Respiratory Distress in Newborns -Warren Flashcards
How does infant respiratory physiology differ from adults?
- More compliant chest wall
- Greater reliance on diaphragm over intercostal muscles
- Small and fewer alveoli than adults
- Smaller and collapsible intrathoracic airways
What is a normal respiratory rate for a newborn? A. 10 b/min B. 20 b/min C. 40 b/min D. 70 b/min E. 100 b/min
C. 40 b/min
What is considered tachypnea in young infants? Infants? Childhood?
Young infants=> 60breaths/min
infants >50 /min
childhood > 40 /minute
What does grunting indicate?
severely distressed pt
-try to raise peak and expiratory pressures to avoid collapse of alveoli during expiration
A 25 G1 female delivers emergently at 30 weeks gestation because of severe eclampsia. In the delivery room, the premature infant is noted to have increased work of breathing with respiratory rate of 80 b/min, and an elevated heart rate of 170 bpm and O2 sat at 90% RA. What is the likely diagnosis? A. Neonatal pneumonia B. Transient tachypnea of the newborn C. Meconium aspiration syndrome D. Respiratory distress syndrome
D. Respiratory distress syndrome
What is respiratory distress syndrome in a newborn due to?
deficiency of pulmonary surfactant in the immature lung
*disease of prematurity
*Which cells produce surfactant in the lungs? When does this normally occur?
Type II pneumocytes
normally begins at 24 weeks
What can be given to a pregnant woman to help mature the lungs of her fetus? Who should be given this?
antenatal corticosteroids:
- enhange maturation in lung and inducing enzymes
- stimulate phospholipid synthesis and release of surfactant
- should be given to all pregnant mothers at risk for preterm delivery at or less than 34 weeks gestation
What lab test result indicates a mature fetal lung? When does this normally occur?
L:S (lecithin:sphingomyelin) ratio >2
normally around 36 weeks gestation
How is the diagnosis of respiratory distress syndrome made?
- Onset of progressive respiratory failure shortly after birth
- Characteristic chest radiograph
- ABG (Hypoxia, Hypercarbia)
A 25 G1 female delivers emergently at 30 weeks gestation because of severe eclampsia. In the delivery room, the premature infant is noted to have increased work of breathing with respiratory rate of 80 b/min, and an elevated heart rate of 170 bpm and O2 sat at 90% RA. What is the likely diagnosis? A. Neonatal pneumonia B. Transient tachypnea of the newborn C. Meconium aspiration syndrome D. Respiratory distress syndrome
D. Respiratory distress syndrome
What is the treatment for Respiratory distress syndrome?
- surfactant therapy
- assisted ventilation techniques
- supportive care (thermoregulation, fluid management, nutrition)
1 hour old Term baby boy with tachypnea (RR 70s) born via C/S, GBS neg PE: Moderate retractions O2 sat 88% on RA O2 sat 100% on 100%
What is the likely diagnosis? A. Neonatal pneumonia B. Transient tachypnea of the newborn C. Meconium aspiration syndrome D. Respiratory distress syndrome
B. Transient tachypnea of the newborn
When is transient tachypnea of the newborn normally diagnosed? What are the clinical findings?
- Usually occurs in term or near-term infants
- Often after cesarean delivery
- Relatively benign, self-limited disease
- 11:1000 births, M>F
-Tachypnea (>60 bpm) shortly after birth, lasts 1-5 days
A 25 G1 female delivers emergently at 30 weeks gestation because of severe eclampsia. In the delivery room, the premature infant is noted to have increased work of breathing with respiratory rate of 80 b/min, and an elevated heart rate of 170 bpm and O2 sat at 90% RA. What is the likely diagnosis? A. Neonatal pneumonia B. Transient tachypnea of the newborn C. Meconium aspiration syndrome D. Respiratory distress syndrome
D. Respiratory distress syndrome
When is transient tachypnea of the newborn normally diagnosed? What are the clinical findings?
- Usually occurs in term or near-term infants
- Often after cesarean delivery
- Relatively benign, self-limited disease
- 11:1000 births, M>F
-Tachypnea (>60 bpm) shortly after birth, lasts 1-5 days
What is the treatment for transient tachypnea of the newborn?
- does not normally require mechanical ventilation and normally improves within 24 hours.
- if not, consider other causes of distress
1 hour old term baby girl born vaginal delivery with fetal distress , emerged limp
Exam with grunting, retractions, requiring intubation. X-ray looks like shit.
What is your likely diagnosis?
A. Neonatal pneumonia
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Respiratory distress syndrome
C. Meconium aspiration syndrome
What is meconium? Is it normal for this to be in amniotic fluid?
- first intestinal discharge from newborns
- a viscous, dark green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions (bile)
-NOT NORMAL. intrauterine distress can cause the passage of meconium into amniotic fluid
1 hour old term baby girl born vaginal delivery with fetal distress , emerged limp
Exam with grunting, retractions, requiring intubation. X-ray looks like shit (patchy infiltrates).
What is your likely diagnosis?
A. Neonatal pneumonia
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Respiratory distress syndrome
C. Meconium aspiration syndrome
How does meconium aspiration affect the neonate?
- direct toxicity –> chemical pneumonitis
- inactivation of surfactant
- activation of complement
- vasoconstriction
- airway obstruction
- secondary pulmonary HTN
- ball-valve phenomenon: during inspiration air goes into the lower airways but the airway collapses with expiration, trapping air in the lower airways –> hyperinflation
1 hour old term baby girl born vaginal delivery with fetal distress , emerged limp
Exam with grunting, retractions, requiring intubation. X-ray looks like shit (patchy infiltrates).
What is your likely diagnosis?
A. Neonatal pneumonia
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Respiratory distress syndrome
C. Meconium aspiration syndrome
What is the treatment for meconium aspiration?
- Neonatal Resuciation guidelines: endotracheal suction below cords if limp
- Intubation, mechanical ventilation
- Surfactant
- Nitrus Oxide
- Prevent secondary infection
What can congenital diaphragmatic hernias cause? Where do 95% of these occur?
- pulmonary hypoplasia due to the herniation of intestinal contents into the thoracic cavity
- 95% through the posterior foramen of Bochdalek (posterior and lateral to the spine–> most on left)
