Respiratory Perinatology - Neonatal Diseases

What is the onset of MAS?

Acute

What is the onset of RDS?

Acute

What is the onset of TTN?

Acute

What does the ABG look like with RDS?

Acute Respiratory Acidosis with hypoxemia

What does the ABG look like with PPHN?

Acute Respiratory acidosis or alkalosis with hypoxemia

What is the onset of PIE?

Acute caused by Chronic

What is the onset of PPHN?

Acute or chronic

What does the ABG look like with TTN?

Acute respiratory acidosis with hypoxemia

What is the appearance of the x-ray with TTN?

Ground glass appearance mimicking RDS with fluid, flat diaphragm, increased vascular congestion, pulmonary edema

What is the appearance of the x-ray with BPD?

Ground glass appearance with cysts

What is the x-ray appearance with RDS?

Ground glass appearance, bi-lateral infiltrates, white out, air bronchograms as condition worsens

RDS is also know as what?

Hyaline membrane disease

What is the appearance of the x-ray with PPHN?

Hyper-expansion, diminished vasculature, cardiomegaly, white out

What are the signs and symptoms of TTN?

The main symptom is tachypnea greater than 60 bpm, respiratory distress; diagnosis made after everything else is ruled out

What are the signs and symptoms of BPD?

respiratory distress, mild weight loss, Cor Pulmonale

What are the signs and symptoms of PIE?

respiratory distress, ventilator cycle that requires higher vent pressures, hypoxemia, barotrauma

What is the condition/cause of PPHN?

secondary to other conditions such as hypoxia, MAS, polycythemia, sepsis, diaphragmatic hernia, or can be idiopathic

What are the types of pneumothoraxes?

spontaneous, induced, tension

What is the cause/condition of MAS?

term and post-term stress from asphyxia; meconium passes into amniotic fluid; disease of term and post-term babies

What is the treatment for BPD?

treat the cause of RDS, HFOV for barotrauma, fluid balance, smaller ETT, nutrition, Bronchodilators, Caffeine or Theophylline

What is the condition/cause of RDS?

decreased surfactant due to prematurity

What is the treatment for PIE?

decreased vent pressures, JET

What are the 4 stages of BPD?

1. First 3 days = CXR has RDS picture 2. Days 3-10 = Lungs opaque with granular infiltrates 3. Days 10-20 = multiple cyst formations 4. Day 28 and beyond = increased lung density and formation of large irregular cysts.

What are the 4 Air Leak Syndromes?

1. Pneumothorax 2. Pneumomediastinum 3. Pneumopericardium 4. Pulmonary Interstitial Emphysema - PIE

What causes fetal asphyxia?

A low PaO2, low pH, High PaCO2

What is BPD?

Broncho Pulmonary Dysplasia

What is the appearance of the x-ray with PIE?

Bubbly cysts in the lung parenchyma

What are the treatments for RDS?

CPAP is the main one, surfactant replacement, mechanical ventilation, HFOV, hydration and fluid balance, steroids, MDI's, thermoregulation

What is the onset of BPD?

Chronic

What does the ABG look like with BPD?

Chronic respiratory acidosis with hypoxemia

What does the ABG look like with PIE?

Chronic respiratory acidosis with hypoxemia

Air Dissecting = _____

PIE

What factors contribute to BPD?

ET intubation, PPV, High FiO2's, degree of prematurity, genetic disposition, inflammation, excessive fluid administration

What is the condition/cause of BPD?

Increased FiO2 and barotrauma from PPV and oxygenation secondary to RDS; also linked to PDA and fluid overload

What is the condition/cause of PIE?

Increased PEEPs and PIPs, barotrauma caused by prolonged I-Times; vicious cycle of patient requiring higher vent pressures causing V/Q mismatch.

What is the treatment for PPHN?

Mechanical ventilation, HFOV, ECMO, Vasodilate with drugs and oxygen, decrease stressors, minimize stimulation, nitric, nutrition, temp, fluids

What is MAS?

Meconium Aspiration Syndrome

What is PPHN?

Persistent Pulmonary Hypertension of the Newborn; decreased ventilation, right to left shunting

What is the most common air leak syndrome?

Pneumothorax

What is PIE?

Pulmonary Interstitial Emphysema; air dissects through interstitial tissue of lungs

What is the primary cause of respiratory disorders in neonates?

RDS

What is RDS?

Respiratory Distress Syndrome

What are the signs and symptoms of RDS?

Respiratory Distress, ABG with High PaCO2, low PaO2, low pH, hypothermia

What does the ABG look like with MAS?

Respiratory acidosis with hypoxemia

What are the signs and symptoms of PPHN?

Respiratory distress, decreased APGAR, meconium staining, R to L shunt, PVR, Pre-ductal SpO2 higher, refractory hypoxemia

What are the signs and symptoms of MAS?

Respiratory distress, meconium staining, coarse breath sounds

What is the treatment for a pneumothorax?

Stable = just observe Severe Distress = needle aspiration and chest tube On ventilator = chest tube to suction -15 to -20 cmH2O

What is the treatment for MAS?

Suction, DO NOT stimulate, intubate and suction lungs and don't apply PPV until meconium removed, CPT, antibiotics, HFOV

What is TTN?

Transient Tachypnea of the Newborn

What are the clinical signs of a pneumothorax?

high RR, cyanosis, asymmetric chest movement, bradycardia, apnea

What is the appearance of the x-ray with MAS?

irregular densities

What is the treatment for TTN?

oxygen, CPAP of 3-5 cm H2O, nutritional supplements

What are the complications of MAS?

pneumothorax, Intracranial Hemorrhage, PPHN

What is the condition/cause of TTN?

precise cause unknown, delayed reabsorption of fetal lung fluid; retention of fetal lung fluid

What increases the risk of TTN?

premature, delivery by C-Section, maternal smoking, diabetes in mom, Small Gestational Age - SGA.

What increases the risk of RDS?

prematurity, low birth weight, males, PPHN, atelectasis, multiple gestation, maternal complications, placental conditions, umbilical cord disorders