Neonatal Respiratory Diseases

Question 1

What are signs of resp. distress in a neonate?

Answer 1

• RR >60
• Laboured breathing
• Chest wall recessions
• Nasal flaring
• Expiratory grunting (PAP)
• Cyanosis (if severe)

Question 2

What is Transient Tachypnoea of the Neonate?

Answer 2

• Commonest cause of resp. distress in term infants
• Caused by delay in resorption of lung fluid
• More common in C-sections, possibly due to lung fluid not being squeezed out during passage through birth canal)

Question 3

Investigations for TTS?

Answer 3

CXR = hyperinflation of lungs + fluid in horizontal fissure

Diagnosis made after excluding other causes

Question 4

Management of TTS?

Answer 4

• Usually settles within 1st day of life
• Supportive therapy - O2 through hood/nasal cannula - maintain sats >90%
• Maintain neutral thermal environment
• Provide nutrition
  
  • If resp rate 60-80, use NG tube or TPN
• If tachypnoea persists >4-6hrs, begin antibiotics (Ampicillin + Gentamicin)

Question 5

What is Persistent Pulmonary Hypertension?

Answer 5

• Life threatening
• Result of high pulmonary vascular resistance
• Associated with birth asphyxia, meconium aspiration, septicaemia, RDS
• Sx = Cyanosis after birth, absent heart murmurs, signs of HF

Question 6

Investigations for PPH?

Answer 6

• CXR = Normal size heart but some pulmonary oligaemia
• URGENT ECHO to ensure no cardiac defect

Question 7

Management of PPH?

Answer 7

• Oxygen
  
  • Maintain relatively high pO2 (10-13kPa in >34wks infants
• Intubate + Ventilate
  
  • Consider sedation/paralysis to optimise ventilation
• High-frequency oscillatory ventilation
  
  • If oxygenation still problematic despite ventilation
• Surfactant (consider for lung inflation)
• Treat underlying cause
• Suction of secretions from ETT
• Fluids + Inotropes to optimise cardiac output
• Inhaled NO
  
  • If FiO2 requirements remain high

Question 8

Prognosis of PPH?

Answer 8

Mortality <10%

25% likely to have some impairment (learning difficulties, deafness)

Question 9

What is Chronic Lung Disease of Prematurity? (CLD)

Answer 9

• Occurs when infection, barotrauma, iatrogenic injury causes chronic lung problems
  
  • Bronchopulmonary Dysplasia (BPD) is the worse end of the spectrum
• More common in premature babies
• Higher risk in LBW or low GA
• Lung damage due to pressure/volume trauma from mechanical ventilation, O2 toxicity, infection
• Often defined by O2 dependence at ≤36wks

Question 10

Signs/Sx of CLD?

Answer 10

• Typically 23-26wks progresses from ventilation -> CPAP -> supplementary O2
• Increase in O2 and ventilatory requirements in first 2wks of life
• Signs of resp. distress, poor feeding, poor weight gain

Question 11

Investigations for CLD?

Answer 11

CXR -> Widespread opacification

CBG/VBG -> Acidosis, hypercapnia, hypoxia

Question 12

Management of CLD

Answer 12

• Prophylaxis = Corticosteroids for women in suspected/diagnosed/established preterm labour

Question 13

What is Respiratory Distress Syndrome?

Answer 13

• Surfactant deficiency
• Common if born <28wks
  
  • 50% born 26-28wks
  • 25% born 30-31wks
• RFs:
  
  • Male
  • DM mums (due to delayed lung maturation)
  • C section
  • 2nd-born of premature twins
• Signs/Sx
  
  • High RR >60
  • Laboured breathing with recessions + nasal flaring
  • Expiratory grunting
  • Cyanosis (severe cases)

Question 14

Investigations for RDS?

Answer 14

• Clinical diagnosis
• Pulse ox
• CXR
  
  • Pneumothorax
  • Ground-glass appearance
  • Indistinct heart border

Question 15

Management of RDS?

Answer 15

If delivery expected <34w - IM betamethasone

Postnatally:

• O2 + ventilation
• CPAP ± exogenous surfactant
• Mechanical ventilation, high-flow humidified O2 therapy