prematurity and infant resp stuff

Question 1

What system is used to score infant age?

Answer 1

ballard score

Question 2

what are some medical complications of SGA infants?

Answer 2

perinatal asphyxia, hypothermia, hypoglycemia, polycythemia, thrombocytopenia, hypocalcemia, meconium aspiration, fetal death

Question 3

what can cause LGA babies?

Answer 3

maternal diabetes (most common), Beckwith-wideman, prader-willi, nesidioblastosis (diffuse proliferation of pancreatic islet cells = extra insulin)

Question 4

What kinds of diseases should be considered in an infant with cyanosis?

Answer 4

Ts of congenital heart disease, pneomothorax/significant resp. disease, CNS issues (intraventricular hemorrhage), polycythemia, metabolic disorders

Question 5

What is the initial work up for a cyanotic newborn?

Answer 5

CXR, electrolytes and glucose, ABG, CBC, possibly 100% O2 test (differentiates between cardiac and pulmonary etiologies).

Question 6

respiratory distress syndrome: what is the underlying cause? how can lung maturity be assessed prenatally?

Answer 6

• due to inadequate pulmonary surfactant
• may be assessed by the lecithin to sphingomyelin ratio (>2:1 suggests maturity)
• may also be assessed by presence of phosphatidylglycerol
• lung maturity extremely rare before 30-32 weeks

Question 7

How is RDS disagnosed?

Answer 7

CXR. shows ground glass lungs with air bronchograms

Question 8

Treatment of RDS

Answer 8

supplemental O2, CPAP or mechanical ventilation, exogenous surfactant

Question 9

complications of RDS

Answer 9

• air leaks (pneumothorax), intraventricular hemorrhage, sepsis, Right to left shunt across PDA are all acute
• chronic:
  1. bronchopulmonary dysplasia: progressive changes in the immature lunch that affect the parenchyma and airways. criteria include mechanical ventilation in first 2 wks of life, need for O2 beyond 28 days, CXR findings, and ongoing resp. distress
  2. retinopthy

Question 10

persistant pulmonary hypertension of the newborn definition; what kind of babies get this (preterm, term, or post term)

Answer 10

any condition besides congenital heart disease that ias associated with low blood flow to the lungs after birth. most common in term or post-term babies

Question 11

what are the most common causes of persistent pulmonary hyptertension of the newborn?

Answer 11

-perinatal asphyxia
-meconium aspiration syndrome
perinatal hx often significant for fetal distress

Question 12

pathophysiology of persistent pulmonary hypertension of the newborn

Answer 12

incr pulm vascular resistance causes signifcant right to left shunting through the foramen ovale or ductus arteriosus. causes hypoxia. must get echo to r/o cardiac disease

Question 13

management of persistent pulmonary hypertension of the newborn

Answer 13

• prevent hypoxemia- give oxygen (hypoxemia will cause futher pulm HTN from vasoconstriction)
• mechanical ventilation of O2 doesn’t work
• ECMO if mechanical ventilation doesn’t work
• maybe inhaled nitric oxide

Question 14

evaluation of meconium aspiration syndrome

Answer 14

CXR- shows incr. lung volume with diffuse patchy atelectasis and parenchymal infltrates
may have pneumothorax
suggested by hx of meconium at or before delivery

Question 15

complications of meconium aspiration syndrome

Answer 15

persistent hypertension of the newborn, bacterial PNA, long-term reactive airway disease

Question 16

What is apnea of prematurity?

Answer 16

resp pause without airflow lasting >15-20 seconds. Or a resp pause of any duration accompanied by bradycardia, cyanosis, or O2 desaturation

Question 17

What are causes of apnea in premature babies?

Answer 17

infection, lung disease, hypothermia or hyperthermia, seizures, drug withdrawal, anemia, GERD. may also be idiopathic

Question 18

what are features of idiopathic apnea of prematurity?

Answer 18

diagnosis of exculsion. appears 24 hrs after birrht. usually resolves by post-conceptional age of 38-44 wks.
treatment may include ventilation or theophylline