Respiratory distress

Question 1

Signs of respiratory distress in the newborn

Answer 1

• Central cyanosis
• Tachypnoea
• Subcostal/sternal recession
• expiratory grunting
• nasal flaring

Question 2

why does expiratory grunting occur in resp. distress

Answer 2

keeps alveoli from collapsing entirely and occurs as vocal cords are partially closed

Question 3

What are the 6 main causes of respiratory distress in the newborn

Answer 3

1. respiratory distress syndrome
2. congenital pneumonia
3. transient tachypnoea (TTN)
4. Meconium aspiration syndrome
5. air leak (pneumothorax)
6. Upper airway obstruction

Question 4

aetiology of respiratory distress syndrome

Answer 4

surfactant deficiency and immaturity in the lungs, can also be a consequence of neonatal infection

Question 5

What is surfactant

Answer 5

Produced by type 2 pneumocytes and coats alveoli to prevent collapse throughout inhalation and exhalation. The surfactant reduces surface tension in the alveolar air space so preventing collapse on exhalation and allows re-opening with a lower amount of force

Question 6

Diagnosis of RDS

Answer 6

Pre-term infant with signs of increased work of breathing and CXR signs

Question 7

CXR signs

Answer 7

homogenous lung fields and heart (gram-blast appearance) with air bronchograms

Question 8

treatment of RDS

Answer 8

establish lung volume and nasal CPAP

exogenous surfactant therapy

Question 9

what is congenital pneumonia associated with

Answer 9

PROM (>18-24h) and septicaemia with group B strep

Question 10

Presentation of congenital pneumonia

Answer 10

delayed onset after birth (24-48h)

• may present with shock sepsis
• Patchy areas of consolidation bilaterally on CXR

Question 11

Treatment of congenital pneumonia

Answer 11

prevent group B strep transmission with intrapartum abx esp. for high risk groups
- broad spectrum abx e.g. penicillin and co-amox

Question 12

Incidence of TTN

Answer 12

1-2% of all newborns, usually in term infants

Question 13

Why does TTN occur

Answer 13

due to delayed clearanc of lung fluid

Question 14

presentation of TTN

Answer 14

c-section baby with onset of respiratory distress 1-3hours after birth
* any increased work of breathing in term infant*

Question 15

CXR findings of TTN

Answer 15

coarse streaking and fluid in interlobar fissures ‘wet lung’

Question 16

Mx of TTN

Answer 16

Treat infection if present and respiratory support (stop feeds, oxygen and nasal CPAP)

Question 17

presentation of meconium aspiration

Answer 17

passage of meconium in utero

• fetal/neonatal gasping
• aspiration
• fetal hypoxia/distress

Question 18

consequences of mec. aspiration

Answer 18

mechanical airway obstruction, chemical pneumonitis, surfactant inactivation

Question 19

CXR findings in mec. aspiration

Answer 19

coarse streaking and patchy consolidation

- may have pneumothorax, pneumomediastinum or pneumonia

Question 20

aetiology of air leak (pneumothorax)

Answer 20

1. spontaneous
2. complication of respiratory illness (RDS, mec aspiration, pneumonia)
3. complication of treatment (PPV or CPAP)

Question 21

diagnosis of pneumothorax

Answer 21

transillumination

or typical CXR changes (same as adult)

Question 22

Tx of pneumothorax

Answer 22

use butterfly needle with syringe to drain air away and allow lung to re-inflate

Question 23

causes of inspiratory stridor

Answer 23

1. Laryngomalacia- epiglottis folds over and soft larynx
2. mechanical obstruction; haemangioma, granuloma from trauma (ET suction), sub-glottic stenosis (ET tube)
3. vocal cord palsy