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15 Cards in this Set

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How often do you see meconium aspiration and in who?
-10-15% of deliveries
-Rare before 34 wk. Common in postmature infants.
Why is it so bad?
-It can plug the airways and cause pulmonary pneumonitis. Predisposing the infant to pulmonary hypertension.
What do you do for meconium aspiration babies?
1.CR/Pox. Pox< 94 : hood oxygen and ABG. O2 >30% - place UAC.
2.CBC/chemstrip/Hgb/ Bcx/CXR
3.Abnl CBC, need oxygen, distress, or abnl CXR --> abx.
4.Echo if evidence of pulm HTN (O2, NO)
What causes RDS?
Deficiency of pulmonary surfactant.
Who is at increased risk for RDS?
-Prematurity
-Maternal diabetes
-Asphyxia
-Male
-Hydrops fetalis
What happens when you don't have enough surfactant around?
Leads to alveolar atelectasis:
-Low lung volumes
-Stiff lungs
-Increased shunt (V/Q mismatch)
-Increased pulm vascular resistance (less pulm blood flow)
-Increased WOB
How do babies present with RDS?
-Tachypneic, retracting, grunting
-Cyanosis
-Apnea
When does RDS usually present?
-Almost always at birth
-Peak at 2-3 days
What do you see on lab with RDS?
-L/S (lecithin/sphingomyelin)<2.5
-Negative PG (phosphatidylglycerol)
What do you expect to see on blood gases for RDS?
Hypoxemia --> Hypercarbia --> Metabolic acidosis
What do you see on CXR?
-Low lung volumes
-Homogeneous ground glass hypoaeration
-Air bronchograms
What else should you be thinking on your DDx besides RDS?
-Congenital PNA ( in near term infants, assume it is GBS unless proven otherwise)
-CHD
-TTN (dx of exclusion)
How do you treat RDS?
1.Restrict fluid - b/c diuresis is delayed in RDS and doesn't start till day 2-3.
2.Respiratory improvement starts 12 hr after diuresis begins.
<1000g 80-100 cc/kg/d
>1000g 60-80 cc/kg/d
4.Pox 88-94%
-NCAP (5-8 cm H20)
-Ventilator
5.Survanta (4 cc/kg) - should hear bubbling after given
6.Caffeine - prior to extuabeion in infants less than 30 wk
What are some complications with RDS?
1.Pulmonary interstitial emphysema
2.Pneumothorax
3.PDA - deteriorate or has pulmonary hemmorage
4.BPD
When to you exxtubate RDS to NCPAP?
1.FiO2 <40
2.PIP <20, MAP<7
3.Stable