Respiratory Disorders

Question 1

What is transient tachypnoea of the newborn (TTN)?

Answer 1

• Tachypnoea (>60 RR/Min) within 2 hours of birth as a result of extra fluid or slower absorption of fluid in lungs creating higher demand for oxygen

Question 2

What are the risk factors of a newborn developing TTN?

Answer 2

• C-section = fluid not expelled from lungs with contractions and chest wall being squeezed through birth canal
• Precipitous birth (rapid birth) = not enough time to absorb/expel fluid from lungs

Question 3

What is the concern with TTN?

Answer 3

• Can develop into respiratory distress syndrome

Question 4

What is your midwifery management with TTN?

Answer 4

• Regular and close observation (OBS T, HR, R, O2 sats, colour, tone, behaviour, feeding)
• Has it resolved by two hours?

Question 5

What is respiratory distress syndrome (RDS)?

Answer 5

Respiratory distress symptoms in newborns caused by inadequate production of surfactant that usually develops within 24 hours of birth

Question 6

What are the risk factors for RDS?

Answer 6

• Preterm baby
• Maternal diabetes (hyperinsulinemia interferes with surfactant production)
• Sepsis
• Exposure to meconium and blood
• Hyperoxia
• Hypoxia

Question 7

What are the signs and symptoms of RDS?

Answer 7

• Cyanosis
• Nasal flaring
• Grunting
• Tachypnoea

Question 7

What is sepsis?

Answer 7

A chain reaction of events caused by an already existing infection. Chain reaction events include tachypnoea, tachycardia, temperature instability, confusion, pain, lethargic

Question 8

What is meconium aspiration syndrome?

Answer 8

Aspiration of meconium into the lungs

Question 9

What is the risk with meconium aspiration syndrome?

Answer 9

That the newborn has inhaled meconium increasing the likelihood of developing an infection in the lungs (pneumonitis)

Question 10

Risk factors for meconium aspiration syndrome (MAS)?

Answer 10

• Post dates (>42 weeks)
• Meconium stained liquor
• Fetal distress

Question 11

Signs and symptoms of MAS?

Answer 11

• Meconium stained liquor
• Skin stained green (cord can be green)
• Breathing rapid, laboured or absent
• Limp with low Apgar
• Peeling skin, no vernix
• Fetal bradycardia in labour
• Tachypnoea
• Hyperthermic
• Poor feeding

Question 12

What effects can MAS cause?

Answer 12

• Airway obstruction
• Surfactant dysfunction
• Chemical pneumonitis
• Persistent pulmonary hypertension

Question 13

What is the fear with airway obstruction and MAS?

Answer 13

• That meconium with obstruct the airway either completely or partially which can lead to pneumothorax (Air trapping)

Question 14

What is the fear with surfactant dysfunction and MAS?

Answer 14

• Meconium will strip surfactant from the alveoli, reducing surface tension and making it difficult for the lungs to inhale and expand.
• Can result in generalised atelectasis, partial collapse or incomplete inflation of the lung

Question 15

What is the fear with chemical pneumonitis and MAS?

Answer 15

• Enzymes, fats and bile salts in meconium can cause irritation in airway and alveoli causing a chemical response that may cause pneumonitis within a few hours of aspiration

Question 16

What is the fear with persistent pulmonary hypertension and MAS?

Answer 16

• MAS can lead to other effects (airway obstruction, surfactant dysfunction, chemical pneumonitis) that can increase the likelihood of ventilation/perfusion mismatch
• Chronic stress in utero can also cause thickening of the pulmonary blood vessels

Question 17

Treatment for MAS in labour?

Answer 17

• Treated as high risk
• Continuous monitoring
• Regular Obs
• CTG

Question 18

Treatment of newborn suspected of MAS/Meconium exposure? After Birth

Answer 18

• Vigorous baby monitoring of obs (T, HR, RR, Sats, Colour, Tone, Behaviour, Feeding)
• input vs output (observe feed)
• Apgars, Weigh, Full check
• Document
• Discuss with whanau
• Paediatrician called
• Babies that have cord PH <7.2, need significant resus, respiratory distress = admitted to ICU?

Question 19

What OBS are required for a baby that had meconium exposure that was thick, thin, had an Apgar less than 9 at five minutes or required resus as per NEWS chart?

Answer 19

• T, HR, RR, WOB, Colour, Behaviour, Feeding = 1 and 4 hours post birth, then 4 hourly for 24 hours
• Sats = 1 and 4 hours post birth
• Blood glucose monitoring if signs of hypoglycaemia

Question 20

What is persistent pulmonary hypertension of the newborn (PPHN)?

Answer 20

Failure of normal circulatory transition after birth and is characterized by elevated pulmonary vascular resistance (pulmonary vasoconstriction)

Question 21

What are the risk factors for PPHN?

Answer 21

• Term or late term
• Hypoxia and acidosis
• Meconium aspiration
• TTN, pneumonia
• Group B streptococcal sepsis
• Some maternal medications e.g. NSAIDs, SSRIs

Question 22

Signs and symptoms of PPHN?

Answer 22

• Severe respiratory distress
• Heart murmur
• Process of exclusion of heart and other conditions are difficult to diagnose

Question 23

What is the midwives role after meconium exposure at birth?

Answer 23

• Have notified obstetrician and paediatrics
• Begin early feeding to avoid hypoglyceamia
• Obs completed as per news chart (T, HR, RR, WOB, Colour, Tone, Behaviour, Feeding, Sats)
• Alert to intrapatrum and AN history and risk factors
• Apgars, Weigh, Full check
• Document findings
• Discuss with family