Respiratory distress

Question 1

Which two or more cardinal signs does respiratory distress presents with

Answer 1

• Persistent tachypnea (> 60 breaths per minute).
• Central cyanosis (tongue) in room air.
• Sternocostal (sternum and rib) recession.
• Expiratory grunting.
• Nasal flaring

Question 2

Predisposing factors of respiratory distress

Answer 2

• Preterm delivery.
• Underweight for gestational age or wasting (especially if covered in meconium).
• Fetal distress or failure to breathe well at birth.
• Complicated labour e.g. prolonged rupture of membranes or vacuum extraction.
• Infant of diabetic mother.
• Clinical chorioamnionitis in the mother.
• Elective caesarean section.

Question 3

Respiratory causes of respiratory distress

Answer 3

• Hyaline membrane disease.
• Wet lung syndrome (transient tachypnea of the newborn).
• Meconium aspiration.
• Pneumonia.
• Chronic lung disease (bronchopulmonary dysplasia).
• Pneumothorax.
• Lung hypoplasia.
• Persistent pulmonary hypertension of the Newborn.
• Congenital diaphragmatic hernia

Question 4

Non- Respiratory causes of respiratory distress

Answer 4

• Hypothermia.
• Metabolic acidosis.
• Anaemia or polycythaemia.
• Patent ductus arteriosus.
• Congenital heart disease

Question 5

How do identify causes of respiratory distress

Answer 5

chest X ray

Question 6

What is Hyaline Membrane Disease (HMD)?

Answer 6

Hyaline Membrane Disease (HMD), also known as respiratory distress syndrome (RDS), is the most significant cause of respiratory distress in newborn infants. It primarily affects preterm infants and can also occur in term infants born to poorly controlled diabetic mothers.

Question 7

What causes Hyaline Membrane Disease?

Answer 7

Hyaline Membrane Disease is caused by a deficiency of surfactant in the infant’s lungs. Surfactant is essential for reducing surface tension in the alveoli, allowing for efficient gas exchange during respiration. Lack of surfactant leads to progressive collapse of the alveoli.

Question 8

Why are preterm infants particularly susceptible to Hyaline Membrane Disease?

Answer 8

Preterm infants are particularly susceptible to Hyaline Membrane Disease due to their immature lungs and insufficient surfactant production. Their underdeveloped respiratory system makes them more vulnerable to respiratory complications, including alveolar collapse.

Question 9

How can healthcare providers mitigate the risk factors for Hyaline Membrane Disease in preterm infants?

Answer 9

Healthcare providers should make every effort to avoid risk factors such as hypoxia, acidosis, and hypothermia in preterm infants, as these factors further inhibit surfactant synthesis. Implementing strategies to optimize respiratory support and thermal regulation can help reduce the risk of Hyaline Membrane Disease in these vulnerable infants.

Question 10

When do the clinical signs of respiratory distress typically become apparent in newborn infants?

Answer 10

The clinical signs of respiratory distress, including tachypnea, recession, grunting, and cyanosis, are usually apparent at or soon after birth. These signs may worsen over the first 72 hours if left untreated before eventually improving.

Question 11

How do infants with respiratory distress typically position themselves?

Answer 11

Infants with respiratory distress often adopt the frog position, where they lie with their hips abducted and knees flexed. This position may help alleviate some of the respiratory effort.

Question 12

What are the characteristic findings on chest X-ray in infants with respiratory distress syndrome (RDS)?

Answer 12

The chest X-ray of infants with respiratory distress syndrome typically shows an under-expanded chest with a fine reticulo-granular appearance over both lung fields. “Air-bronchograms” extend beyond the borders of the heart and thymus, and the outline of the cardiothymic shadow may be indistinct.

Question 13

What complications may arise as Hyaline Membrane Disease progresses?

Answer 13

As Hyaline Membrane Disease progresses, infants may develop ventilatory failure, characterized by rising carbon dioxide concentrations in the blood. Additionally, prolonged cessations of breathing, known as “apnea,” may occur, further complicating the condition.

Question 14

What measures can be taken to prevent Hyaline Membrane Disease in newborn infants?

Answer 14

To prevent Hyaline Membrane Disease in newborn infants, efforts should be made to avoid preterm delivery and elective cesarean section before 39 weeks gestation whenever possible. Additionally, antenatal steroids should be administered to all women at high risk of preterm delivery before 34 weeks gestation to accelerate fetal lung maturity.

