Respiratory Assessment of Neonate Flashcards
(39 cards)
Spontaneous Parameters of Neonate
RR: 40-60
Vt: 5-7
Vd/Vt: 0.3
FRC: 30
Resistance: 25-50
Compliance: 1-2
Neonate Respiratory Anatomy Compared to Adult
Anteroposterior transverse diameter ratio
Neonate: 1:1
Adult: 1:2
Neonate Respiratory Anatomy Compared to Adult
Angle of mainstream bronchi
Neonate: 10 degree to the right and 30 degrees to the left
Adult: 30 degrees to the right and 50 degrees to the left
Infant has a higher degree of curvature and are less prone to right lugnintubation also the trachea is shorter which is why they are so easy to extubate
Neonate Respiratory Anatomy Compared to Adult
Compliance of Trachea
Neonate: Compliant, fleixble
Adult: Noncompliant
Neonate Respiratory Anatomy Compared to Adult
Level of Trachea Bifurcation
Neonate: T3-4
Adult: T5
Neonate Respiratory Anatomy Compared to Adult
Shape and Location of Epiglottis
Neonate: Long/C1
Adult: Flat C4
large and floppy epiglottis (in infants we are using the miller blade to help move the large floppy epiglottis).
Neonate Respiratory Anatomy Compared to Adult
Narrowest Portion of Upper airway
Neonate: Cricoid Cartilage
Adult: Rima Glottidis
Cricoid cartilage is the narrowest part of the airway and is shaped in a funnel shape.
Neonate Respiratory Anatomy Compared to Adult
Laryngeal Shape
Neonate: Funnel Shape
Adult: Rectangular
Laryngeal soft tissue and lymph nodes which meakes them more susceptible to swelling and injury.
Neonate Respiratory Anatomy Compared to Adult
Tongue Size
Neonate: Large
Adult: Porportional
Largetongue with small mouth which makes it easy to cause an obstruction and is more difficult to navigate around it with a laryngoscope.
Neonate Respiratory Anatomy Compared to Adult
Head/Body Ratio
Neonate: 1:4
Adult: 1:8
Neonate Respiratory Anatomy Compared to Adult
Body Surface Area/Body Size Ratio
Neonate: 9 x adult
Large heart and belly- increase impedance for tidal volume as the heart is taking up more room
Adult: Normal
Neonate Respiratory Anatomy Compared to Adult
Location of Heart
Neonate: Center of chest midline
Adult: Lower portion of chest left of midline
Neonate Respiratory Anatomy Compared to Adult
Resting Poistion of Diaphragm
Neonate: Higher than adult
Adult: Normal
Neonate Respiratory Anatomy Compared to Adult
Thoracic Shape
Neonate: Bullet shaped
Adult: Conical shaped
Respiratory Anatomy and Sniffing Position
Large occipital which makes it harder to get the baby in sniffing position (best way is to put a small blanket under their shoulders or even just use your hand),
Sniffing position is very important becase the airway is easy to coallpse
Neonates Aspiration Risk
Airway and trachea more anterior and superior which puts them on a greater risk for aspiration and difficult intubation
Smaller trachea making it easier for stuff to get stuck in there
Obligated nose breathers so when they get an infection with a stuffy nose their nose will occlude quicker and will have to be stimulated to breath
Neonatal Compliance
Morecompliant chest wall because the cartilage under developed which will create high airway resistance in upper airway and more collapse in the lower airway (so when it comes out easier it will also collapse inwards easier
Accessory muscle are under developed so they are more susceptible to failure
Infant Trachea and Carina
Infant trachea is 4 mm wide; adult trachea is 16 mm wide
Carina is higher (3rdvertebrae), T4/5 by age 10
Infant airway is more funnel shaped, narrowest point is cricoid
Infant epiglottis is OMEGA Ω shaped, less flexible, more horizontal
Infants have poor neck flexion = higher obstruction risk
Infants have large tongue with posterior placements and larger amounts of lymph tissue = higher obstruction risk
Respiratory Failure
- CO2 production is higher than adults and, so if baby/child is working harder to breathe than normal, they will tire out faster than an adult
- Metabolic rate is twice as high as adults
- O2 consumption is much higher than in adults, so hypoxemia effects will be more profound
- Respiratory failure will occur much more quickly in an infant than in an adult
- If infant goes hypoxemic it will be very profound and very quick
- Infants tend to have smaller FRC’s than adults, so airway closure can occur more quickly creating shunting
Respiratory distress in the neonate
- Observed prior to birth via fetal monitoring strip, scalp pH, heart rate:
- Distress = profound bradycardia, late decelerations, variable decelerations, loss of normal heart rate variability, scalp pH less than 7.15
- Allows for preparation for resuscitation
- Observedafter delivery via rapid assessment:
- Assessment of the neonate commences as soon as baby presents…inspection!
Questions at the Time of Delivery
- Expected gestational age
- Clear amniotic fluid
- Singleton or…?
- Other risk factors
Rapid Assessment at Delivery
Inspection
- Color
- Tone / movement (active, flexed extremities vs flaccid, extended extremities)
- WOB/ respiratory distress (gasping vs vigorous cry)
- Presence of Meconium
- RR [absent, too fast, too slow, depth]
Rapid Assessment at Delivery
Routine
Infants who meet the following four criteria generally will not require resuscitation and can be quickly dried, placed on the mother’s abdomen, and covered with dry, warm linen to maintain temperature
–Infants born at full-term gestation
–Amniotic fluid clear with no evidence of infection
–Crying or normal breathing
–Good muscle tone
APGAR Scores
- Used to assess infants at
- 1 and 5 minutes…
- Will continue to be done q 5 minsuntil the baby is 7 or greater
- Best use: reflective indication of fetal well being at time of delivery and the efficiency of interventions
- Does not guide the resuscitation, rather it is a means of gauging the effectiveness of the resuscitation
