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Flashcards in Respiratory distress Deck (23):
1

Signs of respiratory distress in the newborn

- Central cyanosis
- Tachypnoea
- Subcostal/sternal recession
- expiratory grunting
- nasal flaring

2

why does expiratory grunting occur in resp. distress

keeps alveoli from collapsing entirely and occurs as vocal cords are partially closed

3

What are the 6 main causes of respiratory distress in the newborn

1. respiratory distress syndrome
2. congenital pneumonia
3. transient tachypnoea (TTN)
4. Meconium aspiration syndrome
5. air leak (pneumothorax)
6. Upper airway obstruction

4

aetiology of respiratory distress syndrome

surfactant deficiency and immaturity in the lungs, can also be a consequence of neonatal infection

5

What is surfactant

Produced by type 2 pneumocytes and coats alveoli to prevent collapse throughout inhalation and exhalation. The surfactant reduces surface tension in the alveolar air space so preventing collapse on exhalation and allows re-opening with a lower amount of force

6

Diagnosis of RDS

Pre-term infant with signs of increased work of breathing and CXR signs

7

CXR signs

homogenous lung fields and heart (gram-blast appearance) with air bronchograms

8

treatment of RDS

establish lung volume and nasal CPAP
exogenous surfactant therapy

9

what is congenital pneumonia associated with

PROM (>18-24h) and septicaemia with group B strep

10

Presentation of congenital pneumonia

delayed onset after birth (24-48h)
- may present with shock sepsis
- Patchy areas of consolidation bilaterally on CXR

11

Treatment of congenital pneumonia

prevent group B strep transmission with intrapartum abx esp. for high risk groups
- broad spectrum abx e.g. penicillin and co-amox

12

Incidence of TTN

1-2% of all newborns, usually in term infants

13

Why does TTN occur

due to delayed clearanc of lung fluid

14

presentation of TTN

c-section baby with onset of respiratory distress 1-3hours after birth
* any increased work of breathing in term infant*

15

CXR findings of TTN

coarse streaking and fluid in interlobar fissures 'wet lung'

16

Mx of TTN

Treat infection if present and respiratory support (stop feeds, oxygen and nasal CPAP)

17

presentation of meconium aspiration

passage of meconium in utero
- fetal/neonatal gasping
- aspiration
-fetal hypoxia/distress

18

consequences of mec. aspiration

mechanical airway obstruction, chemical pneumonitis, surfactant inactivation

19

CXR findings in mec. aspiration

coarse streaking and patchy consolidation
- may have pneumothorax, pneumomediastinum or pneumonia

20

aetiology of air leak (pneumothorax)

1. spontaneous
2. complication of respiratory illness (RDS, mec aspiration, pneumonia)
3. complication of treatment (PPV or CPAP)

21

diagnosis of pneumothorax

transillumination
or typical CXR changes (same as adult)

22

Tx of pneumothorax

use butterfly needle with syringe to drain air away and allow lung to re-inflate

23

causes of inspiratory stridor

1. Laryngomalacia- epiglottis folds over and soft larynx
2. mechanical obstruction; haemangioma, granuloma from trauma (ET suction), sub-glottic stenosis (ET tube)
3. vocal cord palsy