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OBG: Oncology and neonatalology > Neonatal respiratory problems > Flashcards

Neonatal respiratory problems Flashcards

1
Q

What are 6 signs of respiratory distress in newborn infants?

A
  1. Tachypnoea (>60 RR)
  2. Laboured breathing
  3. Chest wall recession (particularly sternal and subcostal indrawing)
  4. Nasal flaring
  5. Expiratory grunting
  6. Cyanosis if severe
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2
Q

What is the definition of tachypnoea in a neonate?

A

>60 bpm

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3
Q

What is the commonest cause of respiratory distress in term infants?

A

transient tachypnoea of the newborn

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4
Q

What are 2 groups of causing of respiratory distress in term infants?

A
  1. Pulmonary
  2. Non-pulmonary
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5
Q

What are 7 pulmonary causes of respiratory distress in term infants?

A
  1. Transient tachypnoea of the newborn
  2. Meconium aspiration
  3. Pneumonia
  4. Respiratory distress syndrome
  5. Pneumothorax
  6. Persistent pulmonary hypertension of the newborn
  7. Milk aspiration
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6
Q

What are 5 rare causes of respiratory distress in term infants?

A
  1. Diaphragmatic hernia
  2. Tracheo-oesophageal fistula
  3. Pulmonary hypoplasia
  4. Airways obstruction e.g. choanal atresia
  5. Pulmonary haemorrhage
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7
Q

What are 4 non-pulmonary causes of respiratory distress in term infants?

A
  1. Congenital heart disease
  2. Hypoxic-ischaemic/ neonatal encephalopathy
  3. Severe anaemia
  4. Metabolic acidosis
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8
Q

What are 5 investigations that must be performed on all newborn infants with respiratory distress?

A
  1. Monitor heart rate
  2. Monitor respiratory rate
  3. Monitor oxygenation
  4. Monitor circulation
  5. Chest x-ray - to help identify cause needing immediate treatment e.g. pneumothorax or diaphragmatic hernia
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9
Q

What is the management of all infants with respiratory distress?

A
  1. Admit to neonatal unit
  2. Additional ambient oxygne, respiratory support as required
    • non-invasive: CPAP or high-flow nasal cannula therapy
    • mechanical ventilation and circulatory support
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10
Q

What causes transient tachypnoea of the newborn?

A

delay in the resorption of lung liquid

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11
Q

What factor increases the likelihood of transient tachypnoea of the newborn?

A

caesarean section

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12
Q

What are 2 types of causes of respiratory distress in neonates that can be identified by x-ray and require immediate treatment?

A
  1. Pneumothorax
  2. Diaphragmatic hernia
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13
Q

What may be seen on the chest x-ray in transient tachypnoea of the newborn?

A

fluid in the horizontal fissure

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14
Q

What management of transient tachypnoea of the newborn may be required?

A

additional ambient oxygen

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15
Q

What is the usual outcome of transient tachypnoea of the newborn?

A

usually settles wtihin first day of life, can take several days to resolve completely

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16
Q

How is a diagnosis of transient tachypnoea of the newborn made?

A

after consideration and exclusion of other causes such as infection

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17
Q

In what proportion of babies is meconium passed before birth?

A

8-20% (rarely by preterm infants)

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18
Q

What increases the likelihood of passing meconium before birth?

A

greater gestational age (20-25% by 42 weeks)

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19
Q

What can trigger the passing of meconium?

A

may be passed in response to fetal hypoxia

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20
Q

How does aspiration of meconium come about?

A

asphyxiated infants may start gasping and aspirate meconium before or at delivery

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21
Q

What are 3 effects of meconium aspiration?

A
  1. Mechanical obstruction
  2. Chemical pneumonitis - irritant to the lungs
  3. Predisposes to infection
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22
Q

What are 3 things that may be seen on chest x-ray in meconium aspiration?

A
  1. Overinflation of lungs
  2. Patches of collapse and consolidation
  3. High incidence of air leak, leading to pneumothorax and pneumomediastinum
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23
Q

What management of meconium aspiration is often required?

A

Mechanical ventilation

24
Q

What complication can develop as a result of meconium aspiration?

A

persistent pulmonary hypertension of the newborn

25
Q

What difficulty can persistent pulmonary hypertension lead to in the management of a newborn with meconium aspiration?

A

may make it difficult to achieve adequate oxygenation despite high-pressure ventilation

26
Q

How serious is meconium aspiration?

A

serious - associated with significant morbidity and mortality

27
Q

How effective is aspiration of meconium from an infant’s oropharynx immediately after delivery of head/ removal by intubation+ tracheal suctioning in meconium aspiration?

A

no evidence that it reduces incidence or severity of meconium aspiration

28
Q

What are 3 factors which predispose to pneumonia in the neonate?

