What outcomes has antenatal steroids been shown to reduce?
RDS, NEC, IVH, mortality
NOT BPD
What is the lung histology of an ex 24 weeker who died of severe BPD?
arrested lung development, specifically alveolar simplification (fewer, larger alveoli with reduced septation) and dysmorphic vascular growth, resulting in less gas exchange surface area and abnormal pulmonary vessels. Key features include fewer, larger air sacs, thickened vessel walls, inflammation, fibrosis in smaller airways, and prominent intrapulmonary shunts
What is alveolar capillary dysplasia?
Abnormal barriers for gas exchange, severe hypoxia, and pphn
What reflex causes cessation of inspiration from lung over inflation? and responsible for slower breathing once on cpap
Hearing-Breuer Reflex
Opposing reflex to hearing-Breuer reflex that results in extended inspiration. Deep sighs and initial NB breaths
Paradoxical reflex of head
What is the newborn’s response to hypoxemia?
Initial surge in ventilation followed by respiratory depression
Where do pulmonary arteries originate from embryologically
6th pair of aortic arches
Where does pulmonary vein originate from embryologically?
Outgrowths of the left atrium
CDH embryology
Failure of closure of pleuroperitoneal canal at approx 8 weeks
Gene implicated in ACD. And what stage of embryology?
FOXF1 gene
Canalicular and saccular stage
What genetic conditions are assoc with congenital pulmonary lymphangiectasis?
Noonan’s, T21, ulrich-Turner
What does ABCA3 deficiency show on electron microscopy?
Electron dense inclusions
Lab characteristics of exudate? How about Chylous?
Exudate:
WBC>1000
LDH>200
PH<7.4
Transudate:
PH more basic, >7.4
Triglycerides >110
Normal pao2 in the fetal ascending aorta in utero is?
25-35mmHg
What type of stridor in vocal cord paralysis? What condition is assoc with b/l vocal cord paralysis?
inspiratory/extrathoracic
Arnold Chiari - get MRI
Effects of caffeine?
Adenosine antagonism (adenosine usually is an a1a and a2a receptor blocker in medulla)
Decreased: BPD, PDA, mechanical ventilation, CP, cognitive delay
Better: CO2 responsiveness, visual acuity, periodic breathing, hypoxic ventilatory depression, airway smooth muscle relaxation
What kind of compound is disaturated phosphatidyl choline?
lipid
aka lecithin
Effects of antenatal and postnatal corticosteroids on the lung?
-decrease in mesenchymal tissue and thus increased airspace
-arrest of alveolarization: arrest of alveolar/saccular septation
-arrest microvascular development
What delays alveolarization?
Antenatal steroids AND postnatal steroids
Mech ventilation
Oxygen
Nutritional deficiencies