Question 15

How are antenatal steroids administered to pregnant women to prevent Hyaline Membrane Disease?

Answer 15

Antenatal steroids are typically administered intramuscularly to pregnant women at high risk of preterm delivery. Two doses of betamethasone are given 24 hours apart, with the aim of delaying delivery for at least 48 hours to allow for optimal lung maturation in the fetus.

Question 16

What is the significance of antenatal steroids in preventing Hyaline Membrane Disease?

Answer 16

Antenatal steroids play a crucial role in reducing both the incidence and severity of Hyaline Membrane Disease. By accelerating fetal lung maturity, these steroids help reduce the risk of respiratory complications in preterm infants born prematurely.

Question 17

Why is delaying delivery for 48 hours after administering antenatal steroids important?

Answer 17

Delaying delivery for 48 hours after administering antenatal steroids allows sufficient time for the steroids to exert their effects and promote fetal lung maturation. This delay enhances the efficacy of the steroids in preventing Hyaline Membrane Disease in preterm infants.

Question 18

What is the primary aim of treatment in newborn infants with respiratory distress syndrome (RDS)?

Answer 18

The primary aim of treatment in newborn infants with respiratory distress syndrome (RDS) is to prevent progressive alveolar collapse, maintain oxygen saturation at 88 to 92%, regulate body temperature, and ensure normal blood glucose concentration. Adequate nutrition is also essential for supporting the infant’s growth and development.

Question 19

How should sick infants with respiratory distress syndrome be managed in terms of handling and monitoring?

Answer 19

Sick infants with respiratory distress syndrome should be handled as little as possible to minimize stress and respiratory effort. Regular and frequent observations, including monitoring of skin temperature, color, heart rate, and respiration, should be recorded to assess the infant’s condition and response to treatment.

Question 20

Why is it important to maintain oxygen saturation within the range of 88 to 92% in infants with respiratory distress syndrome?

Answer 20

Maintaining oxygen saturation within the range of 88 to 92% in infants with respiratory distress syndrome helps prevent the potential complications associated with both hypoxia and hyperoxia. This optimal oxygen saturation range balances the need for sufficient tissue oxygenation while minimizing the risk of oxygen toxicity.

Question 21

How can healthcare providers ensure adequate nutrition for infants with respiratory distress syndrome?

Answer 21

Healthcare providers can ensure adequate nutrition for infants with respiratory distress syndrome by providing appropriate feeding support, which may include enteral feeding via feeding tubes or parenteral nutrition if enteral feeding is not feasible. Ensuring adequate caloric intake is crucial for supporting the infant’s energy needs during this critical period of growth and development

Question 22

What is the primary objective of treatment for newborn infants with respiratory distress syndrome (RDS)?

Answer 22

The primary objective of treatment for newborn infants with respiratory distress syndrome (RDS) is to relieve hypoxia, which is achieved by ensuring adequate oxygenation of the lungs and tissues.

Question 23

What is the preferred method for providing respiratory support in infants with RDS, and why?

Answer 23

Nasal prong CPAP (continuous positive airway pressure) is the preferred method for providing respiratory support in infants with RDS, as it helps maintain lung expansion and prevents alveolar collapse. Early initiation of nasal CPAP is essential to improve oxygenation and respiratory function.

Question 24

Why is it important to monitor oxygen concentration and arterial blood gases in infants receiving oxygen therapy?

Answer 24

Monitoring oxygen concentration (FiO2) and arterial blood gases (PaO2 and SaO2) is crucial in infants receiving oxygen therapy to prevent potential complications associated with both hypoxia and hyperoxia. This ensures that the infant receives the appropriate level of oxygen to maintain optimal oxygen saturation without causing oxygen toxicity

Question 25

How is oxygen saturation typically monitored in infants with respiratory distress syndrome?

Answer 25

Oxygen saturation is typically monitored using a pulse oximeter, which provides continuous non-invasive monitoring of oxygen saturation levels in the blood. This allows healthcare providers to assess the infant's oxygenation status and adjust oxygen therapy as needed.

Question 26

What is the target range for arterial oxygen tension (PaO2) in infants with respiratory distress syndrome?

Answer 26

The target range for arterial oxygen tension (PaO2) in infants with respiratory distress syndrome is between 7 and 10 kPa (50–80 mmHg). This range ensures adequate oxygenation of tissues while minimizing the risk of oxygen toxicity.

