RDS and BPD

Question 1

When is prophylactic surfactant administered?

Answer 1

administered after initial stabilization about around 15 minutes after birth

Question 2

When is rescue surfactant administered?

Answer 2

When clinical signs and symptoms of RDS are present and surfactant indications are met

Question 3

What evidence supports redosing surfactant?

Answer 3

shown to improve oxygenation, decrease ventilatory requirements, and decrease risks of air leaks

Question 4

How is surfactant administered?

Answer 4

1. ETT
2. LMA

Question 5

How is surfactant dosed?

Answer 5

manufacturer specific, 75-100 mg/kg

Question 6

How should the infant be positioned for surfactant replacement therapy?

Answer 6

Rotate infant to have the side being administered be down, rapidly deliver surfactant, wait ten seconds, rotate sides and repeat

Question 7

What are the indications for surfactant replacement therapy?

Answer 7

1. RDS
2. Pulmonary hemorrhage
3. meconium aspiration syndrome
4. PNA and sepsis
5. Congenital diaphragmatic hernia MAYBE

Question 8

What are complications associated with surfactant delivery?

Answer 8

1. transient airway obstruction
2. hypoxia
3. bradycardia

Question 9

Define respiratory distress syndrome

Answer 9

severe impairment of respiratory function due to a decrease in surfactant production which causes low alveolar compliance

Question 10

what is the primary etiology of RDS?

Answer 10

underdevelopment of the lung related to prematurity

Question 11

Describe the pathophysiology of RDS

Answer 11

1. Surfactant deficiency
2. Decreased surface area for gas exchange
3. Thick AC membrane
4. Overly compliant chest wall
5. Under developed vascularization
6. Pulmonary edema

Question 12

How does RDS present?

Answer 12

1. Respiratory distress within minutes or hours after birth
2. Apnea, tachycardia, nasal flaring, grunting, intercostal and subcostal retractions, cyanosis, bradycardia, hypoxemia

Question 13

What does the CXR of an infant with RDS look like?

Answer 13

1. reticulogranular pattern
2. rough grainy appearing lung tissue
3. ground glass
4. peripheral air bronchograms
5. Alveolar collapse-low lung volumes

Question 14

How is RDS managed?

Answer 14

1. Prevention of premature delivery
2. corticosteroids
3. Proper delivery room management
4. surfactant replacement therapy
5. Respiratory support as needed
6. Mechanical ventilation

Question 15

What are infants with RDS at increased risk for?

Answer 15

air leak syndromes

Question 16

What can RDS develop into?

Answer 16

Bronchopulmonary dysplasia

Question 17

What characterized the “old BPD”?

Answer 17

1. Airway injury due to mechanical ventilation
2. Volutrauma, barotrauma, atelectrauma and oxygen toxicity

Question 18

What characterizes the “new BPD”?

Answer 18

arrest of lung development