Respiratory disease in a Neonate Flashcards
What is the most common cause of resp distress in the newborn period?
Transient tachypnoea of the Newborn - TTN
What is Transient tachypnoea of the Newborn
Delayed fluid resorption in the lungs
- more common following CS
In transient tachypnoea of the newborn fluid does not leave the lungs fast enough, what happens in a healthy newborn?
Fluid in lungs would normally be pushed out due to the force of contractions and length of labour in a vaginal delivery.
What will CXR show on for a baby with transient tachypnoea?
CXR will show hyperinflation of lungs and fluid in the horizontal fissure.
How to manage Transient Tachypnoea of the Newborn (TTN)?
Supportive care
May need supplementary oxygen to maintain sats but usually settles within 1-2 days
What is Neonatal respiratory distress syndrome?
Deficiency of surfactant
What are the risk factors of neonatal resp distress syndrome?
Risk Factors →
maternal diabetes mellitus (insulin, which is increased in diabetic mothers, inhibits surfactant production and maturation of the fetal lungs)
male sex
caesarean section
second born of premature twins.
At what gestation is neonatal resp distress syndrome more common?
If born <28 weeks
Symptoms of neonatal respiratory distress syndrome?
High RR
Laboured breathing
Nasal flaring
Expiratory grunting
What will CXR show for neonatal respiratory distress syndrome
will show ‘ground glass’ appearance. (Bilateral diffuce granular opacities with air bronchograms).
Manage of neonatal distress syndrome?
antenatal: corticosteroids + tocolytics (give steroids 24 hours to work).
Postnatal: supportive → oxygen and ventilation.
What is Persistent pulmonary hypertension?
Result of high pulmonary vascular resistance - when newborns vessels dont open
Usually associated with birth asphyxia, meconium aspirate, septicaemia, RDS
Risk factors of persistent pulmonary hypertension
Usually associated with birth asphyxia, meconium aspirate, septicaemia, RDS
What are the symptoms of persistent pulmonary hypertension?
Cyanosis after birth
Signs of heart failure
How to manage persistent pulmonary hypertension?
Oxygen +/- ventilation
Nitric oxide
Sildenafil (also used in viagra - opens and relaxes arteries)
What is chronic lung disease of premature also known as?
Bronchopulmonary dysplasia
What is chronic lung disease of prematurity?
long term breathing issue affecting premature babies,
When premature infants need mechanical ventilation and oxygen therapy for resp distress persistently at 36 weeks too
What risk factors for chronic lung disease of prematurity?
Infections
barotrauma
iatrogenic injury
Symptoms of chronic lung disease of prematurity?
23-26 weeks progresses from ventilation to CPAP to supplementary oxygen
What is seen on CXR for chronic lung disease of prematurity?
CXR: widespread opacification.
What is cyanosis in the neonatal period?
Bluish discolouration of the skin in newborn indicating lack of oxygen with suboptimal SpO2 readings
Can indicate underlying cause (Cardiac/non cardiac)
How to distinguish between cardiac vs non cardiac causes of cyanosis of newborn?
Nitrogen washout test
- infant given 100% oxygen for 10 mins, ABG taken after
-> pO2 of less than 15kPa indicates cyanotic congenital heart disease
What is the nitrogen washout test
- infant given 100% oxygen for 10 mins, ABG taken after
-> pO2 of less than 15kPa indicates cyanotic congenital heart disease
- used when cyanosis in the neonatal period
What are some cyanotic congenital heart disease (3)
Tetralogy of fallot
Transposition of the great arteries
Tricuspid atresia
