respiratory problems in the nnewborn Flashcards
what is the most common respiratory disorder in preterm babies ?
respiratory distress syndrome
what are the general signs of respiratory distress ?
tachypnea
nasal flaring
retractions
expiratory grunting
what are the predisposing factors related to the mother that may cause RDS ?
maternal diabetes
hypothyroidism
what factors reduce the risk of RDS ?
IUGR
maternal corticosteroids
when should antenatal steroids be administered to the mother to avoid RDS ?
2 doses 12 hours apart at 24-34 gestational age
or
at 35-36 weeks with antepartum haemorrhage and rupture of membranes
what are the preparations available for surfactants ?
curosurf
Survanta
KL4
what are the schedules for surfactant use in neonatal respiratory distress syndrome ?
early selective- prophylactic but only if the baby is ventilated
rescue - to ventilated infants with clinical and radiological signs of RDS
what time period is RDS usually diagnosed at ?
at birth or within the first 4 hours of birth
what are the differential diagnosis of RDS ?
pneumonia
sepsis ( esp group b strep )
what is the typical radiological appearance of RDS ?
small volume lungs
homogenous ground glass opacity
air bronchogram
what interventions may change the appearance of the X-ray findings in RDS ?
CPAP tends to result in lungs of normal size
surfactant administration given before the x-ray can result in a less homogenous appearance
how can RDS be prevented ?
by the prevention of prematurity
administration of antenatal steroids ( dexamethasone and betamethasone )
prevention of postnatal asphyxia
avoiding drug depression and polyhydraminous
what is the management of RDS ?
Oxygen
surfactant administration
ventilation
what is the oxygen saturation target ?
91-95% to avoid hyperoxia
what are the complications of RDS ?
Air leaks pneumothorax
PDA
periventricular intraventricular Hge
bronchopulmonary dysplasia
when do babies with RDS develop CLD ?
chronic lung disease develops when the baby becomes ventilator dependent or oxygen-dependent
what is the management for pneumothorax ?
decompress by inserting a chest tube
what are the diagnostic criteria of BPD ?
at 28 days :
- positive pressure ventilation during the first 2 weeks of life for a minn of 3 days
- clinical signs of abnormal resp function
- requires oxygen supplementation for longer than 28 days to maintain Pao2 >50 mmHG
- chest imaging with findings of BPD
what are the radiological findings in a chest x-ray of an infant with BPD ?
hyperinflation
low diaphragm
atelectasis
what is the management for BPD ?
short and low doses of corticosteroids
may go home with supplemental oxygen
what is apnea ?
cessation of breathing for more than 20 seconds
or
associated with bradycardia (<100)
or
associated with cyanosis , pallor , hypotonia
what is the main risk factor for apnea ?
very low birth weight
what is the most important etiology of apnea of prematurity ?
prematurity lol
what are the different causes of apnea of prematurity ?
central : immaturity of the brain stem centers
obstructive : excessive secretion, neck flexion
mixed apnea
