Neonatal Respiratory Distress Flashcards
Which delivery method, vaginal or c-section, is more likely to result in transient tachypnea?
C-section
What are the major constituents of surfactant? Where is surfactant stored?
Lecithin, sphingomyelin, cholesterol
What factors predispose to RDS?
Male sex, Caucasian, fetal distress/asphyxia, c-section, 2nd born twin, IDM, Fh/o newborn RDS
What testing can be use to predict which infants are susceptible to developing RDS?
Lecithin/spingomyelin ratio to determine lung maturity.
Describe the treatment of RDS.
CPAP 5-8 mmHg to maintain PaO2 >50, antenatal corticosteroids recommended at 23-34W GA
Which infants are candidates for surfactant therapy?
Requires FiO2 >30% to maintain PaO2 >80 mmHg.
Which disorder should you consider if the infant appears to have very labile oxygen requirements?
Persistent pulmonary hypertension of the newborn (PPHN)
Pulmonary vascular resistance frequently oscillates
What are the common etiologies that cause PPHN?
Mec aspiration, pulmonary infections, birth asphyxia, sepsis, pulmonary hypoplasia, hypoglycemia, hypothermia, RDS, congenital diaphragmatic hernia, hyperviscosity/polycythemia, maternal use of NSAIDs or SSRIs
Describe some treatment measures for PPHN.
Largely supportive
Direct treatment of underlying etiology
Environmental interventions: minimize cold stress, bright light, and loud noises
Inhaled nitric oxide - monitor for methemoglobinemia
Is apnea of prematurity a risk factor for SIDS?
No
Describe delivery room management of meconium aspiration.
Clear secretions using a bulb syringe or large-bore suction catheter followed by routine NRP (dry, stim, oxygen PRN)
What are the presenting signs of meconium aspiration syndrome?
Presents as respiratory distress shortly after delivery - tachypnea, intercostal retractions, end-expiratory grunting, and frequently cyanosis
Describe the findings on CXR for a pneumothorax.
Intrathoracic structures will be shifted toward the HEALTHY side and away from pneumothorax. Diaphragm on affected side is displaced downward; a right sided PTX often causes the liver to be displaced downward.
What is the treatment for a pneumothorax in an asymptomatic infant?
Conservative management; observe and repeat CDXR to monitor improvement
What should you do if a tension pneumothorax persists after needle decompression and the infant is still hypoxic?
Chest tube insertion
True or False? Most cases of penumomediastinum require intervention.
False, unless signs for cardiopulmonary compromise.
What 2 interventions help prevent BPD from developing?
- Delaying premature birth past 30 weeks of gestation
- Giving antenatal corticosteroid therapy to any woman 23-34 weeks who is at risk fo premature delivery within the next week to advance fetal lung development
What is the cornerstone of therapy for BPD?
Oxygen
Which diuretic is effective in improving BPD symptoms?
Furosemide: improves lung mechanics and gas exchange, usually given to children with primary respiratory acidosis and renal compensation.
Are systemic corticosteroids typically recommended for BPD therapy?
No, potential benefit is not justified due to many adverse effects.
Why is palivizumab (Synagis) recommended for infants with BPD?
Infants with BPD are increase risk of serious complications from RSV infections. Synagis has been shown to reduce incidence of hospitalization from RSV bronchiolitis.
An infant presents with a continuous murmur and bounding peripheral pulses. What cardiac condition should you suspect?
Persistent Ductus Arteriosus (PDA)
What are the contraindications for indomethacin or ibuprofen use in the neonate with PDA?
NEC, serum creatinine >1.6 mg/dL, hourly urine output <1ml/kg, bleeding diathesis, platelet count <50K