A
  1. Prolonged rupture of membranes
  2. Chorioamnionitis
  3. Low birthweight
29
Q

What is the usual investigation to identify any infection as a cause of respiratory distress in the newborn?

A

CXR, blood cultures

30
Q

What is the management of pneumonia in the newborn?

A

broad-spectrum antibiotics until results of infection screen are available

31
Q

In what proportion of deliveries may a pneumothorax occur spontaneously?

A

2%

32
Q

What symptoms can pneumothorax produce?

A

usually asymptomatic but can cause respiratory distress

33
Q

What are 4 causes of pneumothorax in the newborn?

A
  1. Spontaneous
  2. Meconium aspiration
  3. Respiratory distress syndrome
  4. Complication of mechanical ventilation
34
Q

What is the management of pneumothorax?

A

tension pneumothorax treated urgently with decompression by inserting chest drain

35
Q

What are 2 ways to confirm the diagnosis of pneumothorax?

A
  1. Transillumination with bright fibre-optic light source applied to the chest wall
  2. Chest x-ray
36
Q

What are 5 risk factors for milk aspiration in the newborn, causing respiratory distress?

A
  1. Preterm infants
  2. Respiratory distress
  3. Neurological damage
  4. Bronchopulmonary dysplasia - often have GORD which predisposes to aspiration
  5. Cleft palate
37
Q

What are 4 conditions that can predipose to persistent pulmonary hypertension of the newborn?

A
  1. Birth asphyxia
  2. Meconium aspiration
  3. Sepsis
  4. RDS
  5. Sometimes occurs as primary disorder
38
Q

What happens in persistent pulmonary hypertension of the newborn?

A
  • as a result of high pulmonary vascular resistance, there is right-to-left shunting within the lungs and at atrial and ductal levels
39
Q

What are 2 features of presentation of persistent pulmonary hypertension of the newborn?

A
  1. Cyanosis soon after birth
  2. Heart murmurs and signs of heart failure often absent
40
Q

What are 2 investigations required for persistent pulmonary hypertension and what will they show?

A
  1. Chest x-ray: normal size heart, pulmonary oligaemia
  2. Urgent echocardiogram: exclude congenital heart disease, identify signs of pulmonary hypertension: raised pulmonary pressures, tricuspid regurgitation
41
Q

What are 2 signs of persistent pulmonary hypertension of the newborn on the echo?

A
  1. Raised pulmonary pressures
  2. Tricuspid regurgitation
42
Q

What are 6 treatment aspects for persistent pulmonary hypertension?

A
  1. Mechanical ventilation
  2. Circulatory support
  3. Inhaled nitric oxide - potent vasodilator
  4. Sildenafil (Viagra) - vasodilator
  5. High-frequency or oscillatory ventilaion
  6. Extracorporeal membrane oxygenation (ECMO)
43
Q

When is ECMO indicated for persistent pulmonary hypertension?

A

severe but reversible cases, but only performed in a few specialist centres

44
Q

What does extra-corporeal membrane oxygenation (ECMO) involve?

A

infant placed on heart and lung bypass for several days

45
Q

How are many diaphragmatic hernias diagnosed?

A

antenatal ultrasound screening

46
Q

What are 2 ways that diaphragmatic herniation may present?

A
  1. Respiratory distress
  2. Failure to respond to resuscitation
47
Q

What happens anatomically in most cases of diaphragmatic herniae?

A

left-sided herniation of abdominal contents through the posterolateral foramen of the diaphragm

48
Q

On examination what are 3 signs of diaphragmatic hernia?

A
  1. Displaced apex beat to right of chest
  2. Displaced heart sounds to right of chest
  3. Poor air entry in left chest
49
Q

What can vigorous resuscitation for diaphragmatic hernias result in and why?

A

can result in a pneumothorax and worsening of situation

50
Q

How is diagnosis of diaphragmatic hernia confirmed and what will it show?

A

chest x-ray: loops of bowel in the left chest and displacement of the mediastinum.

51
Q

What are 4 aspects of management of a diaphragmatic hernia?

A
  1. Once diagnosis suspeced, large NG tube passed, apply suction to prevent distension of intrathoracic bowel
  2. Repaired surgically after stabilisation
52
Q

What is the main problem associated with a diaphragmatic hernia in most infants?

A

pulmonary hypoplasia due to compression by herniated viscera preventing development of lung in fetus

53
Q

What causes mortality from diaphragmatic hernia to be high?

A

hypoplastic lungs

54
Q

What are 2 signs that heart failure is the cause of respiratory distress in the newborn?

A
  1. abnormal heart sounds and/or heart murmurs
  2. enlarged liver from venous congestion
55
Q

What physical sign on examination must you look for in every infant with respiratory distress and why?

A

Femoral pulses: coarctation of aorta and interrupted aortic arch are important causes of heart failure in newborn infants

OBG: Oncology and neonatalology (14 decks)

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