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Final Review > Neonatal Pulmonary Diseases > Flashcards

Neonatal Pulmonary Diseases Flashcards

1
Q

Pneumonia

A

Bacterial or viral infection of the lungs

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2
Q

Pneumonia Categories

A
  • Early onset or perinatal
    • Occurring < 7 days of age
    • Can occur in association with amnionitis following PROM
    • Often associated with transplacental infection or prolonged delivery
  • Late-onset or post-natal
    • Occurring after 7 days of age.
    • Typically easier to treat with less sequella
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3
Q

Pneumonia Modes of Transmission

A

–Intrauterine (transplacental)

–Ascending vertical transmission (extrauterinetransmission, usually during labour

–Postnatal (nosocomial or community acquired)

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4
Q

Early Onset Pneumonia

Bacterial Causes

A
  • Bacterial
    • Group B streptococcus (GBS)
      • Found in vaginal and cervical area
      • Early onset from GBS may progress rapidly to shock or death
      • Mortality is 20%-50% regardless of treatment
    • E. Coli
      • Most common among VLBW infants
    • Listeria monocytogenes
    • Kelbsiella
    • Group D streptococci
    • Pneumococci
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5
Q

Early Onset Pneumonia

Group B streptococcus

A

Will clinically be very similar to RDS and we need a sputum analysis

Spread from maternal cervical and vaginal secretions

ROM >12 hours increases infection risk

Onset of symptoms occurs between hours to days

Occurs most often in low birth weights

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6
Q

Early Onset Pneumonia

Viral

A
  • TORCH Syndrome
    • Toxoplasmosis
    • Rubella
    • Cytomegalovirus
    • Herpes simplex virus
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7
Q

Late Onset Pneumonia

A

–Typically occurs after 7 days of age

–Commonly found in NICU where infants require prolonged intubation

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8
Q

Late Onset Pneumonia

Bacterial

A
  • Bacterial
    • Staphylococcus
    • Pseudomonas
    • Chlamydia trachomatis
    • E. Coli
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9
Q

Late Onset Pneumonia

Viral

A

Respiratory Syncytial Virus (RSV)

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10
Q

Late Onset Pneumonia

Fungi

A

Candidaalbicans

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11
Q

Pneumonia

Clinical Manifestations

A
  • Early onset
    • Lethargy
    • Poor feeding
    • Irritability
    • Cyanosis
    • Temp instability
  • Progressive Respiratory Distress
    • Tachypnea
    • Intercostal retractions
    • Grunting
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12
Q

Pneumonia

CXR

A

Patchy asymetrical densities

Hyperinfaltaion

Pleural effusion

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13
Q

Pneumonia

Diagnosis

A
  • Positive blood cultures (bacteria)
  • Virus: Possibly elevated serum antibodies
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14
Q

Pneumonia

Antibiotics for Early Onset

A

Ampicillin or Penicillin G + aminoglycoside

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15
Q

Pneumonia

Antibiotics for Late Onset

A

Nafcillin+ aminoglycoside

3rd generation cephalosporin

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16
Q

Pneumonia

Candida

A

Amphotericin B

17
Q

Pneumonia

Virus Medicine

A

Ribavirin

Acyclovir

18
Q

Pneumonia

Management (non-pharmacological)

A
  • Supportive therapies
  • Oxygen
  • Humidification
  • Bronchial Hygiene (coughing, suction in mechanically ventilated)
  • Mechanical ventilation
  • Physiotherapy
19
Q

Pulmonary Interstitial Emphysema (PIE)

A

Air Leak Syndrome- Increase air space distal to the terminal bronchioles.

Collection of gases outside of the normal air passages

Iatrogenic-We cause it as it is due to overdistention from mechanical or manual ventilation

Occurs almost exclusively in low birth weight infants

20
Q

PIE

Risk Factors

A

Prematurity (<32 weeks GA) due to immature lungs and decreased surfactant

VLBW (<1000g)- Inversely related to birth weight meaning the lower the weight the higher the risk

Resuscitation: PPV, Use of increased PIP, Vt, and Ti

Other Disease Processes: RDS, MAS, Amniotic fluid aspiration, Infection, Neonatal sepsis, Pneumonia , Pulmonary Hypoplasia

21
Q

Pulmonary Interstitial Emphysema (PIE)

Pathophysiology

A

The rupture of the small airways will allow airway into the connective tissue which will compress the vasculature which leads to decreased pulmonary perfusion, increased PVR, and R-L shunt

