Quiz 3 BPD/RDS/ROP

Question 1

When was BPD discovered?

Answer 1

1967 by Norway and assoc.

Question 2

When was CPAP invented?

Answer 2

1971

Question 3

Most common long term complication in infants born at <1000 grams

Answer 3

BPD

Question 4

Mortality and rates of severe BPD are _____ with current preventative measures

Answer 4

decreased

Question 5

BPD has these characteristics

Answer 5

Persistent small airway damage
persistent airway obstruction
Not seen in premature infants without CLD

Question 6

Introduction of mechanical ventilation to manage severe RDS caused increased survival of smaller and sicker infants leading to what?

Answer 6

sequale of chronic lung damage

Question 7

Severe BPD

Answer 7

> 30% O2 or PPV at 36 wks PMA

Question 8

CXR of BPD

Answer 8

areas of hyperinflation and increased densities. Not homogenous like RDS

Question 9

The one treatment that causes BPD is

Answer 9

ETT

Question 10

New/Mild CLD

Answer 10

increased frequency bc more immature infants surviving.
Occurs even after gentle ventilation
Affects alveolarization and pulmonary vascular development

Question 11

Clinical features of new BPD

Answer 11

smaller infants (400-1000g)
Early PPV with honeymoon period (1-2 weeks)
Then progressive decline
Should then slowly improve and gradually wean from support

Question 12

If clinical progression not improving for BPD, what do you look for?

Answer 12

Fluid overload
infection
aspiration
L to R shunts

Question 13

Lung development stages

Answer 13

embryonic
pseudoglandular 10-16
canalicular 16-24
saccular 24-36
alveolar 36-2 years

Question 14

Pathogenesis of BPD

Answer 14

barotrauma - pressure trauma
Oxygen - toxic to lungs
lung immaturity
Inflammation
infection - urea plasma
Fluid overload and pulmonary edema - mainly secondary to leak, PDA floods lungs
PDA
Increased airway resistance (ETT)
Nutrition - vitamin A deficiency

Question 15

How does mechanical ventilation induced lung injury

Answer 15

Barotrauma, volutrauma, atelectotrauma, cytokine production from injury, permissive hypercapnea,

Question 16

barotrauma

Answer 16

high airway pressures

Question 17

volutrauma

Answer 17

high tidal volumes

Question 18

atelectotrauma

Answer 18

too gentle and alveoli collapse. Need PEEP

Question 19

Oxygen toxicity leads to oxidative stress which causes:

Answer 19

alveolar edema, neutrophil infiltration, alveolar cell proliferation, fibrosis

Question 20

BOOST trial found what?

Answer 20

No evidence that higher SpO2 improved growth development, but it did increase days of oxygen therapy and use of resources

Question 21

STOP ROP trial found what?

Answer 21

Higher range cause more adverse respiratory events, including pneumonia, CLD requiring oxygen and diuretic therapy

Question 22

BOOST II trails compared SpO2 85-89% and 91-95% in 24-28 weeks and found what?

Answer 22

death occurred more frequently in lower SpO2 group but severe ROP among the survivors occurred less often.

Question 23

Maternal chorioamnionitis

Answer 23

less HMD but more BPD due to increased inflammatory stimuli in the first 5 days of life

Question 24

Infectious agents leading to BPD

Answer 24

ureaplasma
coag neg staph
CMV
RSV
most common: gram negative (psuedamonas, klebsiella)

Question 25

Infants that develop BPD have been shown to have increased PVR in first week of life from what types of obstruction?

Answer 25

epithelial hyperplasia edema inflammation

Question 26

these nutritional insufficiencies increase the vulnerability of oxidant lung injury and dev of BPD

Answer 26

protein, Vitamin A, magnesium, selenium, inositol.

Question 27

Waterberg, et al found that LBW infants with lower _____ the first week of life had increased incidence of PDA, inc lung inflammation, and inc risk of BPD

Answer 27

cortisol

Question 28

RBC transfusions

Answer 28

the greater the number the greater the risk of BPD

Question 29

Who will develop BPD?

Answer 29

sepsis, pda, severity of RDS, boy