Neonatal Respiratory Distress

Question 1

Which delivery method, vaginal or c-section, is more likely to result in transient tachypnea?

Answer 1

C-section

Question 2

What are the major constituents of surfactant? Where is surfactant stored?

Answer 2

Lecithin, sphingomyelin, cholesterol

Question 3

What factors predispose to RDS?

Answer 3

Male sex, Caucasian, fetal distress/asphyxia, c-section, 2nd born twin, IDM, Fh/o newborn RDS

Question 4

What testing can be use to predict which infants are susceptible to developing RDS?

Answer 4

Lecithin/spingomyelin ratio to determine lung maturity.

Question 5

Describe the treatment of RDS.

Answer 5

CPAP 5-8 mmHg to maintain PaO2 >50, antenatal corticosteroids recommended at 23-34W GA

Question 6

Which infants are candidates for surfactant therapy?

Answer 6

Requires FiO2 >30% to maintain PaO2 >80 mmHg.

Question 7

Which disorder should you consider if the infant appears to have very labile oxygen requirements?

Answer 7

Persistent pulmonary hypertension of the newborn (PPHN)

Pulmonary vascular resistance frequently oscillates

Question 8

What are the common etiologies that cause PPHN?

Answer 8

Mec aspiration, pulmonary infections, birth asphyxia, sepsis, pulmonary hypoplasia, hypoglycemia, hypothermia, RDS, congenital diaphragmatic hernia, hyperviscosity/polycythemia, maternal use of NSAIDs or SSRIs

Question 9

Describe some treatment measures for PPHN.

Answer 9

Largely supportive

Direct treatment of underlying etiology

Environmental interventions: minimize cold stress, bright light, and loud noises

Inhaled nitric oxide - monitor for methemoglobinemia

Question 10

Is apnea of prematurity a risk factor for SIDS?

Answer 10

No

Question 11

Describe delivery room management of meconium aspiration.

Answer 11

Clear secretions using a bulb syringe or large-bore suction catheter followed by routine NRP (dry, stim, oxygen PRN)

Question 12

What are the presenting signs of meconium aspiration syndrome?

Answer 12

Presents as respiratory distress shortly after delivery - tachypnea, intercostal retractions, end-expiratory grunting, and frequently cyanosis

Question 13

Describe the findings on CXR for a pneumothorax.

Answer 13

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.

Question 14

What is the treatment for a pneumothorax in an asymptomatic infant?

Answer 14

Conservative management; observe and repeat CDXR to monitor improvement

Question 15

What should you do if a tension pneumothorax persists after needle decompression and the infant is still hypoxic?

Answer 15

Chest tube insertion

Question 16

True or False? Most cases of penumomediastinum require intervention.

Answer 16

False, unless signs for cardiopulmonary compromise.

Question 17

What 2 interventions help prevent BPD from developing?

Answer 17

1. Delaying premature birth past 30 weeks of gestation
2. 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

Question 18

What is the cornerstone of therapy for BPD?

Answer 18

Oxygen

Question 19

Which diuretic is effective in improving BPD symptoms?

Answer 19

Furosemide: improves lung mechanics and gas exchange, usually given to children with primary respiratory acidosis and renal compensation.

Question 20

Are systemic corticosteroids typically recommended for BPD therapy?

Answer 20

No, potential benefit is not justified due to many adverse effects.

Question 21

Why is palivizumab (Synagis) recommended for infants with BPD?

Answer 21

Infants with BPD are increase risk of serious complications from RSV infections. Synagis has been shown to reduce incidence of hospitalization from RSV bronchiolitis.

Question 22

An infant presents with a continuous murmur and bounding peripheral pulses. What cardiac condition should you suspect?

Answer 22

Persistent Ductus Arteriosus (PDA)

Question 23

What are the contraindications for indomethacin or ibuprofen use in the neonate with PDA?

Answer 23

NEC, serum creatinine >1.6 mg/dL, hourly urine output <1ml/kg, bleeding diathesis, platelet count <50K