Neonatal Respiratory Distress Flashcards
What are the manifestations of neonatal respiratory distress?
- Tachypnoea
- Nasal falring
- Inter/subcostal retractions
- Grunting
- Cyanosis
What are the common respiratory disorders of perinatal transition?
- TTN
- RDS
- PPHN
What is PPHN?
Persistent pulmonary hypertension of the newborn
What are the changes that occur to allow transition from foetal to neonatal life?
- Alveolar fluid replaced with air
- Onset of regular breathing
- Increase in pulmonary blood flow as increased SVR and decreased PVR
What is the pathophysiology of TTN?
- Failure of adequate fluid clearance= excess lung liquid
- Moves interstitially until cleared by lymph
= decreased pulmonary compliance
What is RDS?
Deficient surfactant; infant unable to generate pressure required to maintain alveolar inflation. Progressive diffuse atelectasis results
What is the primary cause of hypoxemia in RDS?
- VQ mismatch secondary to blood shunting away from areas of atelectasis
- R to L shunt through PDA and PFO due to increased PVR
What is the pathophysiology PPHN?
Abnormal persistence of elevated PVR producing R to L shunting of deoxygenated blood through PFO and PDA
Major feature of infants with RDS?
Preterm
Typical signs of RDS?
- Grunting
- Nasal flaring
- Intercostal / subcostal retraction
What is the purpose of grunting?
Prevents end expiratory alveolar collapse
Which infants are most at risk of PPHN?
Term infants (PLUS - mec fluid - IUGR - nrCTG suggesting chronic uteroplacental insufficiency)
Characteristics of PPHN?
- tachypnoea
- cyanosis
- differentail pre and post ductal saturation
Associations with PPHN?
- Sepsis
- Mec asp
- CDH
Infants at greatest risk of TTN?
Late preterm infant post cesarean without labour
