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24 Cards in this Set
- Front
- Back
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Adam is a 2-hour-old infant born at 32 weeks' gestational age viasvdo a healthy mother with negativeGBSstatus. There was no premature rupture of membranes and no meconium in the amniotic fluid. His Apgars were 8 at one minute and 9 at five minutes. Over the last two hours he has become progressively tachypneic. On physical examination he is large for gestational age. His vital signs are respiratory rate 75, temperature 36.5 C and heart rate is 130 beats per minute. His lung exam is remarkable for intercostal and subcostal retractions, grunting, and equal breath sounds. His heart exam reveals normal rhythm, normal S1 and S2, no murmurs, and normal peripheral pulses and capillary refill. Which of the following is the most likely cause of the patient’s condition? |
Respiratory distress syndrome |
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TTN common in which mothers? |
Diabetic mothers R/O with CXR |
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Pneumothoraces |
consider in infant with respiratory distress consider if air entry not bilateral |
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CHF triad |
Triad: tachypnea, tachycardia, hepatomegaly |
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RDS features |
tachypnea more common in premature infants |
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Sepsis |
Look for abnormal vitals |
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A 3-hour-old infant boy, born by C-section at 36 weeks to a 30-year-old G1P1 with Apgars of 8 and 9 at 1 and 5 minutes, respectively, is found to be tachypneic in the newborn nursery. His mother has a history of Type II diabetes that was poorly controlled during her pregnancy. She was compliant with prenatal vitamins and took no other drugs during her pregnancy. Prenatal labs, including GBS, were negative. The mother’s membranes ruptured 9 hours prior to delivery, she was afebrile, and the amniotic fluid had no meconium. On physical exam, the infant is large for gestational age. He has good air movement through the lungs bilaterally, without retractions or nasal flaring. He appears well perfused with normal cardiac exam. He is not in a flexed posture and has a weak suck reflex. A screening test at 3 hours of life reveals blood glucose of 39 mg/dL. What is the most likely diagnosis? |
Hypoglycemia |
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Hypglycemia features |
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Transposition of great arteries features |
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TTN features |
respiratory distress infants born by C section and to diabetic mothers at increased risk X-ray include wet appearing lungs resolves within 24-48 hours treated sympatomatically |
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Neonatal sepsis features |
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Pneumothorax characteristics |
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A male infant weighing 3200 grams is born to a G1P1 female at 39 weeks gestational age via planned C-section. Maternal PMH is unremarkable, and GBS status is unknown. Apgars are 7 and 8 at 1 and 5 minutes of life, respectively. The delivery is uncomplicated, and the infant initially appeared in good condition. However, one hour following delivery the infant develops increasing respiratory distress. RR is assessed as 90 bpm. All other vital signs are within normal limits. On exam, the infant is acyanotic with rapid respirations and robust capillary refill. Chest x-ray shows bilateral lung fields with the appearance of “a radio-opaque line of fluid in the horizontal fissure of the right lung." No air bronchograms are noted. What is the most likely etiology of the infant’s respiratory distress?
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TTN |
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TTN complications |
unable to nurse require feeding via NG tube until respiratory status stabilizes |
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CXR characteristics of RDS? |
ground glass appearance and air bronchograms |
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Evaluation of neonatal sepsis |
screening labs blood cultures |
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Meconium aspiration risks |
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Adam is a newborn male who was just born to a G2P1 mother at 36.2 weeks' gestation via a vaginal delivery. The mother reports that she did not receive prenatal care because she did not have insurance. She says that she thinks her “water broke” about two days ago, but she did not have any contractions after that, so she decided not to come to the hospital. She did not start having contractions until 19 hours before she delivered. After delivery, Adam did not cry vigorously, was tachypneic, cyanotic, and febrile to 100.5 F. Amniotic fluid did not contain meconium. His chest x-ray is normal. Given Adam’s birth history, what is the most likely cause of his symptoms? |
Sepsis secondary to prolonged rupture of membranes
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TTN CXR findings |
fluffy densities that represent fluid filled alveoli and/or fluid in pleural space and small amount of lfuid in fissures on lateral view |
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A newborn baby boy is born at 30 5/7 weeks' gestation after induction of labor for the severe maternal preeclampsia. He is noted to have subcostal and intercostal retractions, grunting, nasal flaring, persistent cyanosis, and tachypnea 30 minutes after delivery. Apgars were 6 (–2 for color, –1 for breathing and –1 for tone) and 7 (–2 for color and –1 for breathing) at 1 and 5 minutes, respectively. Due to lack of prenatal care and the mother’s presentation with severe preeclampsia, betamethasone x 1 was given during induction, but she did not receive a second dose prior to delivery. A chest x-ray is obtained, which reveals diffuse ground-glass appearance and air bronchograms bilaterally. What is the most likely diagnosis?
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Respiratory distress syndrome (RDS)
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T/F: between 20 to 34 weeks gestation fetus will pass meconium infrequently |
true |
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PPHN risk factors |
underdevelopment: congenital diaphragmatic hernia, oligo, IUGR, renal agenesis maldevelopment: assoc with post term delivery and meconium aspiration syndrome maladaptation: GBS |
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TTN |
prematurity CS LGA or SGA CXR: perihilar streaking and other evidence of interstitial fluid |
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BPD |
bronchopulmonary dysplasia: result of prolonged mechanical ventilation CXR:
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