respiratory problems in the nnewborn

Question 1

what is the most common respiratory disorder in preterm babies ?

Answer 1

respiratory distress syndrome

Question 2

what are the general signs of respiratory distress ?

Answer 2

tachypnea
nasal flaring
retractions
expiratory grunting

Question 3

what are the predisposing factors related to the mother that may cause RDS ?

Answer 3

maternal diabetes

hypothyroidism

Question 4

what factors reduce the risk of RDS ?

Answer 4

IUGR

maternal corticosteroids

Question 5

when should antenatal steroids be administered to the mother to avoid RDS ?

Answer 5

2 doses 12 hours apart at 24-34 gestational age
or
at 35-36 weeks with antepartum haemorrhage and rupture of membranes

Question 6

what are the preparations available for surfactants ?

Answer 6

curosurf
Survanta
KL4

Question 7

what are the schedules for surfactant use in neonatal respiratory distress syndrome ?

Answer 7

early selective- prophylactic but only if the baby is ventilated
rescue - to ventilated infants with clinical and radiological signs of RDS

Question 8

what time period is RDS usually diagnosed at ?

Answer 8

at birth or within the first 4 hours of birth

Question 9

what are the differential diagnosis of RDS ?

Answer 9

pneumonia

sepsis ( esp group b strep )

Question 10

what is the typical radiological appearance of RDS ?

Answer 10

small volume lungs
homogenous ground glass opacity
air bronchogram

Question 11

what interventions may change the appearance of the X-ray findings in RDS ?

Answer 11

CPAP tends to result in lungs of normal size

surfactant administration given before the x-ray can result in a less homogenous appearance

Question 12

how can RDS be prevented ?

Answer 12

by the prevention of prematurity
administration of antenatal steroids ( dexamethasone and betamethasone )
prevention of postnatal asphyxia
avoiding drug depression and polyhydraminous

Question 13

what is the management of RDS ?

Answer 13

Oxygen
surfactant administration
ventilation

Question 14

what is the oxygen saturation target ?

Answer 14

91-95% to avoid hyperoxia

Question 15

what are the complications of RDS ?

Answer 15

Air leaks pneumothorax
PDA
periventricular intraventricular Hge
bronchopulmonary dysplasia

Question 16

when do babies with RDS develop CLD ?

Answer 16

chronic lung disease develops when the baby becomes ventilator dependent or oxygen-dependent

Question 17

what is the management for pneumothorax ?

Answer 17

decompress by inserting a chest tube

Question 18

what are the diagnostic criteria of BPD ?

Answer 18

at 28 days :

1. positive pressure ventilation during the first 2 weeks of life for a minn of 3 days
2. clinical signs of abnormal resp function
3. requires oxygen supplementation for longer than 28 days to maintain Pao2 >50 mmHG
4. chest imaging with findings of BPD

Question 19

what are the radiological findings in a chest x-ray of an infant with BPD ?

Answer 19

hyperinflation
low diaphragm
atelectasis

Question 20

what is the management for BPD ?

Answer 20

short and low doses of corticosteroids

may go home with supplemental oxygen

Question 21

what is apnea ?

Answer 21

cessation of breathing for more than 20 seconds
or
associated with bradycardia (<100)
or
associated with cyanosis , pallor , hypotonia

Question 22

what is the main risk factor for apnea ?

Answer 22

very low birth weight

Question 23

what is the most important etiology of apnea of prematurity ?

Answer 23

prematurity lol

Question 24

what are the different causes of apnea of prematurity ?

Answer 24

central : immaturity of the brain stem centers
obstructive : excessive secretion, neck flexion
mixed apnea

Question 25

what is the treatment for acute apneic episodes ?

Answer 25

1. physical stimulation

2. if no response - bag and mask ventilation, suctioning and neck positioning

Question 26

what is the general management for apnea ?

Answer 26

monitoring with a bedside respiratory and heart rate monitor
caffeine citrate ( reduces recurrence)
CPAP and mechanical ventilation
correction of the cause