Question 27

What is the standard procedure for administering surfactant replacement therapy in newborns with respiratory distress syndrome (RDS)?

Answer 27

The standard procedure for administering surfactant replacement therapy in newborns with respiratory distress syndrome (RDS) is known as Less Invasive Surfactant Administration (LISA). This involves administering surfactant via the endotracheal route using an 'in-and-out' technique.

Question 28

When should surfactant replacement therapy be considered in infants with worsening respiratory distress syndrome?

Answer 28

Surfactant replacement therapy should be considered in infants with worsening respiratory distress syndrome if the condition deteriorates despite other interventions such as nasal CPAP. If respiratory distress continues to worsen, surfactant therapy can be initiated to improve lung function and oxygenation.

Question 29

What are the potential treatment options if respiratory distress syndrome does not respond to surfactant replacement therapy?

Answer 29

If respiratory distress syndrome does not respond to surfactant replacement therapy, other treatment options may include intermittent positive pressure ventilation or high-frequency oscillation. These advanced ventilation techniques help support respiratory function in infants with severe respiratory distress.

Question 30

What is the typical outcome for infants with hyaline membrane disease (HMD) after receiving surfactant replacement therapy?

Answer 30

Infants with hyaline membrane disease (HMD) typically show improvement in respiratory distress following surfactant replacement therapy. With appropriate management including antenatal steroids, surfactant administration, and early nasal CPAP, many infants with HMD can avoid the need for mechanical ventilation, leading to better outcomes and shorter hospital stays.

Question 31

How can hypothermia be prevented in newborn infants?

Answer 31

Hypothermia in newborn infants can be prevented by ensuring they are nursed under a radiant heat source or in a closed incubator with temperature control to maintain a neutral thermal environment. This helps minimize oxygen requirements and prevents heat loss from the infant's body.

Question 32

What are the recommended methods for providing nutrition to newborn infants initially?

Answer 32

: Initially, fluid, electrolyte, and energy requirements should be supplied by intravenous infusion. Milk feeds via nasogastric tube should be initiated as soon as possible, provided the infant does not vomit. In some cases, total parenteral nutrition may be necessary for a few days to ensure adequate nutrition.

Question 33

Why is it important to prevent hypothermia in newborn infants?

Answer 33

Preventing hypothermia in newborn infants is crucial because hypothermia can lead to various complications, including respiratory distress, hypoglycemia, and increased oxygen requirements. Maintaining a stable body temperature helps optimize physiological function and promotes overall well-being in newborns.

Question 34

When should milk feeds via nasogastric tube be initiated in newborn infants?

Answer 34

Milk feeds via nasogastric tube should be initiated as soon as possible in newborn infants, provided they do not have any contraindications such as vomiting. Early initiation of feeds helps meet the infant's nutritional needs and supports growth and development.

Question 35

How can respiratory acidosis due to high PaCO2 be corrected in newborn infants?

Answer 35

Respiratory acidosis due to high PaCO2 in newborn infants can be corrected by improving ventilation. This may involve interventions such as adjusting ventilator settings or providing respiratory support to enhance gas exchange and decrease carbon dioxide levels in the blood.

Question 36

Is mild respiratory acidosis a cause for concern in newborn infants?

Answer 36

Mild respiratory acidosis is generally well tolerated and is not typically an indication for ventilation in newborn infants. However, healthcare providers should monitor the infant's condition closely and intervene if respiratory acidosis worsens or if other complications arise.

Question 37

How can metabolic acidosis in newborn infants be managed effectively?

Answer 37

Metabolic acidosis in newborn infants can usually be managed effectively by ensuring adequate oxygenation, maintaining normal body temperature, and providing hydration. Addressing the underlying cause of metabolic acidosis, such as fluid imbalance or electrolyte abnormalities, is essential for correction

Question 38

What interventions can help improve metabolic acidosis in newborn infants?

Answer 38

Improving metabolic acidosis in newborn infants involves addressing contributing factors such as hypoxia, hypothermia, or dehydration. Providing appropriate oxygen therapy, maintaining normal body temperature, and ensuring adequate fluid intake can help correct metabolic acidosis and restore acid-base balance

Question 39

Early Complications of HMD

Answer 39

* Pneumothorax. * Intraventricular haemorrhage. * Heart failure due to a persistent patent ductus arteriosus

Question 40

Late Complications of HMD

Answer 40

Chronic lung disease (Bronchopulmonary dysplasia)

Question 41

What is transient tachypnoea of the newborn (TTN)/ Wet lung syndrome

Answer 41

Transient tachypnoea of the newborn (TTN) is a respiratory condition that occurs shortly after delivery, typically in term newborn infants, especially following elective Caesarean section. It is characterized by rapid breathing (tachypnoea) and signs of respiratory distress due to retained lung fluid.

