How does ARDS present?
- respiratory distress
This is respiratory distress due to inadequate surfactant levels.
neonatal respiratory distress syndrome
What is the key component of surfactant?
What is the problem with formation of hyaline membranes?
1. thickened diffusion membrane ---> hypoxemia/cyanosis 2. increased surface tension --> collapse
Name a complication of ARDS recovery.
What are the xray findings in neonatal RDS?
diffuse granularity of the lung
What does ARDS stand for?
acute respiratory distress syndrome
How do pts with neonatal respiratory distress syndrome present?
- increased work of breathing
- use of accessory muscles
- grunting cyanosis
Why are free radicals bad in neonates?
they can travel to the retina and cause blindness, or it can damage the lung to cause bronchopulmonary dysplasia
This type of cells act as the lung stem cell and produces surfactant.
type II pneumocyte
How does maternal diabetes cause neonatal RDS?
Insulin is an inhibitor of surfactant production. Increased sugars causes pancreas to produce more insulin in baby.
In ARDS, activation of neutrophils induces protease-mediated and free-radical damage of ______.
type I and II pneumocytes
How is adequacy of surfactant screened before birth?
the L:S ratio
What is the tx for ARDS?
treat the underlying condition:
- ventilation with positive end expiratory pressure (PEEP)
What are the 2 functions of type II pneumocytes?
- act as the lung stem cell
- to produce surfactant
_____ increases risk of free radical injury, a possible complication of neonatal RDS.
What is neonatal respiratory distress syndrome?
respiratory distress due to inadequate surfactant levels
Why does interstitial fibrosis occur in ARDS?
type II pneumocytes were depleted (they're the stem cells) so instead of regeneration of the lung, it's instead repaired
What is the underlying problem in ARDS?
diffuse damage to the alveolar-capillary interface w/I the air sac --> leaking of protein rich fluid --> fluid reorganizes into formation of hyaline membranes
Hypoxemia increases the risk of ______ and _____ in neonatal RDS.
patent ductus arteriosus (PDA) and necrotizing enterocolitis
In _____, activation of neutrophils induces protease-mediated and free radical damage of type I and II pneumocytes.
_____ is produced by type II pneumocyte in the lungs.
What are the 3 main causes of neonatal RDS?
- C-section delivery
- maternal diabetes
What can cause ARDS?
- hypersensitivity rxn
In ARDS, activation of _____ induces protease-mediated and free radical damage of type I and II pneumocytes.
What do L and S stand for in the L:S ratio of surfactant adequacy?
L = lessafin (increases w/ increasing surfactant production) S = sphingomyolin (constant)
What causes bronchopulmonary dysplasia?
free radical damage to the lungs
Why can C-section delivery cause neonatal RDS?
a vaginal birth stresses the bay, causing steroid release that helps produce and release surfactant. C-section babies don't get this stressor.
What do steroids do to surfactant?
- increase production
- increase its release from the type II pneumocytes
What are the xray findings in ARDS?
diffuse white out
In ARDS, activation of neutrophils induces _____ and ____ damage of type I and II pneumocytes.
protease-mediated; free radical
______ increases the risk of patent ductus arteriosus (PDA) and necrotizing enterocolitis in neonatal RDS.
At what value or greater is the L:S surfactant ratio considered adequate/a mature lung?