Term Babies Flashcards
What is a common cause of respiratory distress in term babies?
Transient tachypnoea of the newborn
What are some of the less common causes of respiratory distress in term babies?
- MAS
- RDS
- Pneumonia
- Pneumothorax
- Milk aspiration
- PPHN
What are some of the non-pulmonary causes of respiratory distress in term babies?
- Congenital heart disease
- HIE
- Severe anaemia
- Metabolic acidosis
How does Transient tachypnoea of the newborn arise?
Occurs due to a delay in the reabsorption of lung liquid, more common after birth by CS
What are the investigations and tx of Transient tachypnoea of the newborn?
- CXR show fluid in the horizontal fissure “wet lungs”
- Usually settles within first few days of life but can take 1-2wks
- Diagnosis of exclusion
- Supplementary O2 may be required to maintain O2 sats
Who does MAS present in?
Increasing incidence with increasing gestation
What are some of the complications of MAS?
- Lungs are over-inflated, accompanied by collage and consolidation.
- High incidence of air leakage leading to pneumothorax and pneumomediastinum.
What is the tx of MAS?
- Oxygen therapy (mild: nasal cannula; mod: CPAP; severe: mechanical).
- Abx and supportive care
- Vasopressor (dopamine)
- Surfactant in severe MAS
What is a complication of MAS?
Many develop persistent pulmonary hypertension of the newborn
What are some of the risk factors for MAS?
- Maternal hypertension
- Pre-eclampsia
- Chorioamnionitis
- Smoking
- Substance abuse
What are the classifications of congenital pneumonia?
True congenital
Intra-partum
Post-natal
What are the predisposing factors for congenital pneumonia?
- PROM
- Chorioamnionitis
- Low birth weight
How does congenital pneumonia present, what are the investigations and tx?
- Presents with respiratory distress
- CXR
- Broad spectrum Abx
How does PPHN arise?
- There is a limit in blood flow to brain and lungs as blood vessels do not open up
- Blood flows via DA and FO from R–>L due to high pulmonary vascular pressure
What are some of the symptoms of PPHN?
- Breathing problems: rapid or slow breathing, grunting, retracting
- Blue colour to skin
- Cold hands and feet
- Low BP
- Low O2 sats
What are the investigations and tx of PPHN?
CXR: cardiomegaly and pulmonary oedema
Tx: mechanical ventilation and circulatory support
Inhaled nitric oxide
How does a pneumothorax in the newborn arise?
- Spontaneous in up to 2% deliveries
- Can occur secondary to MAS, RDS, iatrogenic due to CPAP
- Usually asymptomatic but can cause respiratory distress
What are the investigations and tx of pneumothorax?
CXR: hyperlucency with absent lung markings.
Tx: resolves if small, chest drain if large
When do diaphragmatic hernias typically present in newborns?
As a failure to respond to resuscitation or respiratory distress
What is the most common type of congenital diaphragmatic hernia?
Left-sided posterolateral Bochdalch hernia
What is the outcome for babies with congenital diaphragmatic hernia?
- Only 50% will survive
- Vigorous resuscitation may cause a pneumothorax, aggravating situation
What will be seen o/e of a baby with congenital diaphragmatic hernia?
Apex beat and HS will be displaced to the R side of the chest, with poor air entry in left chest.
What is the diagnosis and tx of a congenital diaphragmatic hernia?
CXR: bowel loops seen in the chest (left sided) mediastinal shift.
Tx: once diagnosis suspected, large NG tube inserted and suction applied to prevent distension of intrathoracic bowel.
-After stabilisation, the diaphragmatic hernia is surgically repaired.
What is a key complication in congenital diaphragmatic hernia?
Pulmonary hypoplasia
Due to compression of herniated viscera throughout pregnancy has prevented lung development. High mortality.
What is oesophageal atresia?
The oesophagus ends in a blind-ended pouch rather than connecting to the stomach
What is oesophageal atresia associated with?
- Usually associated with a tracheo-oesophageal fistula.
- Associated with polyhydramnios during pregnancy.
What is the tx if oesophageal atresia is suspected?
A wide calibre feeding tube is passed and checked by CXR to confirm in stomach.
What is the clinical presentation of oesophageal atresia at birth and beyond ?
After birth: Persistent salivation and drooling from the mouth.
Later on: the baby will cough and choke when fed and have cyanotic episodes.
-There may be aspiration into the lungs
Almost half of babies with oesophageal atresia may have other congenital malformation, called…
VACTERL
V ertebral A norectal C ardiac T rache- O esophageal R enal and radial L imb
What is the investigation and tx of oesophageal atresia?
CXR: NGT is curled up in oesophagus, unable to pass into stomach.
Tx:
- Continuous suction into tube to decrease aspiration
- Surgical repair.
What is the presentation of small bowel obstruction?
- Persistent, bile stained vomiting
- Meconium may be initially passed then delayed or absent.
- High lesions presenting soon after birth, low lesions presenting later.
What are some of the causes of small bowel obstruction in the newborn?
- Atresia or stenosis of duodenum
- Atresia or stenosis of jejunum
- Malrotation with volvulus
- Meconium ileus
How is the diagnosis of small bowel obstruction made?
Clinical + AXR
What are the main causes of large bowel obstruction?
Hirschsprung’s disease or Renal Atresia
How does Hirschsprung’s disease arise?
Absence of ganglion cells from myenteric and submucosal plexus
What is the clinical presentation, diagnosis and tx of Hirschsprung’s disease?
-Delayed passage of meconium and abdominal distension
(>48hrs)
-Full thickness rectal biopsy for diagnosis
-Tx: rectal washouts initially then an anorectal pull procedure.
What should bile-stained vomit be considered to be until proven otherwise?
Intestinal obstruction
What is Gastroschisis?
- Congenital herniation of abdominal contents
- Often diagnosed antenatally.
- Either: Exomphalos or Gastroschisis
What is Exomphalos?
- Herniation through umbilicus
- Bowel and viscera covered with membranous sac
- Associated with other congenital abnormalities
Description of Gastroschisis?
- Herniation through abdominal wall defected right to the umbilicus
- Bowel NOT covered with membrane
What is the tx of Gastroschisis?
- Cover abdomen with cling-film as high risk of heat and fluid loss.
- NG tube
- IV fluid replacement
Small defect: primary closure of abdomen.
Large defect: intestines closed in a sac, sutured to the edges of abdominal wall and contents gradually returned to peritoneal cavity.
