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Perinatal Medicine > Respiratory Distress Syndrome > Flashcards

Respiratory Distress Syndrome Flashcards

1
Q

Who is at risk of HMD?

A

Preterm infantsInfants of diabetic mothers

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2
Q

What is the pathophysiology of HMD?

A

Surfactant deficiency –> increased surface tension causes progressive atelectasis and increased effort of breathing

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3
Q

What inhibits surfactant production?

A

Hypoxia, hypothermia and acidosis

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4
Q

What is the natural history of HMD?

A

Respiratory distress soon after birth –> progressively worsens in next 72 hours –> improves after then as baby starts producing surfactant Usually resolves within one week

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5
Q

What are the typical clinical features of HMD?

A

Preterm infantInactivePoor tone- frog positionOedematous

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6
Q

What are the CXR features of HMD?

A

Under expanded lungsBilateral diffuse reticular-granular ‘ground-glass’ infiltrates Air-bronchograms

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7
Q

What are the 6 complications of HMD?

A

Respiratory failureChronic lung disease2ry bacterial pneumoniaPDA–> cardiac failurePeri- and intraventricular haemorrhage Pneumothorax

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8
Q

How to prevent HMD?

A

Avoid preterm labour and elective C/S before 39/40BMZ if

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9
Q

What are the 5 parameters in managing HMD?

A

Relieve hypoxiaClose monitoringTemperature controlNutritionCorrect acidosis

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10
Q

How is hypoxia relieved in HMD?

A

Respiratory support given- NPO2–> CPAP –> IPPV–> HFOVOxygen therapy - monitored sats (88-92), FiO2, paO2 (7-10kPa)Surfactant replacement therapy (in&out)

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11
Q

How is temperature controlled in HMD and what is the aim?

A

Incubator temperature between 31-34*CAim to maintain neutral thermal environment as to minimize oxygen requirement

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12
Q

What parameters and monitored?

A

BP (inotropes given if needed)Hb (blood transfusion if needed)Heart rateTemperatureGlucoseSaturations

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13
Q

What is the nutrition plan for an infant with HMD?

A

IV fluids, electrolytes and energy requirements ASAPMilk feeds via nasogastric tube if infant tolerates themTotal parenteral nutrition (TPN) if unable to tolerate feeds

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14
Q

How is acidosis in HMD corrected if respiratory in origin?

A

If respiratory acidosis, it is caused by increased paCO2, therefore corrects by improving ventilation.Mild respiratory acidosis is usually tolerate and ventilation not needed.

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15
Q

How is acidosis in HMD treated if metabolic in origin?

A

If metabolic acidosis, then should improve with adequate ventilation and hydration.

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16
Q

What is believed tap cause TTN?

A

Delayed clearing of fetal lung fluid into the pulmonary capillaries and lymphatics after delivery –> interferes with gas exchange and increased the work of breathing

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17
Q

Who is at risk of TTN?

A

Term infants born by elective C/S Can affect prems and NVDs

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18
Q

What is the natural history of TTN?

A

Respiratory distress within 1-2 hours of birth –> Improves within 24-48 hours, but tachypnoea can last for a few days

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19
Q

What are the clinical features of TTN?

A

Hyper inflated chestRespiratory support may be needed but O2 usually not >40%IPPV not usually needed

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20
Q

What are the CXR findings in TTN?

A

Normal lung volume but increased vascular markings Prominent hilar streakingFluid in lung fissures

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21
Q

How do you manage an infant with TTN?

A

Monitor closelyRespiratory support as neededSupportive measures as needed, but usually systemically well

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22
Q

Who is at risk of meconium aspiration?

A

Term or post-term infants who become stressed in utero

23
Q

What increases the risk of meconium aspiration?

A

Infant that is wasted or UGA

24
Q

When is the meconium aspirated?

A

Either at delivery or during gasping in utero when stressed

25
Q

What are the two clinical sequelae following meconium aspiration and how do they arise?

A

Chemical irritation –> pneumonitisParticulate matter blocks bronchi and bronchioles –> areas of emphysema and atelectasis

26
Q

What are the 6 complications of meconium aspiration?

A

Respiratory failurePneumomediastinum or pneumothoraxHIEPPHN2ry bacterial infectionChronic lung disease

27
Q

What are the clues pointing toward meconium aspiration?

