OnlineMedEd: Pediatrics - "Neonatal ICU"

Question 1

Explain the pathology of bronchopulmonary dysplasia.

Answer 1

Think of it as the long-term version of NRDS: without surfactant, the alveoli don’t open. If this happens for long enough, then scarring can cause permanent narrowing of the bronchioles.

Note: harsh ventilator settings can worsen this, so use the minimum amount of ventilation needed.

Question 2

How does BPD present on x-ray?

Answer 2

Ground-glass opacities (from tissue scarring)

Question 3

In addition to increased FiO2, you may want to give ___________ to a child at risk of developing BPD.

Answer 3

PEEP (to keep the airways open)

Question 4

Explain the pathophysiology and treatment of retinopathy of prematurity.

Answer 4

• Increased FiO2 (which almost all preemies need) causes angiogenesis in the retina.
• Laser ablation can oblate the vessels.

Question 5

One of the sequelae of retinopathy of prematurity is _____________.

Answer 5

glaucoma

Question 6

Why are preemies at increased risk of intraventricular hemorrhage?

Answer 6

• They have weak germinal matrix (surrounding the ventricles).
• They often develop hypotensive states (like shock) followed by treatment with pressors and fluids –leading to big changes in blood pressure.

Question 7

How are IVHs diagnosed?

Answer 7

• Asymptomatic screen
• Bulging fontanelle
• US for suspected