Problems in term neonates Flashcards
Cleft lip and palate
feeding problems middle ear infections hearing impairment difficulties speech facial growth and orthodontic problems
Pierre Robin Sequence
AR - x-linked micrognathia posteriorly displaced tongue posterior palatal defect RESPIRATORY OBSTRUCTION - hypoxia and cor pulmonale
feeding difficult
aspiration pneumonia
management
- avoid obstruction by tongue
nurse prone, may need CPAP
Choanal atresia
newborn - obligatory nose breathers
bilateral lesions = respiratory distress and cyanosis
airway obstruction is relieved by crying or opening mouth
Transient Tachypnoea of Newborn
most common cause respiratory distress in term infants
During C/S no stress hormones - catecholamines and liquid does not move from alveolar to interstitial space
Settles within first day to two of life but may low oxygen requirement and tachypnoea for several days
Treatment - supportive
- Oxygen
- NGT feeding
- CPAP
Pneumothorax
spontaneously or complication of CPAP
unilateral decreased breath sounds/ transillumination chest
confirmed CXR
treat - insertion of ICD
number 1 infection causes pneumothorax - CMV
Meconium aspiration
first intestinal discharge - viscous dark green - intestinal epithelial cells, lanugo, mucus, intestinal secretions (bile)
meconium is sterile - does NOT contain bacteria - do not give AB
NOT FOUND before 34 weeks - affects infants at term or post term
due to IU distress
causes airway obstruction surfactant dysfunction chemical pneumonitis pneumothorax PPHN
management mechanical ventilation inotropes - systemic vasoconstrictors sildenafil - Viagra NO DO NOT GIVE CPAP
Pneumonia RF
PROM more 18 hours maternal fever or tachycardia chorioamnionitis history of maternal UTI or vaginitis spontaneous preterm labour
GBS, e coli, Klebsiella, HSV
treatment - Penicillin and ventilation
Congenital diaphragmatic hernia
herniation bowel into thorax
pulmonary hypoplasia - PPHN
left sided - posterolateral foramen - Bochdalek
morgagni type - central-anterior - right sided
respiratory distress asymmetry of chest reduced air entry on affected side apex beat displaced scaphoid abdomen
intubate and ventilate from birth gentle ventilation allowing permissive hypercapnia avoid mask ventilation intubate immediately stabilise and support circulation early PN delay surgical repair until stable and PPHN is resolving CPAP is CI
PPHN
R to L shunt - patent FO or DA or intrapulmonary
cyanosis or difficulty oxygenating
right side oxygenated better than left
10% difference between pre and post ductal saturations
causes birth asphyxia MAS sepsis CDH occasionally primary disorder
O2 optimised mechanical ventilation circulatory support surfactant therapy - RDS or MAS pulmonary vasodilator - NO, sildenafil HFOV ECMO - severe respiratory failure
