Neonate CxRs and Pathologies (Mod 4) Flashcards
What are common lines that would appear as artifact on a CxR?
- UAV and UVC
- Chest tube central lines
- ECG leads
- Temp. probe
- Transcutaneous monitor
Where is the diaphragm located on a CxR?
Around the 8th rib (on inspiration)
- 8th rib should be expanded on inspiration
Which view are CxRs normally used?
AP view will most likely be used
What should you keep in mind with a babes position on the CxR?
- hint disappearing fields on the CxR
Lordosis (anterior chest raised)
- can cause posterior lung field to disappear behind
- Obscures lower lung pathology
How do you address Lordosis when taking a CxR?
Warp up ucassette so infant doesn’t pull away
Overexposed penetration vs under exposed?
- Overexposed = Too dark
- Under expoed = Too light
Why are underexposed CxR’s mistaken for advancing pathologies?
Lung fields appear hazy
What do increased hilar densities indicate?
Increased pulmonary blood flow
What could (not definitive) levels of lucency on a CxR indicate?
Pneumothorax or PIE
(air where it shouldn’t be)
What could (not definitive) levels of density on a CxR indicate?
Atelectasis, effusion, pneumonia
What is Transient Tachypnea of the New Born (TTNB)
- symptoms/signs?
Retention of fetal lung fluid
- Common cause of respiratory distress in newborns
- clears in 24-48 hrs
How does Transient Tachypnea of the New Born (TTNB) present on a CxR?
- Fetal lung fluid
- Infiltrates in the hilar area (engorged veins and lymphatic vessels)
- Hyperaeration (increased Raw due to fluid in airways)
- Clears in 24-48 hrs
What is a sail sign?
Suggests left lower lobe collapse.
In children, however, a sail sign could be normal, reflecting the shadow of the thymus. The thymic sail sign or spinnaker-sail sign is due to elevation of the thymic lobes in the setting of pneumomediastinum.
- can be mistaken for pneumonia, heart border, upper lobe atelectasis
Why do infant heart shadows take up 60% of thoracic space?
Due to infants large thymus gland that adds to the heart shadow
- known as a sail sign
What can sometimes be mistaken advancing pathologies in preterm babes?
Hyperlucency (underexposed) can be mistaken for pathologies. They’re hyperlucent because their vessels are small and thin.
- Sail signs as well, but not restricted to premises
What are general features/presentations of RDS on a CxR?
- Reticulogranular (ground glass) appearance
- Lungs appear as a opaque white density (lack of aeration)
- Pleural fluid is usually absent (not an infectious process)
- Lung clearing occurs over a few days (apical and peripheral clear first, followed by central and basal areas)
What is the most common lung disease in premature neonates?
RDS
- usually presents before week 28
- surfactant issues and oxygenation issues are the usual hallmarks
- Ground glass, looks patchy, and diffuse throughout (uniformly bad)
What are hallmarks of Meconium Aspiration (MAS) on a CxR?
Date dependant, Take time to develops over 2/3ish days.
- look for air leak syndrome when you’re thinking about med on CxRs
- Need to look at Pt history
What are severe features of Meconium Aspiration on a CxR?
- aka how does MAS present?
- Bilateral infiltrates
- Air trapping
- Air leak syndromes (PIE, Pneumomediastnium, pneumothorax)
- Atelectasis
- Inflammation and edema (chemical infiltration via mec)
- pleural effusions
How does Pneumonia present on a CxR?
Variable pattern, difficult to distinguish
- diffuse lung markings
- may be pleural fluid present
- Looks like RDS
When can Pneumonia occur in neonates?
Before, during, or after birth.
What is the most common source of a pneumonia developing?
Group B Hemolytic Streptococcus
- complete white out on cxr
What are the hallmark signs of a Pneumothorax on a CxR?
- Lung displaced away from the chest wall by a dark band of air.
- Dark air space has no lung markings
- Border lungs may be a sharp white line
- Tension pneumothorax?
- Mediastinal shift to unaffected side
- depressed diaphragm on affected side
- widened intercostal spaces
- Rapid deterioration of neonate
How does a tension pneumothorax present on a CxR for a neonate?
- Depressed diaphragm on affected side
- widened intercostal spaces
- mediastinal shift to he unaffected side
- Rapid deterioration of neonate
How do Congenital Diaphragmatic Hernias (CDH) present on a CxR?
- Stomach and bowels are present in the chest
- mediastinal shift away from the affected side
- usually occurs in the left side (80-85%)
when do Congenital Diaphragmatic Hernia (CDH) occur in neonates?
May occur in uteri or at birth.
- in uteri causes hypoplastic lung
What is the golden standard to diagnose pneumothoraxs?
CxR.
- If there isn’t time, transilllumination of the chest can aid diagnosis
What is Transilliumination?
Aids in suspected pneumothorax Dx.
- Place a light (otoscope, tranilluminator) on infants chest, ensure it isn’t hot.
- A normal chest will have a small glowing “Halo” around the light source. Usually it extends less than 1 cm from the light source and is symmetric.
- If the chest “lights up like a jack-o-lantern” (large area of redness that is often asymmetric), then pneumothorax should be HIGH on differential diagnosis
Why is Transillimunation possible?
Neonates have thin skin.
How are Pneumothoraxes managed?
If asymptomatic, just observe.
- O2 therapy for small symptomatic pneumothorax
- Needle decompression (emergent)
- Chest tube (underwater seal and Heimlich valve)
What is the most common GI problem in the neonate to consider?
Necrotizing Enterocolitis (NEC)
- Most threatening GI emergency
What is Necrotizing Enterocolitis (NEC)?
Inflammation of the intestine leading to bacterial invasion causing cellular damage and death which causes necrosis of the colon and intestine.
- Ischemia
- Inflammation
- Enteral feeding (nutrition delivered using the gut)
- Infections
What is the snowball affect of Necrotizing Enterocolitis (NEC)?
Ischemia (lack of blood flow) leads to inflammation. Neonate will be a poor feeder and will be at risk of infections.
What is associated with Necrotizing Enterocolitis (NEC)?
Severe sepsis, intestinal perforation (hole), significant mortality
- blood found in stool
What does abdominal girth/distension indicate in a GI assessment?
Necrotizing Enterocolitis (NEC)
What do Bowel movements indicate in a GI assessment?
Meconium
What does a Residual/Aspirates diagnose?
Feeding tolerance and rate of digestion.
- performed before eating
- avoid overfeeding and underfeeding
- weight specific guidlines based on birth rate and gestational age
What does a Calorimetry diganose?
Resting Energy Expenditure (REE)
- Has a direct and indirect measure of REE
What does a Direct Calorimetry do?
Measure heat produced and lost by the body
What does a indirect calorimetry do?
Measured O2 consumption and CO2 production.
- Partial pressures inspired [control] vs exhaled [sample]
What interventions can be used for GI therapies?
- Feeding
- H2 blockers (decrease stomach acid production)
- Drains/colostomy
What are methods of Feeding for GI issues?
- Colostrum [antibodies and immunoglobulins] aka moms first milk
- Breast
- Bottle [EBM & formulas]
- Tube/gavage [EBM & formulas]
- Total Parenteral Nutrition [TPN]
What are 2 H2 blockers used for GI problems in neonates?
Ranitidine (zantac)
Cimetidine (Tagament)
How does Necrotizing Enterocolitis (NEC) present on a CxR?
Intestines’ are heavily outlined in the abdomen.
