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Neonatology > Respiratory Distress > Flashcards

Respiratory Distress Flashcards

1
Q

Clinical features of respiratory distress: [5]

A
  • persistent tachypnea
  • central cyanosis
  • sternocostal recession
  • expiratory grunting
  • nasal flaring
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2
Q

Predisposing Factors: [7]

A
  • IDM
  • Fetal distress
  • chorioamnionitis
  • complicated labour
  • c-section
  • preterm delivery
  • underweight for gestational age
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3
Q

Causes of Respiratory Distress: Respiratory vs non-respiratory [12]

A
  1. HMD
  2. Wet lung syndrome
  3. Meconium Aspiration
  4. Pneumonia
  5. Chronic Lung disease
  6. Pneumothorax
  7. PPH of newborn
  • CHD
  • Hypothermia
  • Anaemia or polycythemia
  • Metabolic acidosis
  • PDA
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4
Q

What inhibits synthesis of surfactant? [3]

A
  1. hypoxia
  2. acidosis
  3. hypothermia
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5
Q

What does an x-ray of HMD show? [2]

A

under-expanded chest with a fine reticulo-grandular appearance

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6
Q

When to give betamethasone?

And for how long should delivery be delayed when betamethasone is administered?

A
  • before 34 weeks

- 48 hours

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7
Q

Maintenance of Pa02 in Respiratory distress caused by HMD -Management

A
  • 7 to 10 kPa (50 to 80 mmHg)
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8
Q

complications associated with HMD: EARLY VS LATE

A

Early

  • pneumothorax
  • intraventricular hemorrhage
  • heart failure d/t PDA

Late
CHRONIC LUNG DISEASE (Bronchopulmonary Dysplasia)

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9
Q

Xray differences between HMD, TTN, and Meconium aspiration

A

reticular granular appearance
hyperinflation, flattening of the diaphragm, fluid in the horizontal fissure of the right lung
hyperinflated chest, diaphragmatic flattening, cardiomegaly, atelectasis, and consolidation

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10
Q

what are the risks associated with meconium aspiration [4]

A
  1. pneumothorax
  2. pneumomediastinum
  3. pph
  4. pneumonitis due to irritation
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11
Q

what is responsible for pneumonia in an infant before or during the passage through the birth canal and when does it occur? [2]

A

group b haemolytic streptococci and ecoli

within 72 hours

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12
Q

Pneumonia can cause a disease. What is it? [1]

A

chorioamnionitis

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13
Q

syphilis may cause [1]

A

pneumonia

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14
Q

nosocomial pneumonia is caused by

What does a newborn with pneumonia present like? [1]

A

staph aureus
kleibsella
pseudomonas

apneoic spells and needs to be confirmed with chest x ray

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15
Q

common causes for pneumothorax in infant

A
  1. meconium aspiration
  2. vigorous resus after birth
  3. HMD
  4. spontaneous
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16
Q

when does apnoea of prematurity occur

A

affects infants born before 34 weeks

17
Q

what is the treatment of apnoea of prematurity and who is usually affected by it?

A

caffeine citrate

infants born before 34 weeks

18
Q

when are signs of anemia of prematurity seen

A

4 to 8 weeks

19
Q

What causes HMD? [2]

A
  • surfactant deficiency

- poorly controlled diabetic mothers

20
Q

What does surfactant do?

A

surfactant lowers surface tension in the alveoli and allows respiration with minimal effort. Lack of surfactant leads to alveoli collapse.

21
Q

Clinical signs of HMD:

A

normal clinical signs of respiratory distress

22
Q

Tell me when is HMD worse and how will the baby look? Also, tell me when is it best to prevent HMD.

A

72 hours, frog position.

Before 39 weeks.

23
Q

What is the goal of management in HMD? Remember surfactant and what it does. [4] AND ONE IMPORTANT ASPECT OF TREATMENT

A
  • prevent worsening of alveolar collapse
  • maintain oxygen saturation at 88-92%
  • maintain blood glucose and temperature levels
  • provide adequate nutrition

RELIEF OF HYPOXIA

24
Q

If respiratory distress worsens in HMD, what do you do?

A

Give IN AND OUT surfactant therapy called LISA

25
Q

The mainstay treatment for HMD: [3]

A
  • nasal CPAP
  • antenatal steroids
  • ## surfactant therapy
26
Q

When do you see wet lung syndrome the most?

A

Usually after a c-section

27
Q

When does WLS present and when does it improve?

A

An hour or 2 after delivery

12-24 hours later

28
Q

What is seen in Meconium Aspiration on xray?

A

atelectasis and emphysema

29
Q

Management of meconium aspiration?

A

nasal CPAP
antibiotics if there is secondary infection
STEROIDS ARE NOT HELPFUL and may cause pneumonia

30
Q

What does an infant with pneumothorax look like

A
  • apneic, shocked or cyanosed
31
Q

Difference between pneumothorax and tension pneumothorax on x ray

A

tension - mediastinal shift

pneumothorax - absence of lung markings and collapsed lung on affected side

32
Q

How does PPH occur?

A

failure of the high pulmonary artery pressures to fall rapidly after birth which leads to hypoxia caused by pulmonary under perfusion with a right to left shunt from pulmonary to systemic circulation via the PDA

33
Q

How do you confirm PPH and what will you see?

A

CARDIAC U/S

Normal heart with raised pulmonary artery pressure with a ductal shunt

34
Q

what is the treatment for PPH? Its not just what you think

A

oxygen
sedate infant and maintain pressure with inotropes
slidenafil or nitric oxide may be needed for severe cases

35
Q

What is BPD?

A
  • Chronic lung disease caused by preterm infants needing long term oxygen
36
Q

How to prevent BPD?

This was evidence based

A
  • steroids within 8 days
37
Q

What are the most common preterm complications and discuss them [19]

A
  1. Hypothermia 2. Hypoglycemia 3. Respiratory Distress 4. Infections
  2. Jaundice 6. Apnea of Immaturity 7. PDA 8. Metabolic Bone Disease 9. IVH
  3. NEC 11. Anemia of Prematurity 12. ROPS 13. Periventricular leukomalacia 14. CLD 15. Iron deficiency anemia 16. SIDS
  4. Cerebral palsy, cognitive and behavioral deficits, Barkers hypothesis

Neonatology (11 decks)

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