Respiratory distress of the newbom.

Question 1

what are the most common factors for RDS ?

Answer 1

weight less than 1.5 kg 
preterm fetus 
diabetic mother 
c section - no vaginal squeeze 
intrapartum and postpartum asphyxia

Question 2

what are the clinical signs and symptoms

Answer 2

low apgar score 
high silverman 
cyanosis 
tachypnea 
tachycardia 
nasal flaring 
intercostal and subcostal retraction 
expiratory grunting

Question 3

why is there an expiratory grunting ?

Answer 3

infant exhales against a partially closed glottis. This

maintains back pressure on the airways and prevents the alveoli from collapsing. Severely affected infants will grunt with every breath.

Question 4

what is the pathophysiology of hyaline membrane found in RDS?

Answer 4

the decreased surfactant produced gives into atelectasis
there is alveolar hypo diffusion
ischemia of the lung
this changes the alveoli permeability to be leaky allowing the entrance of hyaline membrane = which is porteinacsous and cellular debris = this further impairs the gas exchange

Question 5

in histology what is the appearance of hyaline membrane disease ?

Answer 5

hyaline membrane lining the lung made up of blood and fibrin
dilated ducts and atelectasis

Question 6

with the signs and symptoms what other differential diagnosis can be made

Answer 6

diaphragmatic hernia

pneumothorax

Question 7

however how can we diagnose res distress syndrome ?

Answer 7

chest x ray
= resembles ground glass appearance = reticulogranular densities
WITH AIR BRONCHOGRAMS
and CARDIOMEGALY

blood glucose =
hypoglycaemia

-----
blood gas analysis 
hypoxia- frist 
then later 
hypercapnia 
acidosis

Question 8

what is the treatment for respiratory distress syndrome ?

Answer 8

give oxygen support to prevent hypoxia
= measure its effects through pulse , oxygen saturation and vital signs

infants in a thermal environment

expiratory grunt = CPAP nasal or oral
nasal between 50 and 70 mm Hg (91–95% SaO 2 )
CPAP will stabilise the alveoli and decrease the atlectaisis

infants with respiratory or ventilatory failure or apnea = need mechanical ventilation

direct installation of artificial surfactant where infants are intubated or ventilated

apnea or irregular respration = ominous sign = immediate intervention

Question 9

when does respiratory distress syndrome first occur after birth ?

Answer 9

4 hours after birth

Question 10

what is the cause of respiratory distress syndrome ?

Answer 10

premature infants
fetal asphyxia

high risk 
maternal diabetes 
multiple birth 
c section - no vaginal contraction 
precipitous delivery 
asphyxia 
cold stress

Question 11

risk of RDS is reduced in what cases ?

Answer 11

chronic or pregnancy associated hypertension
maternal heroin use
prolonged rupture of membranes
antenatal corticosteroid prophylaxis

Question 12

how can we check if the lung is matured before birth

Answer 12

amniocentesis
check the L/S ratio and PG
greater than 2
and PG positive

it appears in the amniotic fluid between 28-32 weeks

Question 13

the combo of hypercapnia , hypoxia and acidosis causes pulmonary arterial vasoconstriction what can occur in this can ?

Answer 13

high to left shunting through foramen ovale and ductus arteriosusu
and within the lung itself

Question 14

severe RDS can have what complication ?

Answer 14

intraventricular haemorrhage

bronchopulmonary dysplasia

Question 15

if there is no treatment of RDS the signs and symptoms may worsen till when

Answer 15

peak till 3 days and progressive betterment

Question 16

what are the cause for death in RDS ?

Answer 16

pneumothorax
pulmonary haemorrhage
intraventricular hemorrhage

Question 17

through diagnosis what can mimic ads ?

Answer 17

total anomalous pulmonary venous return)
so echocardiography needs to be done in infants with no improvement after surfactant therapy to rule on cyanotic congenital heart disease

pneumonia in x ray

Question 18

what is congenial alveolar proteinosis ?

Answer 18

congenital surfactant protein B deficiency) is a rare familial disease that manifests as severe and lethal RDS in predominantly term and near-term infants

Question 19

prevention of RDS

Answer 19

Administration of antenatal corticosteroids to women before 37 wk gestation significantly reduces the incidence and mortality of RDS as well as overall neonatal mortality

Betamethasone and dexamethasone

Question 20

antenatal steroids also reduce what sort of diseases aswell /

Answer 20

incidence of severe IVH, necrotizing enterocolitis (NEC), and neurodevelopmental impairmen

Question 21

universally, but reasonable measures of respiratory failure are?

Answer 21

<7.20, (2) PaCO 2 ≥60 mm Hg, (3) SaO 2 <90% at
O2 concentration of 40–70% and nCPAP of 5-10 cm H2 O, and (4) persistent or
severe apnea

Question 22

what are the complications of endotracheal intubation

Answer 22

pneumothorax
sphyxia from obstruction or dislodgment of the tube, bradycardia during intubation or suctioning, and the subsequent development of subglottic stenosis