Respiratory Emergencies in the Neonate Flashcards

1
Q

Signs of respiratory distress?

A

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)

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2
Q

What is Transient Tachypnoea of the Neonate (TTN)?

A

Most common cause of respiratory distress in term infants

short -lived <48 hours, rapid breathing.

due to delay in resorption of lung fluid

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3
Q

Investigations for TTN?

A

Cyanosis, high RR (i.e. >60)

CXR → fluid in horizontal fissure

Diagnosis made after exclusion of other causes

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4
Q

Management for TTN?

A

Usually settles within first day of life

Additional O2 if required

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5
Q

What is persistent pulmonary hypertension?

A

life threatening condition due to high pulmonary vascular resistance - right to left shunting within the lungs.

associated with birth asphyxia, meconium aspiration, septicaemia, RDS

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6
Q

Signs and symptoms of persistent pulmonary hypertension?

A

Cyanosis after birth

Absent heart murmurs and signs of HF

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7
Q

Investigations for persistent pulmonary hypertension?

A

CXR - normal sized heart but some pulmonary oligaemia

o Echocardiogram (urgent) = ensure no cardiac defect

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8
Q

Management of persistent pulmonary hypertension?

A

Medications:

§ O2

§ NO (inhaled)

§ Sildenafil

o Ventilation:
Mechanical ventilation / circulatory support

High-frequency (oscillatory) ventilation

(SEVERE) Extracorporeal membrane oxygenation (ECMO) ± heart and lung bypass

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9
Q

What is Chronic Lung Disease of Prematurity (CLD)?

A
  • 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

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10
Q

Signs and symptoms of CLD?

A

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

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11
Q

Investigations for CLD?

A

CXR à widespread opacification

CBG or VBG à acidosis, hypercapnia, hypoxia

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12
Q

Management of CLD?

A

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)

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13
Q

What is Respiratory Distress Syndrome?

A

Deficiency of surfactant (phospholipids and proteins produced by type II pneumocytes)

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14
Q

Who is at risk of RDS?

A

Common if born <28w gestation

50% born 26-28w
25% born 30-31w

male, diabetic mothers

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15
Q

Signs and symptoms of RDS?

A

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)

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16
Q

Investigations for RDS?

A

Clinical diagnosis
Pulse Oximetry
CXR -> pneumothorax, ground-glass, indistinct heart border

17
Q

Management for RDS?

A

Antenatal:
Steroid therapy (delivery <34w)
Tocolytic therapy so steroids have at least 24 hours to work

Postnatal:
O2 and ventilation
CPAP or artificial ventilation

18
Q

What is a pneumothorax and what causes it in a newborn?

A

A collapsed lung

Due to RDS or ventilation used to treat RDS.

19
Q

What can pneumothorax lead to in the newborn?

A

pulmonary interstitial emphysema - collection of air outside the alveoli, due to alveoli rupture

20
Q

What is meconium aspiration and ileus?

A

respiratory distress in the newborn due to presence of meconium in trachea - mechanical obstruction –> pneumonia/infection

increased risk the greater age

21
Q

Risk factors for MA?

A
GA >42 weeks
fetal distress/hypoxia
meconium stained amniotic fluid
maternal history of smoking/substance abuse
oligohydroamnios
chorioamniotis
22
Q

Signs and symptoms of MA?

A

Respiratory distress – increased RR, chest retraction and hypoxia

23
Q

Investigations of MA?

A

CXR

FBC/CRP/Culture

24
Q

Management of MA?

A

Observe
IV ampicillin/gentamicin
O2 and NIV

25
Q

What is meconium ileus?

A

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.