A

Meconium staining of the placenta and cord, skin and nails

28
Q

What are the CXR features of meconium aspiration?

A

Hyper inflated chestPatchy areas of collapse and overdistensionSigns of complications such as PTX

29
Q

When do you suction an infant?

A

When there is evidence of meconium staining, and the infant when delivered is not vivacious or breathing.

30
Q

If an infant is meconium stained, and cries well after deliver, do you suction the infant?

A

No

31
Q

An infant born after signs of fetal distress is delivered floppy and not breathing, what is the immediate management?

A

Resus the infant. If meconium evident, suction the mouth then the nose, and then dry the infant to stimulate respiration. Continue with resus algorithm if no response.

32
Q

How is suction performed?

A

Large bore catheter used, 8/10FInserted to 5cm for 5 secondsSuction pressure

33
Q

What can occur if infant is suctioned too vigorously?

A

Vagal bradycardia LaryngospasmDelayed onset of breathing

34
Q

How do you manage an infant with meconium aspiration?

A

Suction if indicatedProvide respiratory support as neededGastric lavage - 2% sodium bicarbonate to prevent gastritisGeneral supportive measuresSurfactant may be beneficialMonitor closely Antibiotics if needed

35
Q

What are the ideal saturation a for a baby with meconium aspiration and why?

A

> 95%. You want to prevent the infant developing PPHN and there are fewer risks of O2 toxicity in term infants.

36
Q

Why can surfactant be beneficial in an infant with meconium aspiration?

A

Condition can lead to secondary surfactant deficiency due to the hypoxia

37
Q

Which infants are at risk for developing pneumonia?

A

PROM >18 hoursPPROMPTLChorioamnionitisMaternal untreated chronic infection, such as syphilis

38
Q

What are the signs of chorioamnionitis?

A

Maternal pyrexiaFoul smelling liquorFetal tachycardiaUterine tendernessLeucocytosis

39
Q

How do you differentiate between nocosomial pneumonia and pneumonia contracted from the mother?

A

An infant who contracts pneumonia from the mother develops signs in the first 72 hours, where as a nocosomial pneumonia develops after 72 hours

40
Q

What is the pathogenesis of a maternal,y acquired pneumonia?

A

The infant is exposed to organisms in utero or during passage through the birth canal

41
Q

What are the most likely causes of a congenital pneumonia?

A

E. ColiGroup B streptococcus Chronic infections suchas syphilis, rubella, CMV.

42
Q

What are the most likely causes of nocosomial pneumonia?

A

Staph aureusKlebsiellaPseudomonas

43
Q

How would an infant with pneumonia clinically present?

A

Apnoeic spellsRespiratory distressSepticaemia

44
Q

How does septicaemia present in a neonate?

A

LethargyPoor tonePoor handling Poor perfusionAbdominal distention (septic ileus) Vomiting

45
Q

What are the complications of pneumonia in the neonate?

A

SepticaemiaRespiratory failureChronic lung disease

46
Q

What is the management plan for an infant with pneumonia?

A

Septic screenAntibioticsGeneral supportive measuresRespiratory support

47
Q

What does a septic screen involve?

A

Blood cultureFull blood count with differentialCRP

48
Q

How would you use antibiotics to treat a neonate with pneumonia?

A

Start with empiric broad spectrum antibiotics, then use more specific antibiotic once organism organism identified, using rx that is specific to local resistance patterns

49
Q

What are the CXR findings in an infant with pneumonia?

A

Similar to HMD, especially if GBSPatchy distribution of consolidation and infiltratesAir-bronchograms

50
Q

Signs needed to diagnose RDS

A 
Two or more of:
Tachypnoea >60
Central cyanosis (room air)
Grunting
Sternocostal recession
51
Q

Respiratory causes of RDS

A
  • HMD
  • TTN
  • MAS
  • pneumonia
  • Chronic lung disease
  • Pneumothorax
  • Lung hypoplasia
52
Q

Non-respiratory causes of RDS

A 
Hypothermia
Metabolic acidosis
Anaemia
Polycythemia 
PDA
Heart disease
Diaphragmatic hernia
53
Q

Causes on pneumothorax in neonate

A

MAS
HMD
Vigorous resuscitation after birth

Perinatal Medicine (14 decks)

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