Question 42

What is the most common cause of respiratory distress in term newborn infants?

Answer 42

The most common cause of respiratory distress in term newborn infants is transient tachypnoea of the newborn (TTN). This condition typically occurs shortly after delivery and is characterized by rapid breathing and chest recession due to retained lung fluid.

Question 43

What are the typical symptoms of transient tachypnoea of the newborn (TTN)?

Answer 43

Typical symptoms of transient tachypnoea of the newborn (TTN) include rapid breathing (tachypnoea), chest recession (visible inward movement of the chest wall), and signs of respiratory distress such as nasal flaring or grunting. Infants with TTN may also present with mild cyanosis or difficulty feeding.

Question 44

How is transient tachypnoea of the newborn (TTN) managed?

Answer 44

Management of transient tachypnoea of the newborn (TTN) often involves supportive care to ensure adequate oxygenation and respiratory function. This may include supplemental oxygen therapy, respiratory support such as nasal continuous positive airway pressure (CPAP), and close monitoring of the infant's respiratory status. In most cases, TTN resolves spontaneously within a few days.

Question 45

What are the features of respiratory distress in newborns with wet lung syndrome (transient tachypnoea of the newborn)?

Answer 45

Newborns with wet lung syndrome typically exhibit respiratory distress within an hour or two of birth. Signs may include rapid breathing, chest recession, and hyperinflation of the chest. Infants may also present with symptoms such as nasal flaring, grunting, or mild cyanosis.

Question 46

How is wet lung syndrome (transient tachypnoea of the newborn) diagnosed on chest X-ray?

Answer 46

On chest X-ray, wet lung syndrome is characterized by hyperinflation of the lungs, prominent pulmonary vascular markings, flattening of the diaphragm, and fluid accumulation in the horizontal fissure of the right lung. These features help differentiate it from other respiratory conditions such as hyaline membrane disease.

Question 47

What is the typical course of wet lung syndrome (transient tachypnoea of the newborn), and how long does it usually take to resolve?

Answer 47

Most infants with wet lung syndrome show improvement within 12 to 24 hours, although tachypnoea may persist for several days. With supportive treatment, such as supplemental oxygen and monitoring, the condition typically resolves spontaneously without long-term complications.

Question 48

How does wet lung syndrome differ from hyaline membrane disease, and why is this differentiation important?

Answer 48

Wet lung syndrome, unlike hyaline membrane disease, does not typically require referral to an intensive care unit. This differentiation is crucial for appropriate management and resource allocation, as wet lung syndrome generally resolves with supportive care and does not necessitate aggressive interventions.

Question 49

What is meconium aspiration, and what causes it?

Answer 49

Meconium aspiration occurs when a newborn inhales meconium, the earliest stool passed by a baby, usually during or immediately after delivery. It often follows fetal distress during labor and is more common in term or post-term infants, particularly if they are underweight for gestational age.

Question 50

What are the consequences of meconium aspiration on the newborn's lungs?

Answer 50

Meconium aspiration can lead to areas of emphysema and atelectasis throughout the lungs. The inhaled meconium can obstruct airways, impair gas exchange, and cause inflammation, potentially leading to respiratory distress syndrome and even respiratory failure in severe cases.

Question 51

Are preterm infants at risk of meconium aspiration?

Answer 51

Preterm infants rarely pass meconium in utero, so they are less likely to be affected by meconium aspiration compared to term or post-term infants. However, if meconium is present in the amniotic fluid and the infant experiences fetal distress, meconium aspiration can still occur.

Question 52

How is meconium aspiration managed in newborns?

Answer 52

Management of meconium aspiration typically involves supportive care to maintain adequate oxygenation and ventilation. This may include suctioning the airways, providing respiratory support such as oxygen therapy or mechanical ventilation, and treating any associated complications such as pneumonia or pulmonary hypertension. In severe cases, extracorporeal membrane oxygenation (ECMO) may be considered.

Question 53

What are the potential complications associated with meconium aspiration syndrome?

