Respiratory Disorders of the Neonate Flashcards
What are the Major Categories of Neonatal Adaptation?
- Respiratory Transition
- Cardiovascular Transition
- Thermal & Metabolic Transition
What are the normal vital signs for a term newborn?
Heart Rate - 100-160 bpm
Respiratory rate - 30-60 breaths per min
Temperature - 36.5-37.5 C
Length - 49-53 cm
Head circumference - 32-38 cm
What is the normal transition?
- First period reactivity (0-30mins post birth)
- Decreased Responsiveness (30mins-3hrs)
- Second period of reactivity (2-8hrs)
What happens in the First period reactivity?
increased heart rate, irregular reps, fine crackles on auscultation of breath sounds
What happens in decreased responsiveness?
decrease heart rate, shallow rapid reps, decreased muscle activity & sleep myoclonus
What happens in the second period reactivity?
Exaggerated responsiveness; labile; HR, tone, colour; Gagging/vomiting
What residual symptoms of transition may persist for up to 24 hours?
Crackles (auscultation of breath sounds)
Soft cardiac murmur
Acrocyanosis (24hr max.)
Tachypnoea
Tachycardia
What are major respiratory disorders of the neonate?
TTN
RDS
MAS
PH
PPHN
BPD
Pulmonary Air Leaks
SUPC?
What are the 4 stages of lung development?
- Pseudoglandular Stage
- Cannalicular
- Saccular
- Alveolar
What is the pseudoglandular stage?
6-16 weeks
Subdivision to form bronchial tree
What is the cannalicular stage?
16-28 weeks
terminal and respiratory bronchial develop
development of Type 1 and Type 2 ( endogenous surfactant synthesis)
Pneumocytes
What is the saccular stage?
28-36 weeks
further branching of bronchioles
terminal sacs develop forming bunches of primitive alveoli
What is the alveolar stage?
36 weeks - 2 years
pulmonary fluid is absorbed after birth
air/liquid interface (facilitated by surfactant) forms alveolar lining
surface tensions minimised - alveolar expansion
What are the signs and symptoms of problems in transition?
respiratory distress –> tachypnoae, grunting
Extrapulmonary signs;
central cyanosis
sort cardiac murmur
baby seems “shocked”
pallor
delayed capillary refill
slightly hypotonic, mild head lag, absent moro reflex
low mean BP
seizures
hypoglycaemia
hypertonia
tachycardia
hypothermia
What is TTN?
Transient Tachypnea of the Newborn
Delayed clearance of foetal lung fluid
What is the management for TTN?
- if infant is stable with sats >90% in RA, place in incubator in the delivery suite or PN ward and observe for one hour
- if symptoms persist after one hour or sats are <90% at initial assessment or infant looks unwell –> admit to neonatal unit
What does TTN look like?
Classic “streaky” appearance –> “wet lungs”
absence of “thoracic squeeze” - premature birth, precipitous birth, LSCS
retained fluid = bronchial collapse, areas of air trapping, hyperinflation
poorly ventilate alveoli leads to hypoxemia