PED: Neonatal Respiratory Distress

Question 1

What is the most common esophageal abnormality

Answer 1

Esophageal Atresia

Question 2

Esophageal atresia is classified under A B C D E, which is the most common, and explain it

Answer 2

Type C, an esophageal atresia with distal fistula

Question 3

What is the earliest clinical sign of EA?

Answer 3

Excessive drooling and salivation

Question 4

On exam of EA, what do we see?

Answer 4

Manifestations of respiratory distress and intercostal retractions are noted

Question 5

What clinical exam do we do that confirms EA?

Answer 5

Try putting in a nasogastric tube, obviously won’t pass.

Question 6

What do we do differently when doing an X-ray for EA?

Answer 6

Pass the nasogastric tube, as to see the level of the EA.

Question 7

Air in the stomach and bowl on XR of EA indicates what

Answer 7

EA with Transesophageal fistula

Question 8

Abscence of air in stomach and bowel on XR of EA indicates what

Answer 8

EA without TEF

Question 9

Pre op management of EA

Answer 9

Vit K, antibiotics, and IV fluids

Question 10

Operative treatment of EA with TEF

Answer 10

Right sided extrapleural thoracotomy in 4th ICS

Question 11

Treatment of EA without TEF

Answer 11

Gastrotomy tube to allow enteral feeding

Question 12

Procedure to conserve patient’s esophagus

Answer 12

Delayed primary anastomosis at 2-3 months of life

Question 13

What is Congenital Diaphragmatic hernia?

Answer 13

Life threatening developmental defect of the diaphragm

Question 14

There are 3 types of CDH hernia, explain the Bochdalek hernia

Answer 14

Posterolateral defect

Question 15

Explain the CDH Morgagni hernia

Answer 15

Anteromedial defect

Question 16

Bochdalek Hernia clinical manifestation

Answer 16

Severe RDS at birth or first few hours, clinically shows mediastinal shift, absent breath sounds on affected side

Question 17

Bochdalek hernia X-ray finding

Answer 17

Inestinal loops in the chest

Question 18

When resuscitating a Bochdalek hernia patient, why do we intubate and not use an ambu bag?

Answer 18

To avoid abdominal distention of the stomach and inteestinesvthat may be in the thoracic cavity

Question 19

Prenatal intervention for Bochdalek hernia

Answer 19

FETO procedure (Fetoscopic endoluminal tracheal occlusion)

Question 20

Postnatal intervention for Bochdalek hernia

Answer 20

Thorascopy or laparoscopy(not preferred)

Question 21

How do most surgeons approach the Bochdalek hernia through which incision and why

Answer 21

Subcostal, as it offers good exposure and easy reduction of the abdominal viscera

Question 22

Why is Laparoscopy not preferred to treat Bochdalek hernia?

Answer 22

The pneumoperitoneum prevents easy reduction of the thoracic contents

Question 23

What is the most commonly diagnosed bronchopulmonary malformation?

Answer 23

CPAM (congenital pulmonary airway malformation)

Question 24

Explain CPAM

Answer 24

Benign tumors characterized by overgrowth of pulmonary bronchioles

Question 25

CPAM patients will present in the first few years with what

Answer 25

Recurrent respiratory infections, or pulmonary abscess

Question 26

Diagnosis of CPAM

Answer 26

Chest CT with IV contrast

Question 27

When it comes to treatment of CPAM, what surgery is recommended to be done between 3-6 months of age and why?

Answer 27

Open or Thorascopic lobectomy, this is due to the risk of such CPAM turning malignant later on in life.

Question 28

CLE, congenital lobar emphysema is what

Answer 28

Air trapping and over distention of the lung lobes

Question 29

Asymptomatic children with CLE, or only mild symptoms treatment

Answer 29

Safely/conservatively managed without resection

Question 30

CLE treatment

Answer 30

If presenting with RDS, urgent open lobectomy is the appropriate treatment

Question 31

BPS treatment for extralobar sequestration

Answer 31

Division and ligation via thoracotomy or thorascopy

Question 32

BPS treatment for Intralobar sequestration

Answer 32

Lobectomy, also via thoracotomy or thorascopy

Question 33

GERD surgery

Answer 33

Nissen Fundoplication

Question 34

GERD diagnostic modality

Answer 34

Barium studies and Endoscopy