TTS, SDLS, Congenital diaphragmatic hernia

Question 1

DDs

Answer 1

Congenital diaphragmatic hernia:
*Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft

-This can result in pulmonary hypoplasia and hypertension which causes respiratory distress shortly after birth.
On auscultation of the chest, there is
-reduced breath sounds bilaterally.
-Heart sounds are displaced medially.
-The abdominal wall appears concave.

Transient tachypnoea of the newborn:
-CXR: hyperinflation and fluid in the horizontal fissure
-caused by delayed resorption of fluid in the lungs
-common following caesarean sections, possibly due to the lung fluid not being ‘squeezed out’ during the passage through the birth canal
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations

Transient tachypnoea of the newborn usually settles within 1-2 day

Surfactant deficient lung disease:
-condition seen in premature infants.
-caused by insufficient surfactant production and structural immaturity of the lungs

Other risk factors for SDLD include
male sex
diabetic mothers
Caesarean section
second born of premature twins

Clinical features are those common to respiratory distress in the newborn, i.e. tachypnoea, intercostal recession, expiratory grunting and cyanosis

Chest x-ray characteristically shows ‘ground-glass’ appearance with an indistinct heart border

Management
prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube