Respiratory Flashcards
Define respiratory distress syndrome and risks
Symptoms
An obstructive respiratory syndrome in premature infants caused by developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs (alveolar collapse-atelectasis). It can also be a consequence of neonatal infection. It can result from a genetic problem with the production of surfactant associated proteins. Risks: preterm infant, emergency csection, baby of diabetic mother
S&S: Tachycardia Tachypnoea Expiratory grunting Nasal flaring Intercostal recession cyanosis
Diagnosis of Respiratory Distress Syndrome?
Diagnosis:
- CXR: typically gives diffuse ground glass lungs with low volumes and a bell-shaped thorax
often tends to be bilateral and symmetrical
- FBC, cultures
Management of Respiratory Distress Syndrome
Manage:
- minimal handling
- nurse prone
- antibiotics
- nasal CPAP- prevent collapse of alveoli, recruit more alveoli and help to increase the functional residual capacity
- surfactant administration- initial: 200 mg/kg/dose
- If severe distress: intubation with intermittent positive pressure ventilation (IPPV)
What is TTN?
Risk factors?
A restrictive respiratory condition seen shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms. It is the most common cause of respiratory distress in term neonates
Risk factors:
- Elective csection with no labour
- precipitus birth
- maternal diabetes
S&S for TTN?
First hours of life with respiratory distress.
- Tachypnoea (80-120/min); Recession/retraction/nasal flaring, grunting.
- Cyanosis which appears to resolve with < 40% O2.
- Barrel chest (symmetric hyperinflation) in some infants.
- Normally full-term infants, large for GA
Diagnosis and management for TTN?
May be indistinguishable from sepsis (e.g. pneumonia) or RDS and hence is a
diagnosis of exclusion:
- Arterial blood gas (look for mild-moderate hypoxemia, mild hypercarbia).
- CXR- small pleural effusions, interstitial oedema
Manage:
- general support, 02
Clinical features of meconium aspiration syndrome?
Early onset of respiratory distress (within two hours) in a meconium-stained infant.
Tachypnoea, cyanosis and variable hyperinflation are the main clinical findings.
Auscultation: widespread ‘wet’ inspiratory crackles
CXR: global atelectasis in early x-rays to a widespread patchy opacification accompanied by areas of hyperinflation and/or atelectasis.
Management meconium aspiration?
Do not stimulate Suctioning 02 If baby flat- intubation Surfactant replacement Antibiotics- Ampicillin, Gentamicin
Causes of Pneumothorax in the infant and S&S?
Spontaneous, use of excessive pressures, RDS, underlying lung disease, mec aspiration
S&S:
- Respiratory distress, cyanosis, hypotension, decreased breath sounds on affected sounds
Diagnosis and management of Pneumothorax?
Transilumination: light source next to the
infant’s skin should transilluminate the whole hemithorax in the presence of a large pneumothorax
CXR: increase in lucency may be
noted on the affected side
Manage:
May resolve on its own
Needle thoracentesis
Thoracotomy tube- chest drain
What is Chronic Lung Disease/Bronchopulmonary Dysplasia and risk factors?
A form of chronic lung disease that affects newborns (mostly premature) and infants. It results from damage to the lungs caused by mechanical ventilation (respirator) and long-term use of oxygen
Risks:
Prematurity
Prolonged mechanical ventilation
Male gender
Symptoms and management of Bronchopulmonary Dysplasia?
hypoxemia;
hypercapnia;
crackles, wheezing, & decreased breath sounds
Manage:
May require supplemental 02 for several months
Bronchodilators/steroids
Describe Apneoa of prematurity?
A developmental disorder due to immature pulmonary reflexes and breathing responses to hypoxia and hypercapnia. Nil respiratory effort over 20secs with cyanosis and bradycardia. Onset 2-7 days of life
Types of Apnoea?
Central apnoea: (40%) decreased central nervous system stimuli to respiratory muscles. Both the respiratory effort and airflow cease simultaneously.
(Absence of chest wall movement and airflow).
Obstructive apnoea:(10%) Caused by pharyngeal instability / collapse, neck flexion or nasal obstruction. Absence of airflow in presence of inspiratory efforts. (Presence of chest wall movement but no airflow).
Mixed apnoea:(50%) Has a mixed aetiology. Central apnoea is either preceded (usually) or followed by obstructed respiratory effort
Acute management for Apnoea?
Acute:
-Positioning: Ensure the neonate’s head and neck are positioned correctly (head and neck in neutral position) to maintain a patent airway.
-Tactile stimulation: Gentle rubbing of soles of feet or chest wall is usually all that is required for episodes that are mild and intermittent.
-Clear airway:Suction mouth and nostrils.
Provision of positive pressure ventilation
