Respiratory: Neonate Lung Disease

Question 1

What are the five neonate lung diseases should consider? [5]

Answer 1

Hyaline Membrane Disease
Bronchopulmonary Dysplasia
Transient Tachypnea of the Newborn
Meconium Aspiration Syndrome
Neonatal Pneumonia

Question 2

Describe what is meant by hyaline membrane disease [1] and how it would present (clinically [3] and on imaging [4]

Answer 2

Lack of sufficient surfactant production

Clinical findings:
* Symptoms present in first 2 hours of life
(Symptoms that begin > 8 hrs are not due to HMD)
* May increase severity from 24 - 48 hours
* Then, gradual improvement > 48-72 hours

Imaging:
* Typically, diffuse “ground-glass” or finely granular appearance
* Bilateral and symmetrical distribution
* Air bronchograms are common
* Hypoaeration in non-ventilated lungs (Hypoaeration in non-ventilated lungs)

Question 3

Tx plan for hyaline membrane disease? [4]

Answer 3

• Positive end-expiratory pressure (PEEP
• Continuous positive airway pressure (CPAP)
• Surfactant administered via ETT
• Oxygen and diuretics

Question 4

Describe what is meant by Bronchopulmonary Dysplasia (AKA Chronic Respiratory Insufficiency of the Premature) [2]

Answer 4

BPD is consequence of early acute lung disease
- One definition involves an oxygen requirement at 28 days of life to maintain arterial oxygen tensions >50 mm Hg accompanied by abnormal chest radiographs

Question 5

What imaging findings would you get for Bronchopulmonary Dysplasia (AKA Chronic Respiratory Insufficiency of the Premature)?

Answer 5

• May be impossible to distinguish early stages of BPD from later stages of HMD
• Coarse, irregular, rope-like, linear densities
• Represents atelectasis or fibrosis
• Lucent, cyst-like foci
• Hyperexpanded areas of air-trapping
• Hyperaeration of the lungs

Question 6

Describe what is meant by Transient Tachypnea of the Newborn (TTN) [1]

Which populations is it exibiited in? [2]

Answer 6

Transient Tachypnea of the Newborn (TTN):
- Mild respiratory distress immediately after birth that resolves in several hours
- Usually full-term or slightly preterm

Question 7

Imaging findings for TTN? [4]

Answer 7

Imaging Findings
* Hyperinflation of the lungs
* Fluid in the fissures
* Laminar effusions
* Fuzzy vessels

Question 8

Tx for TTN? [3]

Answer 8

Treatment
* Oxygen
* Maintenance of body temperature
* Improvement most often occurs in < 24 hrs

Question 9

What is the most common cause of neonatal respiratory distress in full-term/postmature infants? [1]

Answer 9

Meconium Aspiration Syndrome

Question 10

What is the most common cause of neonatal respiratory distress in premature infants? [1]

Answer 10

Hyaline membrane disease most common cause in premature infants

Question 11

What is the pathogenesis of MAS? [2]

Answer 11

Meconium products produce bronchial obstruction and air-trapping
Chemical pneumonitis

Question 12

Describe the clinical picture of MAS [2]

Answer 12

Post-mature
Severe respiratory distress almost immediately
Respiratory distress more severe than TTN

Question 13

What are the imaging findings of MAS? [4]

Answer 13

• Diffuse “ropey” densities (similar to BPD)
• Patchy areas of atelectasis and emphysema from air-trapping
• Hyperinflation of lungs
• Spontaneous pneumothorax and pneumomediastinum