It can occur naturally when babies have very low surfactant

There will be an increased airway resistance due to the decrease in the lumen of the bronchioles

22
Q

Pulmonary Interstitial Emphysema (PIE)

CXR

A

The tiny black little dots are the PIE in the lungs

This disease is a mix of atelectasis and hyperinflation

23
Q

Pulmonary Interstitial Emphysema (PIE)

Clinical Manifestation

A

Progressive respiratory deterioration

Deteriorating ABG’s,

Decreased compliance

Increasing SOB

Increasing ventilatory requirements due to decreased compliance and increasing airway resistance

Disease course of mild PIE is approx. 5 days

Excess air continues to accumulation which can lead to the rupture of the mediastinum (pneumomediastinum) which is a very severe stage of the disease

There can also result in subcutaneous emphysema

24
Q

Pulmonary Interstitial Emphysema (PIE)

Management

A

Decrease barotrauma, minimal vent support and PPV

Prone positioning or positioning the affected side down

Selective intubation of “good” lung to rest affected lung

In severe cases-HFOV and pneumonectomy/lobectomy

25
Q

PIE Prevention

A

The best treatment for PIE is prevention

In the past this was very common now it is not common and is causethrough a severe case of another disease or mismanagement of the vent

We try to keep down PIP and Peak pressure in order to help prevent/worsen PIE

26
Q

PIE Prognosis

A

Poor if evident within 24 hours of birth.

The faster that someone develops PIE the less likely the chance of survival

27
Q

Pneumothorax

Pathophysiology

A

Occurs spontaneously due to high inspiratory effort or secondary to the use of positive pressure ventilation

Rupture of alveoli allowing air leak causes air accumulation in the pleural space this may be asymptomatic or symptomatic

Symptomatic - enough air leak to cause respiratory distress

If the air accumulation is large enough and under pressure = a tension pneumothorax = can be life-threatening

PIE can lea to a pneumothorax

28
Q

Pneumothorax

Primary and Secondary

A

Primary-When there is no underlying disease

Secondary- Caused by an underlying disease

29
Q

Pneumothorax

Spontaneous Pneumothorax

A

Neonates with spontaneous pneumothorax tend to be asymptomatic and they tend to be small and may only need a small amount of oxygen. The problem is when they develop there is a chance that the pneumothorax can get bigger

30
Q

Pneumothorax

Clinical Manifestations

A
  • •Ranges depending on severity –asymptomatic to respiratory distress with:
  • Cyanosis,
  • Hypoxia,
  • Tachypnea,
  • Grunting-Kin to pursed lip breathing and will increase FRC
  • Asymmetrical chest
  • Decreased breath sounds on the affected side
  • A shift of the mediastinum away from the affected side
    • Breath sounds will also be decreased on the affected side
  • Remember that even a significant pneumothorax may not be detectable with auscultation
31
Q

Pneumothorax

Diagnosis

A

CXR-Large left pneumothorax appears black and outlines the partially collapsed left lung and left cardiac border (arrow).

Transluminationis a quick way to identify a pneumothorax without a chest x ray

One of the main problem with PIE is that they will have a decrease SA for gas exchange and also when it heals it can lead to fibrosis

If you have a left penumoyour mediastinum will pull to the other side

If you have ataelctasisyou mediastinum will pull to the affected side

32
Q

Pneumothorax

Management

A
  • In spontaneous breathing infant with a small pneumothorax – observe or consider 100% oxygen (wash out nitrogen) –
    • Not really used anymore and is controversial (wash out nitrogen
  • Consider observation if infant is premature to prevent oxygen toxicity/RDS/ROP
  • Patient in severe respiratory distress requiring ventilation will most likely need chest tube or needle aspiration
  • Needle aspiration - mid-clavicular line above the third rib with angiocathto immediately evacuate air
33
Q

Pneumothorax

Prognosis

A

Good with intervention

34
Q

What are the Pre-Term (<35 week) pathologies

A

RDS

BPD

35
Q

Pre Term (>35 Weeks) Pathologies

A

ACP

Pneumonia

36
Q

Term (40 Weeks) Disorders

A

TTN (C-Section)

PPHN

MAS

Pneumonia

37
Q

Congenital Abnormalities

Typically Term

A

CDH

Tracheoesophageal Fistula

Pierre Robin

Choanal Atresia

Tracheomalacia/Stenosis

38
Q

Air Leak Syndrome

A

PIE

Pneumothorax

Final Review (27 decks)

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