Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Respiratory Distress Syndrome / Neonatal SOB > Flashcards

Respiratory Distress Syndrome / Neonatal SOB Flashcards

1
Q

What happens to the fluid in a neonates lungs before, during and after birth?

A
  • In utero the lungs are full of fluid & pulmonary blood vessels are constricted.
  • Shortly before and during labour respiratory fluid secretion is reduced.
  • The lung fluid is removed by the squeezing of the foetus’s thorax during vaginal delivery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal physiology of a neonates first breath and subsequent breathing?

A
  • Breathing is triggered by
    • thermal (keep warm but its cold vs womb)
    • tactile (rub them with towel)
    • hormonal stimuli

The first breath:

  • normally occurs within 6 seconds of delivery.
  • remainder of the lung fluid is absorbed into the pulmonary lymphatics and circulation.

Neonatal respiratory rate is 30-50 breaths per minute,

  • through the nose (obligate nose breathers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is transient tachypnoea of the newborn common, less common or rare as a cause of SOB in a neonate?

A

Common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

are the following conditions common, less common or rare as a cause of SOB in a neonate?

  • Respiratory distress syndrome
  • meconium aspiration
  • pneumonia
  • pneumothorax
  • persisteny pulmonary HTN of newborn
A

Less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

are the following conditions common, less common or rare as a cause of SOB in a neonate?

  • Diaphragmatic hernia
  • pulmonary hypoplasia
  • lung anomalies
  • airways obstruction e.g. choanal atresia (congenital stenossi of the psoterior nasal apertures blocking the posterior nasal cavity of L or right nostil and nasopharynx)
  • pulmonary haemorrhage
  • neuromusular disorder
  • tracheo-oesophageal fistula
A

Rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do these non-pulmonary (neonatal) conditions all have in common?

  • Congenital heart disease
  • Heart failure
  • Sepsis
  • Severe anemia
  • Metabolic acidosis
  • intracranial birth trauma or encepalopathy
  • hypoxic ischaemia encepathopathy
A

they cause SOB in a neonate!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of SOB in a neonate?

A
  1. ABCDE
  2. ABG
  3. CXR
  4. Blood cultures
  5. Antibiotics FOR ALL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What antibiotics do you give a neonate if you suspect meningitis?

A
  • For suspected meningitis (they’ll look really sick)
    • benpen
    • gentamicin
    • or cephtriaxone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

listeria can cause infection in neonates (<1m old). What antibiotic do you give?

A

Amoxicillin

if suspect listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What bacteria may cause SOB in neonates (<1month)?

A
  • group A strep
  • G -ves
  • Listeria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What microorg may cause SOB in >1 month olds?

A
  • Strep pneumoniae
  • group A strep
  • HiB
  • meningococcus
  • VIRUSES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathophysiology of Respiratory distres syndrome (RDS)?

A
  1. There is a deficinecy of alveolar surfactant
  2. aka proteins, phospholipids excreted by type 2 pneumocytes
  3. this leads to alveolar collapse, atelectasis,
  4. reinflation with each breath exhausts the baby and respiratory failure follows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the hypoxia caused by RDS respiratory failure cause?

A
  • hypoxia –>
  • decreased cardiac output –>
  • hypotension –>
  • acidosis –>
  • renal failure–>

major cause of death from prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for RDS?

A
  1. prematurity
    • especially <28 weeks
    • or no maternal antenatal corticosteroids
  • maternal diabetes (can occur at term)
  1. males
  2. 2nd twin
  3. caesarians
  4. preterm prelabour rupture of membranes (PPROM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs of respiratory distress seen in neonates and in what timeframe do you see these?

A

these signs of RDS are seen within 4 hrs after delivery

  • increased work of breathing
  • tachyponea e.g. >60/min
  • grunting
  • nasal flaring
  • intercostal recession
  • cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes transient tachypnoea of the newborn?

(A ddx for RDS in SOB neonate)

How do you Dx and Rx it?

A
  • is due to excess lung fluid
  • caused by delayed absorption of the lung fluid
  • TF RF: elective C-section!
  • normally resolves after a day or 2

Dx: of exclusion, supported by fluid in the horizontal fissure on a CXR

Rx: use O2 for a few days until the symptoms resolve

17
Q

What causes congenital pneumonia?

(A ddx for RDS in SOB neonate)

A

Group B strep

18
Q

What is a characteristic of a neonate having a tracheo-oesophageal fistula?

A

resp problems after feeds

TF it is ddx for RDS in SOB neonate

19
Q

What would a CXR of RDS show?

A

diffuse “ground glass” appearance

that indicates a partial filling of air spaces in the lungs by exudate or transudate)

+/- air bronchograms

20
Q

What is the prevention of RDS?

A

Betamethasone or dexamethasone should be offered to all women at risk of pre-term delivery from 23-35 weeks;

(mothers at high risk should be transferred to perinatal centres with experience in managing RDS)

  • 2x doses of betamethasone/dex should happen
  • the last being at least 24hrs before birth

Delayed cord camping (now normal practice) promotes placento-foetal transfusion (of the steroids?)

21
Q

What do you do for a baby whos mother has not recieved antenatal steroids (betame/dexa) before 24hrs of the birth?

