Neonatal Respiratory Distress

Question 1

Reassuring APGAR at 1 and 5 minutes

Answer 1

7 at 1 min, 9 at 5 min

Question 2

Caput succedaneum

Answer 2

Diffuse swelling that crosses suture lines caused by head pushing through canal. Resolves in a few days

Question 3

Cephalohematoma

Answer 3

Subperiosteal hemorrhage, no suture line crossing. Can be associated with skull fracture – get CT or XR if traumatic birth
Takes weeks to months to resolve

Question 4

Umbilical cord anatomy and implications of it being abnormal

Answer 4

Normal – 2 arteries and 1 vein

One artery may indicate renal malformation – get renal u/s

Question 5

Importance of vitamin K supplementation

Answer 5

Vit K required for clotting factors 10, 9, 7, 2, protein C and protein S

Does not cross the placenta and breast milk is low in Vit K

Given to all babies IM to prevent hemorrhagic disease of the newborn. – umbilical stump, mucous membranes, GI tract, circumcision or venipuncture sites

Produced invitro in the gut

Question 6

Respiratory distress syndrome of the newborn

Answer 6

Due to surfactant deficiency – immature type 2 pneumocytes
	Premie 24-37 weeks, more work to breath
	Low lung volumes and atelectasis
S/S:
Tachypnea >60
Nasal flaring
Expiratory grunting
Intercostal retractions
Hypoxia
Crackles
Decreased breath sounds

A lecithin/sphingomyelin ratio 2 or more suggests fetal lung maturity (amniotic fluid test)

XR shows low lung volumes with diffuse hazy interstitial infiltrates “ground glass” with bronchograms

Prevent by giving IM corticosteroids (IM betamethasone) for labor prior to 34 weeks – 24-48 hr prior to delivery

Tx: CPAP for all babies
If week resp drive or FiO2 > 0.4 then intubate and give exogenous surfactant via ETT

Question 7

Neonatal conjunctivitis

Answer 7

Ppx erythromycin ointment for GC ppx within 1 hr

Tx with PO erythromycin

Risk blindness if untreated

Question 8

Transient tachypnea of newborn

Answer 8

Increased RR resolves in 24-48 hours
Due to retained lung fluid
MC in C/S w/o labor
Tx: supplemental O2

XR: increased lung volumes, flat diaphragms, prominent vascular markings
-Sunburst hilum
-Fluid streaking
+/- pleural effusion

Question 9

Meconium aspiration syndrome

Answer 9

High risk of postmature infants and in fetal destress during labor -> intestinal contraction

No intrapartum suction (head on perineum)
No suction on vigorous infant
Suction on non-vigorous infants (depressed respiration, decreased tone, HR less than 100) with direct visualization

O2 prn
Intubation for respiratory distress
Empiric abx for pna or sepsis

PE:
Meconium staining of skin
Tachypnea
Intercostal retraction
Distended chest
Hypoxia/cyanosis

CXR: streaky linear densities, hyperinflation with flat diaphragm

Complications:
-PTX, PH, increased risk of reactive airway disease (asthma)

Question 10

Congenital diaphragmatic hernia

Answer 10

Contents of abdomen protrude into chest resulting in pulmonary hypoplasia

Presentation: respiratory distress, barrel chest, and scaphoid-appearing abdomen

50% will have chromosomal abnlities, congenital heart disease, or neural tube defects

Identified on prenatal U/S
XR – abd contents in chest

Tx: immediate intubation and respiratory support
Immediate sx correction