Respiratory Emergencies in the Neonate Flashcards
Signs of respiratory distress?
High RR (>60) o Laboured breathing Beware retinopathy of prematurity if on high O2 levels
Chest wall recessions
Nasal flaring
Expiratory grunting (PAP)
Cyanosis (if severe)
What is Transient Tachypnoea of the Neonate (TTN)?
Most common cause of respiratory distress in term infants
short -lived <48 hours, rapid breathing.
due to delay in resorption of lung fluid
Investigations for TTN?
Cyanosis, high RR (i.e. >60)
CXR → fluid in horizontal fissure
Diagnosis made after exclusion of other causes
Management for TTN?
Usually settles within first day of life
Additional O2 if required
What is persistent pulmonary hypertension?
life threatening condition due to high pulmonary vascular resistance - right to left shunting within the lungs.
associated with birth asphyxia, meconium aspiration, septicaemia, RDS
Signs and symptoms of persistent pulmonary hypertension?
Cyanosis after birth
Absent heart murmurs and signs of HF
Investigations for persistent pulmonary hypertension?
CXR - normal sized heart but some pulmonary oligaemia
o Echocardiogram (urgent) = ensure no cardiac defect
Management of persistent pulmonary hypertension?
Medications:
§ O2
§ NO (inhaled)
§ Sildenafil
o Ventilation:
Mechanical ventilation / circulatory support
High-frequency (oscillatory) ventilation
(SEVERE) Extracorporeal membrane oxygenation (ECMO) ± heart and lung bypass
What is Chronic Lung Disease of Prematurity (CLD)?
- When infection, barotrauma or iatrogenic injury causes chronic lung problems
- lung damage due to pressure and volume trauma from artificial ventilation, O2 toxicity
more common in premature infants, with low birthweight or gestational age
Signs and symptoms of CLD?
23-26weeks progresses from ventilation to CPAP to supplementary O2.
initially positive response but then an increase in O2 and ventilation requirements
barotrauma or iatrogenic injury causes chronic lung problems
Investigations for CLD?
CXR à widespread opacification
CBG or VBG à acidosis, hypercapnia, hypoxia
Management of CLD?
Respiratory support = prolonged artificial ventilation à wean to CPAP à wean to additional O2
(±) Corticosteroid therapy – dexamethasone for short term clinical improvement (limit use due to concern about abnormal neuro development and other adverse effects)
What is Respiratory Distress Syndrome?
Deficiency of surfactant (phospholipids and proteins produced by type II pneumocytes)
Who is at risk of RDS?
Common if born <28w gestation
50% born 26-28w
25% born 30-31w
male, diabetic mothers
Signs and symptoms of RDS?
Delivery (up to 4 hours)
High RR (>60)
Laboured breathing with recessions and nasal flaring
Expiratory grunting (baby trying to make +ve airway pressure)
Cyanosis (if severe)
Investigations for RDS?
Clinical diagnosis
Pulse Oximetry
CXR -> pneumothorax, ground-glass, indistinct heart border
Management for RDS?
Antenatal:
Steroid therapy (delivery <34w)
Tocolytic therapy so steroids have at least 24 hours to work
Postnatal:
O2 and ventilation
CPAP or artificial ventilation
What is a pneumothorax and what causes it in a newborn?
A collapsed lung
Due to RDS or ventilation used to treat RDS.
What can pneumothorax lead to in the newborn?
pulmonary interstitial emphysema - collection of air outside the alveoli, due to alveoli rupture
What is meconium aspiration and ileus?
respiratory distress in the newborn due to presence of meconium in trachea - mechanical obstruction –> pneumonia/infection
increased risk the greater age
Risk factors for MA?
GA >42 weeks fetal distress/hypoxia meconium stained amniotic fluid maternal history of smoking/substance abuse oligohydroamnios chorioamniotis
Signs and symptoms of MA?
Respiratory distress – increased RR, chest retraction and hypoxia
Investigations of MA?
CXR
FBC/CRP/Culture
Management of MA?
Observe
IV ampicillin/gentamicin
O2 and NIV
What is meconium ileus?
thick sticky meconium that hasnt passed within 24 hours
child may vomit it rather than passing through stool
associated with cystic fibrosis and biliary atresia.
