respiratory problems in the nnewborn Flashcards Preview

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Flashcards in respiratory problems in the nnewborn Deck (26)
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1
Q

what is the most common respiratory disorder in preterm babies ?

A

respiratory distress syndrome

2
Q

what are the general signs of respiratory distress ?

A

tachypnea
nasal flaring
retractions
expiratory grunting

3
Q

what are the predisposing factors related to the mother that may cause RDS ?

A

maternal diabetes

hypothyroidism

4
Q

what factors reduce the risk of RDS ?

A

IUGR

maternal corticosteroids

5
Q

when should antenatal steroids be administered to the mother to avoid RDS ?

A

2 doses 12 hours apart at 24-34 gestational age
or
at 35-36 weeks with antepartum haemorrhage and rupture of membranes

6
Q

what are the preparations available for surfactants ?

A

curosurf
Survanta
KL4

7
Q

what are the schedules for surfactant use in neonatal respiratory distress syndrome ?

A

early selective- prophylactic but only if the baby is ventilated
rescue - to ventilated infants with clinical and radiological signs of RDS

8
Q

what time period is RDS usually diagnosed at ?

A

at birth or within the first 4 hours of birth

9
Q

what are the differential diagnosis of RDS ?

A

pneumonia

sepsis ( esp group b strep )

10
Q

what is the typical radiological appearance of RDS ?

A

small volume lungs
homogenous ground glass opacity
air bronchogram

11
Q

what interventions may change the appearance of the X-ray findings in RDS ?

A

CPAP tends to result in lungs of normal size

surfactant administration given before the x-ray can result in a less homogenous appearance

12
Q

how can RDS be prevented ?

A

by the prevention of prematurity
administration of antenatal steroids ( dexamethasone and betamethasone )
prevention of postnatal asphyxia
avoiding drug depression and polyhydraminous

13
Q

what is the management of RDS ?

A

Oxygen
surfactant administration
ventilation

14
Q

what is the oxygen saturation target ?

A

91-95% to avoid hyperoxia

15
Q

what are the complications of RDS ?

A

Air leaks pneumothorax
PDA
periventricular intraventricular Hge
bronchopulmonary dysplasia

16
Q

when do babies with RDS develop CLD ?

A

chronic lung disease develops when the baby becomes ventilator dependent or oxygen-dependent

17
Q

what is the management for pneumothorax ?

A

decompress by inserting a chest tube

18
Q

what are the diagnostic criteria of BPD ?

A

at 28 days :

  1. positive pressure ventilation during the first 2 weeks of life for a minn of 3 days
  2. clinical signs of abnormal resp function
  3. requires oxygen supplementation for longer than 28 days to maintain Pao2 >50 mmHG
  4. chest imaging with findings of BPD
19
Q

what are the radiological findings in a chest x-ray of an infant with BPD ?

A

hyperinflation
low diaphragm
atelectasis

20
Q

what is the management for BPD ?

A

short and low doses of corticosteroids

may go home with supplemental oxygen

21
Q

what is apnea ?

A

cessation of breathing for more than 20 seconds
or
associated with bradycardia (<100)
or
associated with cyanosis , pallor , hypotonia

22
Q

what is the main risk factor for apnea ?

A

very low birth weight

23
Q

what is the most important etiology of apnea of prematurity ?

A

prematurity lol

24
Q

what are the different causes of apnea of prematurity ?

A

central : immaturity of the brain stem centers
obstructive : excessive secretion, neck flexion
mixed apnea

25
Q

what is the treatment for acute apneic episodes ?

A
  1. physical stimulation

2. if no response - bag and mask ventilation, suctioning and neck positioning

26
Q

what is the general management for apnea ?

A

monitoring with a bedside respiratory and heart rate monitor
caffeine citrate ( reduces recurrence)
CPAP and mechanical ventilation
correction of the cause