Neonatal respiratory distress Flashcards Preview

A1. Women's Health > Neonatal respiratory distress > Flashcards

Flashcards in Neonatal respiratory distress Deck (17):
1

Name 4 symptoms/signs of neonatal respiratory distress

Tachypnoea (> 60/min)
Increased WOB
Noisy breathing (stridor, wheeze, grunt)
Central cyanosis

2

Is a blue newborn always a pathological thing? Why/why not? If not, at what point should you start to worry?

No - babies are often blue when first born as foetus only has SaO2 around 60% in utero. Start to worry when SaO2 3 minutes after delivery

3

Name 2 transient causes of neonatal respiratory distress

Post-asphyxia
Hypo/hyperthermia

4

Name 4 causes of neonatal respiratory distress in a term infant. Which is most common? Most dangerous?

Wet lung (Transient Tachypnoea of Newborn) - most common
Pneumonia - most dangerous
Meconium aspiration
Other (congenital heart defect, space occupying lesion)
HMD rare

5

Name 2 agents of neonatal pneumonia. What 2 antibiotics are usually used to treat?

Group B strep
Gram-negative bacilli

Use IV ben pen and gent

6

What causes transient tachypnoea of the newborn? What physiological factors affect this? What is its usual clinical course?

Imbalance in fluid production and removal of foetal lung liquid (continued production and delayed removal)

Adrenaline release on activity suppresses lung liquid production. Lymphatics and mechanical pressure of breathing remove fluid from lung.

Should improve over hours - days

7

Why might a newborn get meconium aspiration? Name 3 complications of meconium aspiration in a newborn. How do you manage it?

Can aspirate from gasping on initiation of breathing after delivery.

Complications:
Block airways
Irritate lungs (pneumonitis)
Potentiate infection

Management - suction from level of trachea

8

What is the different outcomes of a complete vs incomplete airway blockage by meconium aspiration?

Complete = distal collapse
Incompete = air gets in (opens on inspiration) but not out = overinflation, pneumothorax

9

Go through the appearance on CXR of pneumonia, TTN and meconium aspiration of a newborn

Pneumonia - diffuse opacification
TTN - fluid in fissures
Meconium aspiration - overdistension (incomplete block), collapse (complete block), consolidation

10

Is meconium more likely to happen in an extreme preterm baby or a post-dates baby? Why?

Post-dates - the older the foetus, the more meconium it makes.

11

Name 3 diseases that can cause respiratory distress in a pre-term infant. Which is most common, and which is most dangerous?

HMD - most common
Pneumonia - most dangerous
Wet lung

Meconium aspiration unlikely

12

What role does surfactant have in lung function? When is it mostly released and what stimulates its release?

Reduces surface tension to stop alveoli from collapsing. Released mostly between 34-35 weeks after steroid release (but present from 22-24 weeks)

13

Name 3 pathophysiological processes that result from lack of surfactant release/HMD. Name 2 appearances of HMD on CXR

Increased surface tension = alveolar collapse = atelectasis
Can also result in leakage of proteins (= hyaline membrane in respiratory bronchioles) and fluid (= fluid on lung)

CXR - ground-glass appearance and/or collapsed lung

14

What is the positive feedback cycle that leads to severe HMD?

Surfactant deficiency = atelectasis = V/Q mismatching and shunting = pulmonary vasoconstriction = reduced alveolar type II cell metabolism = further surfactant deficiency

15

Name 5 risk factors for HMD

Prematurity
Asphyxia
Maternal DM
Second twin
Male
FHx

16

What are the two main principles of management of respiratory distress in a newborn?

Oxygenation and ventilation

17

Name the major SE of giving too much O2 to a newborn. What SaO2 should you aim for?

Retinopathy of prematurity. Aim between 90-95% (or thereabouts)