Neonatal Diseases (1)

Question 1

Delivery Room Care

Answer 1

1) Action based on APGAR Score

0 - 3: Resuscitate - CPR
4 - 6: Support - Stimulate, warm, O2, ventilate
7 - 10: Monitor - Routine care

Question 2

Apnea of Prematurity

Answer 2

1) Oxygen therapy 30-50% as indicated by oximetry
2) Methylxanthines (caffeine)
3) Teach parents/family CPR
4) Send infant home with an apnea monitor

Question 3

Meconium Aspiration Syndrome

Answer 3

1) Suction the nasopharynx & oropharynx thoroughly when amniotic fluid is stained

2) Follow NRP guidelines
- IF vigorious, active, crying (Pulse > 100, strong RR, good muscle tone)
* suction mouth 7 nose to clear pharynx
* warm, dry, observe
* blow-by oxygen as needed
- NOT vigorious (Pulse < 100, limp, depressed, poor tone, absent/gasping respirations)
* no positive pressure ventilation
* visualize vocal cards with laryngoscope
* intubate w/ a meconium aspirator & suction trachea
* repeat until airway is clear- even if pulse is low
* intubate & provide airway

3) Stabilize infant & transfer to ICU
- vigorous pulmonary hygiene (postural drainage, percussion, suction)
- O2 therapy
- mechanical ventilation for ventilatory failure
- drug therapy
* antibiotics
* steroids

Question 4

Congenital Heart Defects

Answer 4

1) Oxygen therapy - mtaintain PaO2 levels between 60-80 torr
2) Mechanical ventilation for ventilatory failure
3) Supportive care prior to surgery to correct the defect

Question 5

Infant Respiratory Distress Syndrome (IRDS)

Answer 5

1) Correct hypoxemia
- Oxygen via oxyhood/nasal cannula
- CPAP (4-6cm H2O)
- Maintain PaO2 betwen 60-80 torr

2) Maintain neutral thermal envrionment

3) Surfactant replacement therapy
- Administered immediately after birth in neonates < 35 weeks gestation age, or once IRDS has been diagnosed
* Survanta (beractant(
* Infasurf (calfactant)
* Curosurf (poractant alfa)
* Pulmactant (synthetic)
- Instill directly into the trachea thru a 5 Fr. catheter placed into the ET tube
- Solution administered in 4 portions, one at a time
- Catheter is removed after each administration
- Infant is manually ventilated for 30sec
- Observe for adverse reactions (braotrauma, apnea, bradycardia, etc.)
- Change patient position to increase distribution of surfactant in the lungs

4) Mechanical ventilation for ventilatory failure (time cycled pressure limited ventilation) with PEEP

Question 6

Bronchopulmonary Dysplasia (BPD)

Answer 6

1) Oxygen therapy
2) Hyperinflation therapy
3) Pulmonary hygiene
4) Mechanical ventilation for ventilatory failure
5) Ventilation & oxygenation should be maintained at the lowest possible level

6) Drug therapy
- Bronchodilators may be helpful

7) Monitor fluid balance
8) Surgical ligation of PDA for infants who ae difficult to wean
9) Weaning from mechanical ventilation should be slow, involves high concentrations of oxygen. Infants can go home w/ oxygen
10) Maintain blood gas (PaO2 55-70, PaCO2 45-60, pH 7.25-7.40)
11) Minimize mean airway pressures
12) Extubation can be done at ventilator rates between 5-15 breaths/min
13) Avoid endotracheal CPAP (increase airway resistance & WOB)

Question 7

Transient Tachypnea of Newborn (TTNB) / Type II RDS

Treatment/Management

Answer 7

1) Supportive care to relieve signs of respiratory distress
2) Oxygen therapy for hypoxemia
3) CPAP to offset pulmonary congestion & interstitial edema

4) Pulmonary hygiene
* Increased bronchial hydration
* Postural drainage * percussion
* Suctioning

5) Mechanical ventilation for ventilatory failure is rare
6) Anatomic alterations in the lungs usually begin to resolve about 24-48hrs after birth

Question 8

Congenital Diaphragmatic Hernia

Answer 8

1) Always an emergency
2) Prompt Surgical repair is crucial

3) As soon as diagnosis made, insert oral gastric tube to
decrease gas in the bowel

4) Immediate oxygen therapy
5) Place infant on affected side
6) Do not ventilate with mask

7) May require intubation & mechanical ventilation
* Use low PIP (< 30 cm H2O)
* High frequency ventilation

8) ECMO for severe cases