neonates, resp

Question 1

What is a neonate by definition?

Answer 1

0-28 DAYS OLD

Question 2

What score do we use to assess neonates?

Answer 2

APGAR

Question 3

When is the APGAR Score done?

Answer 3

1, 5 and 10 mins post birth

Question 4

What does APGAR stand for?

Answer 4

Appearance
-pale, cyanotic

Pulse
->100 good, <100 ok

Grimace
-sneeze, cough, cry good, grimace ok, no response bad

Activity
-active good, flexed A+L ok, absent bad

RR
-crying good, gasping + irregular ok

Question 5

what do the APGAR scores mean?

Answer 5

0-4 = bad
5-6 = not amazing
7-10 = good

Question 6

what will many neonates not have an APGAR score of 10?

Answer 6

Most kids are acrocyanotic (cyanosis of peripheries) at birth

Question 7

what is given to all neonates one off and why?

Answer 7

Vit K IM injection as there’s no vitamin K in breastmilk

Question 8

What 2 other tests are done within 72 hrs of birth?

Answer 8

NIPE (done after 34+0)
Otoacoustic emission testing

Question 9

name 4 neonatal respiratory syndromes?

Answer 9

respiratory distress syndrome (NRDS)
Bronchopulmonary dysplasia (BPD)
Transient tachypnoea of newborn (TTON)
Meconium aspiration syndrome (MAS)

Question 10

What is respiratory distress syndrome?
when does it usually occur?
what is it caused by?

Answer 10

<24hrs post birth

Atelectasis (collapse of part/all lung) due to low production of surfactant = high alveolar surface tension + collapse = Resp distress!!!

In premature baby, C section, maternal DM

Question 11

When is surfactant produced?

Answer 11

26wks - 35 weeks (sufficient)

Question 12

Sx of Resp distress syndrome?

Answer 12

resp distress Sx
laboured rapid breathing
cyanosis
indrawing chest wall

Question 13

Dx of resp distress syndrome?

Answer 13

Chest xray - ground glass reticular

Question 14

Tx prenatal and post natal for resp distress syndrome?

Answer 14

pre = maternal corticosteroids

post = surfactant (through endotracheal intubation), CPAP + O2

Question 15

What are 2 complications of resp distress syndrome?

Answer 15

traumatic pneumothorax (with high O2/CPAP)
Bronchopulmonary dysplasia

Question 16

What is bronchopulmonary dysplasia? (BPD)
What is it caused by?

Answer 16

Re perfusion injury due to chronic high flow O2 >4 weeks (used due to chronic lung disease) - alveolar septal injury

Prematurity

Question 17

Sx of bronchopulmonary dysplasia?

Answer 17

Chronic resp distress Sx, recurrent chest infection, poor feed

Question 18

Dx of bronchopulmonary dysplasia?

Answer 18

CXR = widespread opacity

Question 19

Tx for bronchopulmonary dysplasia?

Answer 19

Vit A for 7 days postnatal + IV caffeine, CPAP, Consider IM palivizumab monthly (RSV)

Question 20

What is the MC cause of resp distress neonatally in full term babies?

Answer 20

transient tachypnoea of newborn (TTON)

Question 21

What is transient tachypnoea of newborn (TTON)?
caused by?

Answer 21

delayed resorption + clearance of fetal alveolar fluid due to C.section + prematurity

Question 22

Sx of transient tachypnoea of newborn (TTON)?

Answer 22

Resp distress Sx

Question 23

Dx of transient tachypnoea of newborn (TTON)?

Answer 23

chest xray = fluid in horizontal fissure and hyper inflated lungs

Question 24

Tx of transient tachypnoea of newborn (TTON)?

Answer 24

self resolving <48hrs
consider CPAP/O2

Question 25

What is meconium aspiration syndrome (MAS)? caused by?

Answer 25

Aspirated meconium (bile water, vernix, desquamation), chemical irritation, inflammation and mechanical obstruction in post term baby

Question 26

Sx of meconium aspiration syndrome (MAS)?

Answer 26

-<1hr resp distress -Meconium stained amniotic fluid (MSAF) -Yellow/green stained skin and nails -Low APGAR score -crackles auscultated in fetal lung

Question 27

Dx of meconium aspiration syndrome (MAS)?

Answer 27

Chest xray = consolidation, patchy atelactesis Amniotic Fluid = High -ve RODS

Question 28

Tx of meconium aspiration syndrome (MAS)?

Answer 28

suction nose + mouth supportive O2 supportive (IV Fluid) Abx?

Question 29

MSAF + NO Resp distress = MSAF + Resp distress =

Answer 29

monitor Tx + O2....

Question 30

What is apnoea of prematurity? when does it usually occur? Tx?

Answer 30

decreased myelination of autonomic ns resp centre (ponto-med) occurs 32-34 weeks therefore premature infant high risk Tx = IV Caffeine