypoplasia.

A

Bilateral renal agenesis aka Potter’s syndrome and Oligohydraminos results in a decreased lung fluid volume.

Oligohydraminos - prolonged rupture of membranes.

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18
Q

What are the signs and symptoms of pulmonary hypoplasia?

A

Prenatal: poor fetal movement, amniotic fl uid leakage, oligohydramnios.

Postnatal: asymptomatic/severe respiratory distress, apnea, cyanosis.

Small, bell-shaped chest; heart displacement; decreased/absent breath sounds

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19
Q

Congenital lobar emphysema

A

Congenital lobar emphysema is a rare respiratory disorder in which air can enter the lungs but cannot escape, causing overinflation (hyperinflation) of the lobes of the lung.

20
Q

What is the pathology of congenital lobar emphysema?

A

Abnormality of bronchial cartilage where the airway collapses on expiration leading to air trapping.

21
Q

What can congenital lobar emphysema lead to?

A

Left upper lobe / left lower lobe collapse.

22
Q

Congenital cystic adenomatoid malformation.

A

Congenital cystic adenomatoid malformation (CCAM) is a benign lung lesion that appears before birth as a cyst or mass in the chest. It is made up of abnormal lung tissue that does not function properly, but continues to grow.

23
Q

What is the treatment for congenital cystic adenomatoid malformation?

A

Can be small and asymptomatic needs monitoring and in some cases may need surgery.

24
Q

What is the treatment of congenital lobar emphysema?

A

Decompression / excision.

25
Q

What is a risk factor for respiratory distress syndrome?

A

Mother having diabetes.

Increased gestational age.

26
Q

What is classed as chronic lung disease?

A

Chronic lung disease is a general term for long-term breathing problems in premature babies.

Symptoms include having trouble breathing and needing oxygen after a premature baby reaches an adjusted age of 36 weeks’ gestation.

27
Q

What are some of the complication of prematurity?

A

Lungs may not have finished developing properly and there may not be sufficient surfactant production - NRDS.

28
Q

Bronchopulmonary dysplasia aka

A

Chronic lung disease

29
Q

What can cause bronchopulmonary dysplasia?

A 
Decreased number of alveoli.
Interstitial thickening.
Abnormal development of pulmonary vasculature.
Pulmonary oedema
Atelectasis
30
Q

Atelectasis

A

Collapse of lung tissue with loss of volume.

31
Q

How does a baby with bronchopulmonary dysplasia present?

A

Respiratory distress
Mild severe retractions and scattered rales may be audible.
Intermittent expiratory wheezing.

32
Q

How does bronchopulmonary dysplasia appear on a chest X-ray?

A

Diffuse haziness due to accumulation of exudative fluid.
Multicystic sponge like appearance.
Emphysema / pulmonary scarring.
Atelectasis and areas of gas trapping.

33
Q

What is the treatment of bronchopulmonary dysplasia?

A

Nutritional supplementation
O2 supplementation
Fluid restriction

34
Q

When does persistent pulmonary hypertension of the newborn occur?

A

When the pulmonary vascular resistance doesn’t decrease after birth.

35
Q

When the pulmonary vascular resistance doesn’t decrease after birth what does this result in?

A

Pulmonary left to right shunting through patent ductus arteriosus or patent foramen ovale.

36
Q

What can cause PPHN?

A 
Idiopathic
Secondary to neonatal pulmonary diseases:
Congenital diaphragmatic hernia
RDS
Meconium aspiration syndrome
37
Q

How does PPHN present in babies?

A

Tachypnea
Retraction
Severe cyanosis / Desaturation that is unresponsive to O2.

38
Q

How is PPHN diagnosed?

A

Echocardiogram

Pulse Oximetry

39
Q

What will pulse oximetry show on a baby with PPHN?

A

Difference >10% between the pre and post ductal O2 saturation.

40
Q

Where are the pulse oximeters placed to test for PPHN?

A

Right wrist - pre-ductal

Left leg - post-ductal

41
Q

Through what steps is breathing normally initiated in a baby?

A
  1. Cut umbilical cord.
  2. Baby takes a big breath.
  3. Fall in pulmonary vascular resistance.
  4. Rise in systemic vascular resistance.
  5. Oxygen goes to the lungs and then to blood.
42
Q

What is the treatment for PPHN?

A

O2 supplementation.
Vasodilatory agents - nitric oxide.
Give IV fluids and inotropes to increase systemic pressure.

43
Q

How does nitric oxide act?

A

Relaxes the endothelial smooth muscles and dilates the pulmonary arterioles increasing pulmonary blood flow and improving oxygenation.

44
Q

How does respiratory distress syndrome present on an X-ray?

A

Low lung volume.

Diffuse reticulogranular ground glass appearance.

45
Q

What are indicators for concern regarding respiratory problems in babies?

A 
Breaths per minute >60
Recession
Grunting
Nasal flaring
Tracheal tug
Structural abnormalities

Respiratory 2 (22 decks)

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