Resp disease of neonates

Question 1

Signs of resp disease of neonates

Answer 1

RR> 60
Grunting
nasal flaring
subcostal recession
cyanosis
laboured breathing

care o2 levels arent always useful - are normally low around birth

Question 2

Define resp disease of neonates

Answer 2

Set of disease that present early after birth (from 2 mins to a few days)
causes can vary

Transient tachypnea of the neonate
Persistant Pulmonary hypertensions
Chronic lung disease of prematurity
Respiratory distress syndrome

Question 3

Transient tachypnea of newborn

Answer 3

Most common pulmonary issue in TERM babies
caused by delayed resorbtion of fluids by the lungs

Risk factors – C sections!

sx -the classical resp distress signs (1st card -RR>60, grunting, nasal flaring, subcostal recession, cyanosis,

Question 4

Investigations and management of transient tachypnea of the newborn

Answer 4

Ix - RR>60, cyanosis (spo2 low)
CXR -fluid in horizontal fissure +/- hyperinflation of lungs
diagnosis of EXCLUSION

Mx -usually resolves on its own in 1-2 days
O2 supplementation if needed

Question 5

Persistant pulmonary hypertension

Answer 5

Dangerous condition that can either be primary or secondary to other serious perinatal events :
Meconium aspiration, RDS, Birth asphixia, spesis

High pulmonary vasc resistance -> right to left shunting within lungs

Signs and Sx-
Cyanosis at/after birth
absent heart murmurs
Signs of Heart failure (R HF)

Prognosis Mortality under 10% but complications present in 25% of cases

Question 6

Ix and Mx of persistant pulmonary hypertension

Answer 6

Ix
Urgent Echocardiogram to make sure its not heart
CXR -normal heart with oligaemia

Mx -cut between medication and supportive
support-ventilation
Mechanical CPAP/BiPaP
High frequency ventilation
and if extremely severe - ECMO

Medication-
Nitrous oxide
Sildanefil (viagra)

Question 7

Chronic lung disease of prematurity

Answer 7

Not one disease/cause perse
Usually defined as needing o2 support past 36 weeks
CLD occurs following intrauterine infections, barotrauma (pressure) or iatrogenic trauma

RF- Happens in premature babies (very premmie), Low birth weight, low GA

Signs and Sx -
Signs of resp distress
Weight loss, poor feeding
classically progress in 23w to 26w go from VENTILATION to CPAP to Supplementary O2
Positive response to O2 and ventilation in first 2 weeks of life

Question 8

Ix and Mx of Chronic lung disease of prematurity

Answer 8

CXR - widespread opacication
ABG/VBG -acidosis, hypercania, hypoxia

Mx - wean from full support to CPAP to more normal O2
always be worried by ventilation associated lung injury

Corticosteroids/dexamethasone -helps in short term -but concerned over long usage (neuro issues)

Question 9

Respiratory distress syndrome

Answer 9

Cause by lack or issues in lung surfactant
COMMON in premmie babies <28 weeks

RF -premmie, Male, mother with t2dm, CS, 2nd born premmie twin

Signs and sx –AT DELIVERY OR UP to 4h after birth
RR>60, grunting, flaring, subcostal recession, cyanosis etc

Question 10

Ix and Mx of Respiratory distress syndrome

Answer 10

Ix -clinical diagnosis
O2 sats low
CXR -GROUND GLASS APEARENCE, common pneumothorax, indistinct heart border

Mx -
ANTENATAL (if know baby going to be born before 34w)-steroids help lung developemnt

POSTNATAL -O2 and ventilation (CPAP or artificial), might need exogenous surfactant
mechanical ventilation