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.