Answer 53

Meconium aspiration syndrome can lead to several complications, including a hyperinflated chest, pneumothorax (air in the chest cavity), pneumomediastinum (air in the mediastinum), and persistent pulmonary hypertension. Additionally, chemical irritation from the inhaled meconium or secondary bacterial infection can cause pneumonitis, leading to further lung damage or respiratory distress.

Question 54

How does meconium aspiration syndrome contribute to respiratory complications?

Answer 54

Meconium aspiration syndrome can obstruct airways, impair gas exchange, and lead to inflammation and lung injury. The hyperinflated chest and associated complications such as pneumothorax and pneumomediastinum further exacerbate respiratory distress. Additionally, persistent pulmonary hypertension can occur, complicating the management and prognosis of the condition

Question 55

What are the potential outcomes for infants with severe meconium aspiration syndrome?

Answer 55

Infants with severe meconium aspiration syndrome may face significant risks, including death or severe lung damage. The condition can lead to long-term respiratory problems, including chronic lung disease, and may require intensive medical interventions such as mechanical ventilation or extracorporeal membrane oxygenation (ECMO) support.

Question 56

What are the clinical presentations of meconium aspiration syndrome immediately after birth?

Answer 56

Meconium aspiration syndrome presents with meconium present in the mouth and pharynx, potentially staining the skin, nails, umbilical cord, and placenta. Infants may exhibit poor breathing after delivery.

Question 57

What radiographic findings are typically observed in infants with meconium aspiration syndrome?

Answer 57

What radiographic findings are typically observed in infants with meconium aspiration syndrome?

Question 58

Treatment of meconium aspiration

Answer 58

* Every effort must be made to eliminate fetal hypoxia by good labour management. It has been previously recommended that the throat and nose of the infant be suctioned as soon as the head is delivered. However, this is not useful and the revised Neonatal Resuscitation Guidelines no longer recommend it. * Manage in the same way as severe respiratory distress. Nasal CPAP helps to expand the collapsed alveoli and give better distribution of air in the lungs. * Antibiotics only if secondary bacterial infection develops. * Steroids are not helpful and may increase the risk of secondary pneumonia

Question 59

What can cause early-onset bacterial pneumonia in newborns?

Answer 59

Infection acquired before or during passage through the birth canal, usually within 72 hours of delivery.

Question 60

Which pathogens are commonly responsible for early-onset bacterial pneumonia in newborns?

Answer 60

E. coli and group B haemolytic Streptococcus.

Question 61

How does early-onset bacterial pneumonia in newborns present clinically?

Answer 61

It presents with symptoms similar to hyaline membrane disease, making it challenging to distinguish from other causes of respiratory distress.

Question 62

When does acquired (nosocomial) pneumonia in newborns typically present?

Answer 62

After 3 days of life.

Question 63

What are the common pathogens responsible for acquired pneumonia in newborns?

Answer 63

Staph aureus, Klebsiella, Pseudomonas, and other 'hospital bacteria'.

Question 64

How can the risk of nosocomial infections, including pneumonia, be reduced in newborns?

Answer 64

Strict hand washing or spraying, good aseptic protocols, use of breast milk, and skin-to-skin care.

Question 65

How might a newborn with pneumonia present clinically?

Answer 65

With poor breathing after delivery, apneic spells, or features of respiratory distress.

Question 66

How is the diagnosis of pneumonia in newborns confirmed?

Answer 66

By chest X-ray.

Question 67

What diagnostic test can be done to identify the causative organism?

Answer 67

Blood culture.

Question 68

Treatment for pneumonia

Answer 68

* General measures as for respiratory distress. * Specific therapy with appropriate antibiotics. It is important to know the bacterial resistance pattern and antibiotics of choice in each nursery.

Question 69

Common causes of pneumothorax

Answer 69

* Meconium aspiration * Vigorous resuscitation after birth * Hyaline membrane disease, especially if on positive pressure ventilation or CPAP * Spontaneous (idiopathic)

Question 70

What is pneumothorax?

Answer 70

The presence of air in the pleural space, between the lung and the chest wall.

Question 71

How might a small pneumothorax present clinically in newborns?

Answer 71

It may have few clinical signs, and the infants are not particularly distressed.

Question 72

What is the management approach for small pneumothorax in newborns?

Answer 72

It can be managed without needle aspiration

Question 73

What is tension pneumothorax?

