Newborn

Question 1

DD for respiratory distress in newborns

Answer 1

●Respiratory causes
1. Resp distress syn
2. TTN - Transient tachypnoea of newborn
3. Meconium aspiration syndrome

●Non-respiratory causes
1. Cardiac: Cyanotic CHD
2. Heme: Anaemia, polycythemia
3. Infection
4. Metabolic
5. Neurologic

Question 2

Respiratory distress syndrome c/f

Answer 2

<34wks - no surfactant
RD immediately after birth … worsens

Signs:
1. Hypoxia, cyanosis
2. BELL SHAPED CHEST
3. ↓Breath sounds
4. Resp acidosis
5. ↑working of breathing

Question 3

RDS diagnosis

Answer 3

●Initial - CXR
Ground glass appearance
White lung
Air bronchogram

●Best - L/S ratio of amniotic fluid
Lecithin sphingomyelin ratio

Question 4

RDS Rx

Answer 4

●Initial - O2
●Best - Intubation, exogenous surfactant

Question 5

RDS prevention

Answer 5

1. Avoid prematurity - tocolytics
2. Antenatal steroid in possibility of premature baby
   Betamethasone injection

Question 6

TTN c/f

Answer 6

Term baby - C-section or Rapid 2nd stage of labour
Physiological
Slow absorption of lung fluid
Gets better in 12-72 hrs (mc-1day)

Signs:
1. Hypoxia, cyanosis, ↑Breathing labour
2. BARREL SHAPED CHEST, ↑AP diameter
3. Clear breath sounds
4. Respiratory acidosis

Question 7

TTN diagnosis, mx

Answer 7

CXR - air-trapping, fluid in fissures, perihilar streaking

Improves on its own
O2 if required

Question 8

Meconium aspiration syndrome c/f

Answer 8

Post term >42wks

1. Airway obstruction
2. Chemical pneumonitis
3. Pulm HTN
4. After a min of delivery, significant drop of APGAR score
5. Wet inspiratory crackles
6. Hypoxaemia, hypercarbia

Question 9

Meconium aspiration diagnosis

Answer 9

Initial and best - CXR
Flattening of diaphragm
Patchy infiltrates
↑AP diameter

Question 10

Meconium aspiration Mx

Answer 10

●Initial-
1. Bag and mask ventilation
2. O2 - maintain sats 90-95%
3. Suction if meconium around mouth/nose

●Best -
1. Endotracheal intubation, PPV
When O2 sat <90% or resp acidosis
2. Airway suction - not all cases

Question 11

Diaphragmatic hernia c/f

Answer 11

Deficient devl of diaphragm …
Abd contents into chest cavity …
Pulm hypoplasia - Resp distress

Signs:
1. SCAPHOID ABDOMEN
2 Bowel sounds on auscultation of chest

Question 12

Diaphragmatic hernia diagnosis

Answer 12

Prenatal USG
Best - postnatal CXR

Question 13

Diaphragmatic hernia Mx

Answer 13

Intubation and sx repair

Question 14

Omphalocele vs gastroschisis

Answer 14

Omphalocele:
1. Failure of intestines to return to abdominal cavity with gut through umbilicus
2. Sac +
3. Rx- repair

Gastroschisis
1. Defect in abdominal wall lateral to umbilicus (vascular accident) - any part of GIT protrudes
2. Sac -ve
3. a/w other GIT abn

Question 15

Baby with hyaline membrane disease, on ventilator support, rapid deterioration. Cause?

Answer 15

Spontaneous tension pneumothorax

Question 16

Necrotising enterocolitis

Answer 16

1. Bowel ischemia esp jejunum, ileum,colon
2. *Xray - intramural gas = PNEUMATOSIS INTESTINALIS
3. In newborns who were not given steroids antenatally, cardiac d/o, underdeveloped bowels (preterm), formula feeds
4. Stop enteral feeds for 10 days
   IV fluids Restart feed slowly
   IV VANCOMYCIN + GENTAMYCIN +/- METRONIDAZOLE Gastric decompression

`SX: Laparotomy + peritoneal drainage