neonates, resp Flashcards
What is a neonate by definition?
0-28 DAYS OLD
What score do we use to assess neonates?
APGAR
When is the APGAR Score done?
1, 5 and 10 mins post birth
What does APGAR stand for?
Appearance
-pale, cyanotic
Pulse
->100 good, <100 ok
Grimace
-sneeze, cough, cry good, grimace ok, no response bad
Activity
-active good, flexed A+L ok, absent bad
RR
-crying good, gasping + irregular ok
what do the APGAR scores mean?
0-4 = bad
5-6 = not amazing
7-10 = good
what will many neonates not have an APGAR score of 10?
Most kids are acrocyanotic (cyanosis of peripheries) at birth
what is given to all neonates one off and why?
Vit K IM injection as there’s no vitamin K in breastmilk
What 2 other tests are done within 72 hrs of birth?
NIPE (done after 34+0)
Otoacoustic emission testing
name 4 neonatal respiratory syndromes?
respiratory distress syndrome (NRDS)
Bronchopulmonary dysplasia (BPD)
Transient tachypnoea of newborn (TTON)
Meconium aspiration syndrome (MAS)
What is respiratory distress syndrome?
when does it usually occur?
what is it caused by?
<24hrs post birth
Atelectasis (collapse of part/all lung) due to low production of surfactant = high alveolar surface tension + collapse = Resp distress!!!
In premature baby, C section, maternal DM
When is surfactant produced?
26wks - 35 weeks (sufficient)
Sx of Resp distress syndrome?
resp distress Sx
laboured rapid breathing
cyanosis
indrawing chest wall
Dx of resp distress syndrome?
Chest xray - ground glass reticular
Tx prenatal and post natal for resp distress syndrome?
pre = maternal corticosteroids
post = surfactant (through endotracheal intubation), CPAP + O2
What are 2 complications of resp distress syndrome?
traumatic pneumothorax (with high O2/CPAP)
Bronchopulmonary dysplasia
What is bronchopulmonary dysplasia? (BPD)
What is it caused by?
Re perfusion injury due to chronic high flow O2 >4 weeks (used due to chronic lung disease) - alveolar septal injury
Prematurity
Sx of bronchopulmonary dysplasia?
Chronic resp distress Sx, recurrent chest infection, poor feed
Dx of bronchopulmonary dysplasia?
CXR = widespread opacity
Tx for bronchopulmonary dysplasia?
Vit A for 7 days postnatal + IV caffeine, CPAP, Consider IM palivizumab monthly (RSV)
What is the MC cause of resp distress neonatally in full term babies?
transient tachypnoea of newborn (TTON)
What is transient tachypnoea of newborn (TTON)?
caused by?
delayed resorption + clearance of fetal alveolar fluid due to C.section + prematurity
Sx of transient tachypnoea of newborn (TTON)?
Resp distress Sx
Dx of transient tachypnoea of newborn (TTON)?
chest xray = fluid in horizontal fissure and hyper inflated lungs
Tx of transient tachypnoea of newborn (TTON)?
self resolving <48hrs
consider CPAP/O2
What is meconium aspiration syndrome (MAS)?
caused by?
Aspirated meconium (bile water, vernix, desquamation), chemical irritation, inflammation and mechanical obstruction in post term baby
Sx of meconium aspiration syndrome (MAS)?
-<1hr resp distress
-Meconium stained amniotic fluid (MSAF)
-Yellow/green stained skin and nails
-Low APGAR score
-crackles auscultated in fetal lung
Dx of meconium aspiration syndrome (MAS)?
Chest xray = consolidation, patchy atelactesis
Amniotic Fluid = High -ve RODS
Tx of meconium aspiration syndrome (MAS)?
suction nose + mouth
supportive O2
supportive (IV Fluid)
Abx?
MSAF + NO Resp distress =
MSAF + Resp distress =
monitor
Tx + O2….
What is apnoea of prematurity?
when does it usually occur?
Tx?
decreased myelination of autonomic ns resp centre (ponto-med)
occurs 32-34 weeks therefore premature infant high risk
Tx = IV Caffeine
