Unit 3 study guide

Question 1

Respiratory Distress syndrome

Answer 1

-Also known as Hyaline membrane disease

	-Result of deficiency of mature functioning surfactant, and immature cellular and vascular development of the lung

Question 2

RDS

-Pathophysiology

Answer 2

-Leads to reduced alveolar recruitment (atelectasis)

		-Decreased FRC, decreased pulmonary compliance, increased pulmonary resistance, and ventilation perfusion mismatch

Question 3

RDS

-Clinical presentation and diagnosis

Answer 3

refractory hypoxemia

	-CXR, ground glass (retriculogranular infiltrates) air bronchograms

	-L/S ratio < 2:1

Question 4

RDS

-Prevention

Answer 4

-Antenatal steroid therapy

Question 5

RDS

-Treatment

Answer 5

caffeine citrate

Question 6

-Surfactant Therapy

-4 Exogenous Surfactant Preparation currently used in U.S (All administered a little differently)

Answer 6

-Beractant (Survanta) (Bovine) dosed in 4 aliquots

	-Calftant (Infassuft) (bovine) dosed in 2 aliquots

	-Poractant alpha (Curosurf) (Procine) dosed in 2 aliquots

	-Lucinactant (Surfaxin, aerosurf) (synthetic) dosed in 4 aliquots

	-Via an endotracheal tube

	-Most commonly administered in two aliquots

Question 7

-Surfactant Therapy

ET Tube

Answer 7

-Via an endotracheal tube

	-Most commonly administered in two aliquots

-Methods of administration via ET tube

	-Infant in positioned to allow gravity to aid in distributing surfactant throughout the lung

Question 8

-Surfactant Therapy

Suction time

Answer 8

-Infant should not be suctioned for 1-2 hours after administration unless serious obstruction present

Question 9

Bronchopulmonary Dysplasia (BPD)

Answer 9

-A severe chronic lung injury in premature infants who survived hyaline membrane disease after treatment with mechanical ventilation and oxyge

Question 10

Bronchopulmonary Dysplasia (BPD)

-Pathogensis (4 Major factors)

Answer 10

-Pathogensis

	-4 Major factors in BPD pathogenesis

		-Lung immaturity, respiratory failure, oxygen supplementation, positive pressure mechanical ventilation

Question 11

Bronchopulmonary Dysplasia (BPD)

-Prevention

Answer 11

-Avoidance of factors that predispose to injury

	-Lung protective ventilatory strategies

	-Target oxygen saturation

  -Methylxanthines

Question 12

Transient tachypnea of the newborn (TTN)

Answer 12

-Etiology may be secondary to fetal lung fluid retained after birth

	-Near term or term infant

	-Most common after elective cesarean section delivered without labor

Question 13

Transient tachypnea of the newborn (TTN)

-Clinical presentation and diagnosis

Answer 13

-Lung sounds may be diminished or have crackles on auscultation

	-CXR, pulmonary vascular congestion,

Question 14

Transient tachypnea of the newborn (TTN)

-Treatment

Answer 14

-CPAP levels of approximately 5 cmH2O may be needed

Question 15

Neonatal Infections/ Pneumonia

Answer 15

-An infection caused by the bacteria Group B strep which may lead ri sepsis

-Risk factors

	-Prematurity and low birth weight

Question 16

Neonatal Infections/ Pneumonia

-Prevention & Treatment

Answer 16

-Prevention

	-Aggressive management of suspected maternal chorioamnionitis a bacterial infection of amnion sac or amniotic fluid that occurs before or during labor

	-Rapid delivery of the infant

-Treatment

	-Largly Supportive, antibiotic or antiviral therapy,

Question 17

Meconium Aspiration Syndrome

Answer 17

-Meconium is the thick, black green tinged bowel content of a newborn.which is usually passed within 48 hrs after delivery

-Physical examination

	-Often revealed a newborn with yellow stained skin, nails, and cord and the postmature signs of peeling skin and long finger nails, respiratory distress, barrel chest

Question 18

Meconium Aspiration Syndrome

-Prevention

Answer 18

-Prevention

	-Prevention of postmature delivery by induction of labor at 41 weeks

	-Endotracheal intubation and intratracheal suction in the delivery room

		-Recommendation for intubation and tracheal suctioning has been removed

Question 19

Meconium Aspiration Syndrome

-Compilactions and prognosis

Answer 19

-Ball valve effect

Question 20

Persistent Pulmonary Hypertension of the Neonate (PPHN)