Answer 73

It's a severe condition where air accumulates in the pleural space, causing pressure on the heart and lungs.

Question 74

How does tension pneumothorax present in newborns?

Answer 74

Newborns with tension pneumothorax may rapidly deteriorate, showing signs of dyspnea, apnea, cyanosis, shock, and diminished breath sounds on the affected side.

Question 75

How can tension pneumothorax be diagnosed clinically?

Answer 75

Clinical signs include hyper-resonance on percussion, diminished breath sounds, and transillumination of the affected side with a bright cold light source, showing a diffuse glow.

Question 76

How is tension pneumothorax confirmed?

Answer 76

: Confirmation is typically done via chest X-ray, showing absence of lung markings and a collapsed lung on the affected side, along with mediastinal shift.

Question 77

How are mild cases of pneumothorax managed?

Answer 77

Mild cases may resolve spontaneously without intervention.

Question 78

What is the treatment for more severe cases of pneumothorax?

Answer 78

Urgent intervention is needed, typically involving needle aspiration or chest tube placement to drain the air

Question 79

Is it necessary to wait for a confirmatory chest X-ray before draining air in severe cases?

Answer 79

No, in severe cases, immediate intervention is necessary without waiting for a confirmatory chest X-ray.

Question 80

What is persistent pulmonary hypertension of the newborn (PPHN)?

Answer 80

PPHN occurs when the high pulmonary artery pressures of the fetus fail to decrease rapidly after birth, resulting in persistently high pulmonary vascular resistance.

Question 81

What are the consequences of PPHN?

Answer 81

Persisting high pulmonary vascular resistance leads to hypoxia due to pulmonary underperfusion, often resulting in right-to-left shunting from the pulmonary to the systemic circulation via the patent ductus arteriosus or patent foramen ovale.

Question 82

How does an infant with PPHN typically present?

Answer 82

Infants with PPHN, usually term, present with respiratory distress and hypoxia soon after birth.

Question 83

hat is the typical clinical history associated with Persistent Pulmonary Hypertension of the Newborn (PPHN)?

Answer 83

There may be a history of intrapartum hypoxia, meconium staining, and poor breathing at delivery.

Question 84

How is the diagnosis of PPHN confirmed?

Answer 84

The diagnosis is confirmed via cardiac ultrasonography, which shows a normal heart structure but raised pulmonary artery pressure with a ductal shunt. Chest X-ray may reveal features of vernix or meconium aspiration.

Question 85

What are the initial treatment options for Persistent Pulmonary Hypertension of the Newborn (PPHN)?

Answer 85

Initial treatment may include supplementary oxygen or ventilation.

Question 86

How can blood pressure be managed in infants with PPHN?

Answer 86

Sedation of the infant and maintenance of normal or suprasystemic blood pressure using inotropes can help reduce shunting.

Question 87

What medications might be used in severe cases of PPHN to dilate the pulmonary arteries?

Answer 87

In severe cases, medications like sildenafil or nitric oxide may be administered to dilate the pulmonary arteries.

Question 88

What is diaphragmatic hernia?

Answer 88

Diaphragmatic hernia is the herniation of abdominal viscera through the diaphragm, often occurring on the left side.

Question 89

How does diaphragmatic hernia typically present at birth?

Answer 89

It usually presents with severe respiratory distress, cyanosis, and mediastinal shift, interfering with lung function.

Question 90

What are the main diagnostic clues for diaphragmatic hernia?

Answer 90

Polyhydramnios, a shift of maximal heart sounds to the right, a scaphoid abdomen appearance, and bowel sounds heard in the chest are diagnostic clues.

Question 91

How are many cases of diaphragmatic hernia detected today?

Answer 91

Many cases are detected prenatally through routine antenatal ultrasonography.

Question 92

What are the three major defects involved in diaphragmatic hernia?

Answer 92

* A failure of the diaphragm to completely close during development. * Herniation of the abdominal contents into the chest. * Pulmonary hypoplasia.

Question 93

How should the timing of delivery be managed for a baby with diaphragmatic hernia?

Answer 93

Delivery timing should be planned with surgeons informed beforehand to ensure prompt intervention.

Question 94

What is the recommended approach if resuscitation is needed at delivery for a baby with diaphragmatic hernia?

Answer 94

If resuscitation is needed, the infant should be intubated at delivery. Mask ventilation should be avoided to prevent exacerbation of respiratory distress due to gut expansion

Question 95

How is the diagnosis of diaphragmatic hernia confirmed?

