PED: Neonatal Respiratory Distress Flashcards
What is the most common esophageal abnormality
Esophageal Atresia
Esophageal atresia is classified under A B C D E, which is the most common, and explain it
Type C, an esophageal atresia with distal fistula
What is the earliest clinical sign of EA?
Excessive drooling and salivation
On exam of EA, what do we see?
Manifestations of respiratory distress and intercostal retractions are noted
What clinical exam do we do that confirms EA?
Try putting in a nasogastric tube, obviously won’t pass.
What do we do differently when doing an X-ray for EA?
Pass the nasogastric tube, as to see the level of the EA.
Air in the stomach and bowl on XR of EA indicates what
EA with Transesophageal fistula
Abscence of air in stomach and bowel on XR of EA indicates what
EA without TEF
Pre op management of EA
Vit K, antibiotics, and IV fluids
Operative treatment of EA with TEF
Right sided extrapleural thoracotomy in 4th ICS
Treatment of EA without TEF
Gastrotomy tube to allow enteral feeding
Procedure to conserve patient’s esophagus
Delayed primary anastomosis at 2-3 months of life
What is Congenital Diaphragmatic hernia?
Life threatening developmental defect of the diaphragm
There are 3 types of CDH hernia, explain the Bochdalek hernia
Posterolateral defect
Explain the CDH Morgagni hernia
Anteromedial defect
Bochdalek Hernia clinical manifestation
Severe RDS at birth or first few hours, clinically shows mediastinal shift, absent breath sounds on affected side
Bochdalek hernia X-ray finding
Inestinal loops in the chest
When resuscitating a Bochdalek hernia patient, why do we intubate and not use an ambu bag?
To avoid abdominal distention of the stomach and inteestinesvthat may be in the thoracic cavity
Prenatal intervention for Bochdalek hernia
FETO procedure (Fetoscopic endoluminal tracheal occlusion)
Postnatal intervention for Bochdalek hernia
Thorascopy or laparoscopy(not preferred)
How do most surgeons approach the Bochdalek hernia through which incision and why
Subcostal, as it offers good exposure and easy reduction of the abdominal viscera
Why is Laparoscopy not preferred to treat Bochdalek hernia?
The pneumoperitoneum prevents easy reduction of the thoracic contents
What is the most commonly diagnosed bronchopulmonary malformation?
CPAM (congenital pulmonary airway malformation)
Explain CPAM
Benign tumors characterized by overgrowth of pulmonary bronchioles
CPAM patients will present in the first few years with what
Recurrent respiratory infections, or pulmonary abscess
Diagnosis of CPAM
Chest CT with IV contrast
When it comes to treatment of CPAM, what surgery is recommended to be done between 3-6 months of age and why?
Open or Thorascopic lobectomy, this is due to the risk of such CPAM turning malignant later on in life.
CLE, congenital lobar emphysema is what
Air trapping and over distention of the lung lobes
Asymptomatic children with CLE, or only mild symptoms treatment
Safely/conservatively managed without resection
CLE treatment
If presenting with RDS, urgent open lobectomy is the appropriate treatment
BPS treatment for extralobar sequestration
Division and ligation via thoracotomy or thorascopy
BPS treatment for Intralobar sequestration
Lobectomy, also via thoracotomy or thorascopy
GERD surgery
Nissen Fundoplication
GERD diagnostic modality
Barium studies and Endoscopy