Answer 20

-A clinical syndrome that occurs as a result of disruption in the normal prenatal fetal neonatal circulatory transition

	-Persistent fetal circulation (PFC)

	-Severe hypoxemia due to right to left shunt through foramen ovale and PDA

Question 21

Persistent Pulmonary Hypertension of the Neonate (PPHN)

-Clinal presentation and diagnosis

Answer 21

-Symptoms usually appear within the 1st 24 hrs after birth

		-Should be suspected in all term infants who are cyantic despite adequate ventilation

-Investiations

		-CXS varies, echocardiography

Question 22

Persistent Pulmonary Hypertension of the Neonate (PPHN)

-Pharmacotherapy

Answer 22

-Pharmacotherapy

		-iNO

			-Oxygen index

		-Phosphodiesterase inhibitors

		-Prostacyclin analogs

Question 23

Neonatal Apnea

Answer 23

-Apnea, an unexplained episode of cessation of breathing for 20 seconds or longer, or shorter respiratory pause associated with bradycardia cyanosis, pallor, or hypotonia

-Aonea or prematurity (AOP) a sudden cessation of breathing that last for at least 20 seconds or is accompanied by bradycardia or cyanosis in an infant younger than 37 weeks postmenstrual age

-Apnea of infancy (AOI) infants with a postmenstrual age of 37 weeks or more at the onset of apnea

Question 24

Neonatal Apnea

-Classification

Answer 24

-Classification, central, obstructive, and mixed

-Developmental immaturity of central respiratory drive is a key factor

Question 25

Neonatal Apnea -Treatment

Answer 25

-Xanthine derivatives , caffeine citrate

Question 26

Air Leak Syndromes

Answer 26

-Pneumothorax= thoracic space  -Pneumopericardium= around the heart  -Pulmonary interstitial emphysema (PIE)= into the interstitial space -Pneumoomediastinum= into the mediastinal space

Question 27

Air Leak Syndromes -Etiology and pathophysiology

Answer 27

-Various causes -Lastogenic needle puncture, tracheal suction, intubation vent setting -Occurs due to overdistention of the alveolus

Question 28

Air Leak Syndromes -Dianosis

Answer 28

 transillumination, (halo)

Question 29

-Choanal atresia

Answer 29

-Inlateral or bilateral obstruction of the posterior nares -Obligate nasal breathers -Crying =improved , feeding=symptoms worse

Question 30

-Choanal atresia -Dianosis

Answer 30

-Dianosis verified by inability to pass NG tube past obstruction -Established an airway place an oral airway to relieve distress -Mcgovern,  nipple rubber nipple with the tip cut off 

Question 31

-Macrogossia

Answer 31

-An enlarged tongue

Question 32

-mandibular hypoplasia

Answer 32

-micrognathia, pierre robin (also known as) -A craniofacial abnormality resulting in a small jaw -Dianosis- observation of a short jaw

Question 34

-Esphageal atresia (EA)

Answer 34

-Results when the esophagus is not continuity

Question 35

-Trachealeosopheal fistula (TEF)

Answer 35

-An abnormally connected between part of the esophagus and the airway -A proximal TEF places patients at elevated risk of aspiration of oropharyngeal contents -A distal TEF may lead to aspiration of gastric contents

Question 36

Tracheomalacia

Answer 36

-Cartilage in the trachea has not developed properly and instead of being rigid, the walls are “Floppy”  -Trachea collapses when exhaling -Dianiosis is confirmed by bronchoscopy -Treatment- most often children outgrow by 2 years of age, severe cases may require surgery 

Question 37

Congenital Diaphragmaric Hernia

Answer 37

-the diaphragm forms when the pleura and peritoneum fuse between the fourth and tenth week of embryonic life -CDH occurs with failure of fusion of these layers -90% on the left side -bowel sounds in the chest, flat, sunken/ scaphoid abdomen 

Question 38

Congenital Diaphragmaric Hernia -Dianosis & -Treatment

Answer 38

-Dianosis -CXR= sunken/ scaphoid abdomen -Treatment -Orogatric (Replogle tube) tube to decompress stomach -Surgical repair

Question 40

Abdominal Wall Defects -Omphalocele

Answer 40

-Always occurs at the umbilicus and the eviscerated abdominal contents are covered by the peritoneal sac

Question 41

Abdominal Wall Defects -Gastroschisis

Answer 41

-Birth defect of the abdominal wall, intestines are found outside the body, -Silo is placed over intestines, silo is tightened daily and intestines slowly pushed in