Answer 95

X-ray imaging immediately confirms the diagnosis of diaphragmatic hernia.

Question 96

When should surgical repair of diaphragmatic hernia be performed?

Answer 96

Surgical repair should only be performed once the infant is physiologically stable.

Question 97

What is the prognosis for infants with a large diaphragmatic hernia?

Answer 97

The prognosis for infants with a large diaphragmatic hernia remains poor due to associated pulmonary hypoplasia.

Question 98

What is bronchopulmonary dysplasia (BPD)?

Answer 98

Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly affecting preterm infants, particularly those who required supplemental oxygen and prolonged mechanical ventilation.

Question 99

What factors contribute to the development of BPD?

Answer 99

BPD is more common in infants with low birth weight and those who receive prolonged mechanical ventilation.

Question 100

How has the definition of BPD evolved over time?

Answer 100

The definition of BPD has evolved due to changes in the nursery population, including more survivors at earlier gestational ages, and improvements in neonatal management such as surfactant therapy and antenatal glucocorticoids.

Question 101

What are the new NIH criteria for diagnosing bronchopulmonary dysplasia (BPD)?

Answer 101

According to the new National Institute of Health (NIH) criteria, infants treated with more than 21% oxygen for at least 28 days are diagnosed with BPD if they are still requiring oxygen at specific post-menstrual or postnatal ages.

Question 102

What defines mild BPD according to the NIH criteria?

Answer 102

* Breathing room air at 36 weeks post-menstrual age or discharge (whichever comes first) for infants born before 32 weeks, or * Breathing room air by 56 days postnatal age, or discharge (whichever comes first) for infants born after 32 weeks gestation.

Question 103

What defines moderate BPD according to the NIH criteria?

Answer 103

* Need for <30% oxygen at 36 weeks postmenstrual age, or discharge for infants born before 32 weeks, or * Need for <30% oxygen to 56 days postnatal age, or discharge (whichever comes first) for infants born after 32 weeks gestation

Question 104

What defines severe BPD according to the NIH criteria?

Answer 104

* Need for >30% oxygen at 36 weeks postmenstrual age, or discharge (whichever comes first) for infants born before 32 weeks, or * Need for >30% at 56 days postnatal age, or discharge (whichever comes first) for infants born after 32 weeks’ gestation.

Question 105

How effective are steroids in preventing bronchopulmonary dysplasia (BPD) in infants?

Answer 105

Steroids given to infants less than 8 days old have shown evidence of preventing BPD, but the risks of treatment may outweigh the benefits.

Question 106

When is steroid treatment recommended for BPD prevention?

Answer 106

Steroids should be considered for infants who cannot be taken off a ventilator, but their use beyond 7 days after birth is unclear in terms of effectiveness and safety.

Question 107

What alternative respiratory support is recommended for BPD prevention?

Answer 107

Whenever possible, CPAP should be used instead of assisted ventilation, especially in very small infants. Chronic lung disease is a major problem in industrialised countries where extremely low birth weight infants are offered intensive care with ventilation.

Question 108

There are a number of methods which can support respiration in infants with respiratory distress:

Answer 108

* CPAP via nasal prongs (nCPAP) which includes bubble and flow driven. * Humidified high flow nasal cannula (HHFNC). * Nasal cannula. * Conventional positive pressure ventilation. * Oscillation.

Question 109

What is the preferred respiratory support for term infants with mild respiratory distress?

Answer 109

Nasal cannulas are usually sufficient for term infants with mild respiratory distress.

Question 110

How are nasal cannulas beneficial for smaller infants?

Answer 110

Nasal cannulas are often used in smaller infants to prevent alveolar collapse.

Question 111

What interventions can help avoid ventilation in infants with hyaline membrane disease (HMD)?

Answer 111

Early use of surfactant and nasal prong CPAP in infants with HMD often avoids the need for ventilation.

Question 112

What are the indications for ventilation in newborn infants?

Answer 112

Ventilation may be necessary if other forms of respiratory support fail to maintain adequate oxygenation, if there's respiratory acidosis with a high PaCO2, or in cases of apnoea.

Question 113

How has respiratory support been improved in newborn infants?

Answer 113

The use of nasal CPAP with a pulse oximeter to monitor arterial oxygen saturation has revolutionized respiratory support in newborn infants.