A
  • Synthetic surfactant given to baby via tracheal tube
  • oxygen +/- CPAP via nasal cannulae
  • artificial ventilation also via tracheal tube
  • continuous monitoring of O2, blood gas and chest wall movements
22
Q

Why when giving artificial ventilation/oxygen to a newborn should you aim for sats of 85-93%?

A

to avoid:

  • Retinopathy of prematurity
  • Bronchopulmonary dysplasia (formerly known as chronic lung disese of infancy)

NB: pneumothorax can be caused by artifical ventilation so it is used as little as possible

23
Q

What are the complications of RDS?

A
  • Pulmonary or intra-ventricular haemorrhage
  • pulmonary infection
  • Persistent pulmonary hypertension of the new born
  • renal failure (via hypoxia–>acidosis/dc CO & hypotension)
  • DEATH

[&retinopathy of prematurity, Pneumothorax caused by artificial ventilation & Bronchopulmonary dysplasia (chronic lung disease of infancy); why keep sats @85-93%}

24
Q

How does bronchopulmonary dysplasia cause persistent hypoxia?

A

the pressure & volume trauma caused by artificial ventilation,

–> oxygen toxicity and infection

–> persistent hypoxia +/- difficult ventilator weaning

e.g. Still needed ventilation at 36wks

25
Q

A CXR of a neonate shows hyperinflation, rounded, radiolucent areas alternating with thin dense lines, what does this show?

A

Bronchopulmonary dysplasia

26
Q

Histology shows necrotisin bronchiolitis with alveolar fibrosis. What condition is this related to?

A

bronchopulmonary dysplasia

27
Q

What are the complications of bronchopulmomary dysplasia?

A
  • feeding problems (O2 desaturation during feeding),
  • severe RSV bronchiolitis,
  • GOR,
  • Cerebral Palsy /low IQ,
  • asthma & exercise limitation
28
Q

How do you prevent bronchopulmonary dysplasia?

A
  • antenatal and postnatal steroids
  • surfactant
  • high calorie feeding

(ideally dont put on artificial ventilation / prevent infections too i guess)

29
Q

Which infection is the most frequent cause of early onset e.g. < 7 days, severe infection in newborn infants?

A

Group B streptococcus infection

30
Q

What is a neonates immune system like physiologically?

A
  • Neonates have great macrophages (2x adults)
  • but rest is non-existant
  • relies on mothers IgG via placenta
  • IgA (mucosa) & IgG & maternal lymphocytes (e.g. for specific rxns –>abs) are in milk but not ideal
  • TF Rx any sign of infection in neonates aggressively!
31
Q

Asphyxiation during birth and babies with listeria syndrome are risk factors for what condition?

Rx of this condition?

A

Meconium aspiration syndrome (MAS)

foetuses can pass meconium in response to hypoxia –> inhaled (sticky & chemically nasty) –> obstruction, pneumonitis, predisposition for infection, inactivates surfactants

TF Rx: w/sufactant, ventilation - inhaled NO (vasodilation) & abx maybe required …

NB: due to it being hard to achieve adequate oxygenation as infants develop pulmonary hypertension

32
Q

A CXR shows hyper-inflated lungs with areas of collapse and consolidation what condition is this asociated with?

A

Meconium aspiration syndrome

–> PTX can develop!

(breathed in sticky and chem nasty meconium ~during hypoxic epidose/infection –> incactivated surfactant)

33
Q

What are the signs and symptoms of a pneumothorax in a neonate?

Causes & Rx?

A

they can be asymptomatic or respiratory distress

O/E: decreased breath sounds & chest movment on the affected side

  • often PTX happen spontaneously
    • (babies put a LOT of work into their first breath so PTX happens in 2-4% + increased risk if ventilatied)

or secondary to

  • meconium aspiration or
  • artificial ventilation

Rx: insertion of a chest drain

34
Q

What would signs of respiratory distress and STRIDOR in a neonate indicate?

A

laryngomalacia or bronchomalacia

  • stridor = inspirational high pitched whistle/gasping sound –> airway obstruction @/below larynx level e.g. croup or epiglottitis too… requires med management*
  • (stertor = snoring-like noise @above level of larynx)*
35
Q

What are the consequences of having a diaphragmatic hernia, when are they Dx?

What is the Rx?

A

Diaphragmatic hernia can be diagnosed antenatal w/intestines seen in the thorax or on CXR post-natal

  • they are normally left sided –>
  • result in left lung hypoplasia from development –>
  • & bowel there displaces apex of heart to right

Rx:

  • NG tube for suction to prevent distension or intrathoracic bowel (and give lung tissue space to expand)
  • surgery once stable
36
Q

What causes persistent pulmonary hypertension of a newborn?

A

spontaneous

or secondary to:

  1. meconium aspiration,
  2. birth asphyxia,
  3. diaphragmatic hernia,
  4. sepsis or
  5. respiratory distress syndrome.

anything causing increased WOB/SOB(?)

37
Q

What can a neonate having persistent pulmonary hypertension lead to (the consequences)?

Rx?

A
  • right-to-left shunting of blood (from high pressure in RHS now)
  • across a patent foramen ovale or ductus arteriosus

Rx:

circulatory and resp support

vasodilator agent e.g. nitric oxide / sildenafil (viagra lol)

Paediatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions