Met_2_Resp_20130218_Neonatalrespprobs

Front 1

OBJECTIVES:
! To learn to identify the clinical signs of respiratory distress in the newborn.
! To understand the pathophysiology of respiratory illnesses in the newborn.
! To learn the clinical presentations and management of the common pulmonary causes of neonatal respiratory distress
! To understand the various airway and lung anomalies which may cause respiratory distress in the newborn
! Investigation and management of common respiratory anomalies
! To develop an understanding of non-pulmonary causes of respiratory distress in the newborn.

Back 1

Just objectives

Front 2

What are the 4 Primary Clinical Signs/ Presentation of Resp Distress in the New Born?

Back 2

1. Cyanosis
2. Grunting
3. Retraction
4. Tachypnea

Front 3

What tool is used to assess Neonatal Respiratory Distress? What variables are measured?

Back 3

Respiratory Distress Score - ACoRN
Variables: Resp Rate, O2 requirement, Retractions, Grunting, Breathing sounds on Auscultation, Prematurity

Front 4

What 4 questions can help narrow down the diagnosis of Resp distress?

Back 4

(Age, Severity, Timing, Radio)

1. What gestation is the baby (guessing this means age/how early baby was born)
2. How significant is the resp disorder?
3. When did the distress start?
4. What does the CXray show?

Front 5

What are some Pulmonary Causes of Respiratory problems in the new born: Common (3), Less Common (3), Rare (3)

Back 5

Common:
1.Idiopathic RDS (aka Hyaline Membrane Disease)
2.Transient Tachypnea of the New Born (TTN)
3.Aspiration Syndromes
Less Common:
1.Pneumonia
2.Pneuomothorax
3.Pulmonary Hemorrhage
Rare:
1.Airway Obstruction
2.Abnormal Lung Devo
3.Diaphragmatic Hernia

Front 6

How can Pathophysiology of Lung Development go wrong in A: Normal Lung Devo; B:Abnormal Lung Devo?

Back 6

A: Normal Lung Devo
- Infection
- Interference with normal adaptation to extra-uterine life
- Interference with air-blood interface
B: Abnormal Lung Development
- Timing of Delivery
- Developmental/Congenital Abnormalities
- All can lead to lung AbNorms - form and/or function relationship

Front 7

Pulmonary Embryology (woot!) What are the 5 phases of Lung Development and their Asc. gestational age of development?

Back 7

1.Embryonic Phase - 4th week gestation (6th week preggers)
2.Pseudoglandular Phase - 7-16 weeks (9th-18th)
3.Canalicular Phase - 16-25 weeks (18-27)
4.Terminal Sac Phase - 25-40 weeks (27-42)
5.Alveolar Stage - late fetal-8years old (Langman's =10)

Front 8

The lungs are formed from an ________ of the ________ part of the ______-______ beginning in the ____ week of gestation.

Back 8

The lungs are formed from an -(out-pouching)- of the -(ventral)- part of the -(fore-gut)- beginning in the (4th) week of gestation.

Front 9

How does Alveolar and Capillary development relate?

Back 9

they are linked

Front 10

In weeks 7-16 gestation-the ____ phase- what has been completed? What is forming and being deposited? Is Respiration Possible at this time?

Back 10

- Pseudoglandular Phase
- Bronchial Branching is done
- Pre-Acinar blood vessels are forming and Connective tissue is deposited after 10 weeks gest.
- No Respiration is not possible at this time - lack of Type 2 cell development

Front 11

During what phase and weeks is Respiration possible? Why?

Back 11

-Canalicular Phase - 16-25 weeks
- 22 weeks (earliest) Respiration is "possible" - most places its 23 or later
WHY?:
- Walls of Air spaces start to thin
- Vascularity increases
-Terminal Bronchioles have 2+ Respiratory Bronchioles with terminal sacs Present
- Most Importantly - Type-2 Cells emerge even though No Alveoli are present yet - requires Resp Bronchioles only

Front 12

What 3 key processes occur in the Terminal Sac Phase?What weeks is this occurring?

Back 12

- Gradual Flattening of the air space
- Type 2 Pneumocyte (aka Type 2 alveolar Epithelial cells) differentiation /surfactant production starts
- Capillaries bulge into terminal sacs

Front 13

The Alveolar Stage occurs from ___ to ___ of age. What two processes occur in this time?

Back 13

- late fetal - 8 years
1. terminal Sac Epithelium thins further
2. Surfactant Production matures

Front 14

***What is the most common cause of respiratory distress in term or near term babies? In what population is it more common and why does it occur?

Back 14

- Transient Tachypnea of the New Born
- it occurs more in ***C-section*** delivered babies
- Caused by delay in the the clearance of Residuale lung fluid after birth

Front 15

When do babies present most with TTN? How many require oxygen? When does it resolve?

Back 15

- First few hours of life with mild to moderate Respiratory distress
- with O2 requirement in <40% (I'm pretty sure that's what was meant?)
- Resolves once residual lung fluid is reabsorbed - from minutes to hours after birth but... ***can last up to 72 hours***

Front 16

Name a type of Aspiration Syndrome Discussed in Lecture

Back 16

Meconium Aspiration Syndrome

Front 17

Answer: This is a disease of post-term, term, and occasionally near-term babies. (Jeopardy style)

When is it: worse, more common, acquired?

What does it result in?

What's the presentation?

Back 17

Question: What is Meconium Aspiration Syndrome
- Worse if the meconium is thick or particulate
- More common if the baby is depressed at birth
- Acquired Perinatally
Results in:
- Combination of large and small airway obstruction
-Pneumonitis
-Surfactant inactivation
-Ventilation: perfusion Mismatch - How does this mismatch alter O2 saturation levels?

-Presents Immediately after birth with any degree of O2 requirement/severity of respiratory distress
-***may be accompanied by persistent pulmonary HTN of the new born***
- Severe MAS is life threatening and requires prompt specialized care

Front 18

Pneumonia in the new born is usually due to infection and ______ rather than lobar in appearance

Back 18

Diffuse

Front 19

When is Pneumonia in the New Born more likely to occur?

Back 19

In the presence of Risk factors for sepsis: ie. prolonged rupture of membranes, maternal colonization with GBS, or chorioamnonitis)

Front 20

When/How will pneumonia present in the new born?

Back 20

- Maybe in the first few weeks depending on source of infection
- At any level of Resp Illness
- Babies may/may not be systemically ill at onset, but clinical course may be fulminant
-

Front 21

When should a Respiratory disease in the new born be treated with IV Antibiotics?

Back 21

With the inability to rule out Pneumonia via clinical OR radiographic appearance

Front 22

Who is Respiratory Distress Syndrome mostly a disease of? How does it relate to age?

Back 22

- Primarily a disease of Preterm Babies
- Incidence increases with decreasing Gestational Age

Front 23

Describe the Pathophysiology of Respiratory Distress Syndrome (5 points)

Back 23

1. Lack of Surfactant
2. Decreased Alveoli #
3. Increased Resistance
4. Thick Alveolar Walls
5. Results in Progressive collapse of the terminal bronchioles/alveoli

Front 24

Name two abnormalities that can cause Hypoxemia and Hypercarbia in a New Born

Back 24

Acute: - Inadequate Surfactant

Chronic: - Structurally Immature Lung

Front 25

How do babies present with RDS?

Back 25

- Any degree of Resp Distress and O2 requirements
- *** Presents at <3 hours of age AND persists beyond 6 hours of age and during first few days***

Front 26

How might TTN and RDS be differentiated On Exam?

Back 26

- Edema and decreased urine out put are much more common in RDS than TTN