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Neo Resp Disease 2
MecAsp, PPH, AofP, Congenital Anomalies
| Question | Answer |
|---|---|
| Etiology of Meconium Aspiration | Hypoxia/Asphyxia, Gasping in Utero and Decreased rectal sphincter tone |
| What term babies can have meconium aspiration? | Full term and post term |
| What is the composition of meconium? | amniotic fluid and epithelial cells |
| In the Pathophysiology of Meconium Aspiration, the Ball-Valve obstruction results in what 4 things? | air trapping, overinflation, alveolar collaps and pulmonary shunting |
| Chemical inflammation from Meconium aspiration causes what? | Pneumonitis |
| When hypoxemia and acidosis from Meconium Aspiration are severe it leads to what? | Persistent Pulmonary HTN |
| 2 ways to prevent PPH from occuring d/t meconium aspiration are | ob suctions nasopharynx during delivery, or intubate and suction infant at birth if not vigorous and crying per NRP guidelines |
| 5 Clinical signs of Meconium Aspiration | stained nails and cord, respiratory distress, Rhonchi, Metabolic Acidosis (ABG), Increased AP diameter and Hyperinflation on CXR (barrel chest) |
| Tx of Meconium Aspiration at birth includes | CPT and Suctioning |
| Why do you want to keep PaO2 high after Meconium Aspiration? | bc PaO2>100 helps prevent PPHN |
| Whay wouldn't you use CPAP on infant with Meconium aspiration? | CPAP causes overinflation and air leaks |
| Ventilation used in cases of meconium aspiration? | mechanical ventilation or high frequency- NO PEEP |
| In severe cases after Mecnium aspiration, waht Tx is used? | ECMO |
| Prognoses after meconium aspiration depends on what? | degree of asphyxia and aspiration |
| What dx process is this describing: Severely incerased PVR with rt-lt shunting occurs in term or post term babies and can be related to a clinical condition or idiopathic | Persistent Pulmonary Htn |
| Persistent Pulmonary HTN was formerly known as what | Persistent Fetal Circulation |
| Primary PPHN is usually caused by what? | anatomic malformations |
| Secondary PPHN is usually associated with what? | a disease |
| If the baby is asphyxiated, the hypoxia and acidosis cause what to occur resulting in PPHN | the pulmonary vasculature to constrict |
| 4 disease processes that can lead to PPHN | severe RDS, Meconium Aspiration, CDH, Sepsis |
| Clinical presentation of PPHN | signs of respiratory distress, hypoxia with increased O2 requirements, swings in PaO2, Acidosis |
| 3 ways to diagnose PPHN | echo or cariac cath, hyperoxia test, and simultaneous preductal/postductal ABG's |
| What is the hyperoxia test? | place in 100% for 15 minutes and get ABG, if PaO2<50 infant has PPHN(or could be cardiac) |
| When simultaneously drawing ABGs from preductal/postductal sites, what result indicates PPHN present? | shunting difference of 10-15 |
| Tx for PPHN | Keep PaO2 high(80-100+), wean O2 slowly, Hyperventilate , HFV, Nitric oxide, and ECMO |
| When hyperventilating a pt with PPHN, what do you want to keep you PaCO2 and pH between and why? | PaCO2 20-30 and pH 7.45-7.55, mild pulmonary vasodilator |
| Why is HFV is used for Tx of PPHN? | easy to creat alkalosis and decreases barotrauma |
| What does Nitric oxide cause? | pulmonary vasodilation |
| Pharmacologic therapy for PPHN includes | keep sedated, buffer the acidosis |
| What is Priscoline (Tolazoline hydrochloride), where must it be administered, and why? | peripheral vasodilator given in the systemic side of the scalp so it can quickly reach the pulmonary system |
| What is Apnea of Prematurity and what is it associated with? | no breathing for 20 seconds or greater, associated with bradycardia and desats |
| __% of all infants that present with Apnea of Prematurity are < __ grams | 75%, 1250 grams |
| If a term infant presents with Apnea of Prematurity it is usually related to problems sucha as | sepsis or respiratory distress |
| 6 common causes of Apnea of Prematurity | airway obstruction, CNS prematurity or disorder, Resp center depression, Temp instability, Sepsis, metabolic disorder |
| Tx of Apnea of Apnea of Prematurity involves what? | treating the symptoms while looking for the cause |
| Ways to treat/find cause oo Apnea of Prematurity | cardiac/apnea monitor, pulse ox, positioning, maintain temp, remove feeding tube, R/O sepsis, check ABG for acidosis or hypoxemia, bouncing bed, keep O2 los as possible, NCPAP, intubate/vent if necessary, Methylxanthines, and caffeine |
| Why is bouncing bed not a popular Tx for apnea of prematurity? | danger of intraventricular hemorrhage |
| Name 3 congenital abnormalities of neonates | Choanal Atresia, Treacheoesophageal Fistula, and Diaphragmatic Hernia (CDH) |
| What is Choanal Atresia? | membrane or bony obstruction in nares, unilateral or bilateral, associated with other anomalies |
| 3 Clinical signs for Choanal Atresia | cyanosis, retractions, problems with feedings |
| Diagnosing Choanal atresia | unable to pass a catheter down nare(s) |
| Tx for Choanal Atresia | oral airway, hold feedings or use a special type of nipple, surgery for repair (a stent is placed during healing to hold open) |
| What is the definition of a T-E Fistula? | a congenital interuption and or fistulous connection of the trachea and esophagus |
| 4 Clinical signs of T-E Fistula | excessive salive, drooling, choking, cyanotic episodes |
| Diagnosing T-E Fistula | inability to pass NG tube into stomach, CXR(observe coiling of tube in esophagus), Esophageal pouch often filled with air |
| Tx for T-E Fistula | place on abdomen and eleveate head 45 degrees, suction pouch, start IV or place Gtube, avoid agitation, trach if surgery to be delayed, surgical repair |
| What is a diaphragmatic hernia(CDH)? | migration of abdominal viscera into the thoracic cavity |
| CDH occurs in how many births? | 1in 3000 |
| 70% of Diaphragmatic hernias are on which side of the body? | left side |
| Symptoms of CDH vary with what? | degree of hernia and pulmonary hypoplasia |
| Clinical signs of CDH include | scaphoid abdomen, respiratory distress, decreased BS on affected side, and mediastinal shift |
| A CXR of a pt with CDH would show what? | air filled bowl in the thoracic cavity |
| What should you not do to Tx a pt with CDH | do not bag/mask ventilate |
| Tx for CDH includes | stabilize, place affected side down, keep vent pressures low to avoid barotrauma and pneumos, treat as PPHN (keep PO2>100, keep alkalotic, using HFV works well), ECMO, surgery to repair, outcome is improving |
| When is ECMO used to Tx CDH? | used to stabilize and may also be needed after surgery |
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Dabi2
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