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
