Pulmonary Disorders of Neonates

Question 1

23 y/o primagravid
33 wk AOG male newborn via SVD
several minutes after birth developed tachypnea, prominent grunting, intercostal and subcostal retractions, nasal flaring --> cyanosis
harsh tubular quality - breath sounds
fine crackles

Answer 1

Respiratory Distress Syndrome (RDS)

Question 2

Primary Cause of RDS

Answer 2

surfactant deficiency

Question 3

Expected chest xray in RDS

Answer 3

diffuse, fine reticular granularity of the
parenchyma (ground-glass appearance)

air bronchograms

Question 4

23 y/o primigravid
38 wk AOG via CS male newborn
several minutes after birth developed tachypnea, retractions, expiratory grunting
clear lungs 
(-) wheeze, (-) crackles

Answer 4

Transient Tachypnea of the Newborn

Question 5

Primary cause of Transient Tachypnea of the Newborn

Answer 5

slow absorption of fetal lung fluid

Question 6

Expected chest xray in Transient Tachypnea of the Newborn

Answer 6

prominent pulmonary vascular markings
fluid in the intralobular fissures
overaeration
flat diaphragms

Question 7

32 y/o G4P3
42 wk male via SVD
(+) aspirated meconium
12 hrs after birth - grunting, nasal flaring, intercostal retractions
tachycardia and hypoxemic - 80% O2 sat
PaO2 gradient

Answer 7

Persistent Pulmonary HPN of the Newborn (PPHN)

Question 8

Primary cause of Persistent Pulmonary HPN of the Newborn (PPHN)

Answer 8

persistence of fetal circulatory pattern of R-L shunting through the PDA and foramen ovale after birth

Question 9

Expected chest xray in PPHN

Answer 9

normal

Question 10

Gold standard to confirm diagnosis of PPHN

Answer 10

2D echocardiography

Question 11

30 weeker premature baby treated for severe RDS
intubated on the first day of life given surfactant therapy and was on assisted ventilation for 2 weeks
subsequently extubated however O2 support was never completely weaned off
36 wks post menstrual he could tolerate O2 support at 1 lpm via nasal cannula

Answer 11

Bronchopulmonary Dysplasia