Respiratory distress Flashcards
What is the definition of respiratory distress?
Common and important complication in newborn infants >2 or more of the following signs -tachypnea -expiratory grunting -nasal flaring -central cyanosis on room air -subcostal and intercostal recession
What are the predisposing factors that make a baby more likely to develop respiratory distress?
- Preterm delivery
- Csection
- Infant of diabetic mother
- Underweight for gestational age
- Complicated labour
- failure to breathe well at birth
What are the respiratory causes or conditions that cause respiratory distress?
- Transient tachypnea of the lung
- Meconium aspirations
- Pneumonia
- Bronchopulmonary dysplasia
- Persistent Pulmonary hypertension of the newborn
- Hyaline membrane disease
- Congenital diaphragmatic hernia
What are the non respiratory causes that cause respiratory distress?
- Hypothermia
- Metabolic acidosis
- Patent ductus arterioisus
- Congenital heart disease
What is hyaline membrane disease?
It is the most important cause of respiratory distress in infants
-it is due to the deficiency of surfactant in the lungs which causes the alveolar to collapse and increased effort for the baby to breath
How does surfactant work in the alveoli?
It causes decreased surface tension and allows respiration with minimal physical effort
What are the clinical signs of a baby with hyaline membrane disease?
- On chest X-ray there will be reticule-granular appearance and air bronchograms
- Baby will lay flat in the frog position
- Baby might experience cessation of breathing
What can we do to prevent hyaline membrane disease?
We can try to avoid elective c-sections
We can give the mom antenatal steroids to allow for lung maturity
We can also give betamethasone intramuscularly
What is the management for membrane hyaline disease?
- Prevent progressive alveolar collapse by
- oxygen saturation between 88-92%
- keep body temperature normal
- keep blood glucose normal
- provide adequate nutrition
- surfactant replacement therapy
What sort of oxygen therapy will a baby with HMD need?
- CPAP with nasal cannula
2. if not available give oxygen with nasals prongs
What are the early complications associated with HMD?
- pneumothorax
- intraventricular haemorrhage
- heart failure due to persistent pulmonary hypertension
What are the late complications of HMD?
-bronchopulmonary dysplasia
What is wet lung syndrome/transient tachypnea of the newborn?
- usually occurs to term newborn babies
- it is a respiratory problem that occurs soon after mostly elective c-sections
- period of tachypnea due to fluid remaining in the lungs
How long can we expect TTN to be present for?
Babies improve within 12-24 hours but tachypnea may be present for 7 days
What is the management of TTN?
-give nasal CPAP
What can we expect on chest X-ray?
- hyperinflation of the lungs
- flattened diaphragm
- fluid in horizontal fissure of the right lung
What is meconium aspiration syndrome?
Condition more common in term and post term babies where they aspirate meconium
What does the inhaled meconium do to the lungs?
Causes areas of atelectasis and emphysema
-there is areas of hyperinflation of the lungs
What do we expect to see on X-ray?
- hyperinflation of the lungs
- cardiomegaly
- diaphragmatic flattening
- patchy atelectasis and consolidation
What is the Rx of meconium aspiration?
- Nasal CPAP
2. Antibiotics if at risk of infections
When does pneumonia occur in a newborn baby?
Usually within 72 hours if the baby acquired the infection before or during birth
What organisms cause early onset pneumonia?
- E. Coli
- group B haemolytic streptococcus
What organisms contribute to acquired pneumonia with a baby in hospital.
- staphylococcus aureus
- pseudomonas
How do we treat pneumonia?
With the appropriate antibiotics after doing a blood culture
What is a pneumothorax?
Presence of air in the pleural space(this is the space between the lung and the chest wall)
What are the common causes of a pneumothorax in an infant?
- meconium aspiration
- hyaline membrane disease especially if on CPAP
- vigorous resuscitation after birth
What are the signs of a pneumothorax?
Hyper resonance on the affected side
Baby will become apnoeic and cyanosed
Diminished breath sounds
What is the treatment for a pneumothorax in a baby?
Most of them will resolve spontaneously
But some may need needle aspiration or chest tube drainiage
What is persistent pulmonary hypertension?
This is the failure of the arterial pressure of the fetus to fall after birth
This leads to increased SVR and right to left shunting via the patent ductus arteriosus or foramen ovale
How do we diagnose PPHN?
By doing a cardiac ultrasonography
How do we treat persistent pulmonary hypertension?
We start by giving supplemental oxygen
Then inotropes to reduce the shunting
And then sildenafil or nitric oxide to dilate the pulmonary arteries
What is a diaphragmatic hernia?
Hernia Timon of the abdominal contents through the diaphragm and this usually occurs on the left side
What are the main signs of diaphragmatic hernias?
- Cyanosis
- Apnoea
- shift of the mediastinum
- bowel sounds in the chest cavity
What is bronchopulmonary dysplasia?
-it is a chronic lung disease in which preterm infants require prolonged supply of oxygen
Does bronchopulmonary dy dysplasia have high morbidly and mortality?
Yes
What can we use in the management of bronchopulmonary dysplasia?
Give steroids in the first 8 days of life
CPAP over a ventilator
What are the possible infections that the baby can get from the mother associated with respiratory distress?
- maternal chorioamnionitis
- maternal fever
- prolonged rupture of the membranes >18 hrs
We would do a FBC and blood culture on these babies, CXR, blood gas
The treatment for these infections is penicillin and gentamicin
