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Perinatal Lung Disea
RCP 214 Unit 1 Perinatal lung disease and other problems of prematurity
| Question | Answer |
|---|---|
| Chronic Lung Disease encompasses | Wilson-Mikity Syndrome Pulmonary Insufficiency in prematurity Classic BPD The "new" BPD |
| Other complications of neonatal respiratory care include | Retinopathy of Prematurity (ROP) Intraventricular Hemorrhage (IVH) |
| Chronic Lung disease presents as | prematurity need for ventilation/oxygenation |
| In chronic lung disease diagnosis is | required oxygen or mechanical ventilation. Required oxygen at 36wks gestational age. |
| The pathophysiology of chronic lung disease includes | surfactant deficiency/inactivation oxidative stress (o2 toxicity) inflammation/infection mechanical ventilation barotrauma Barotrauma and air block syndromes |
| The treatment for chronic lung disease is | temperature oxygenation surfactant replacement resusscitation and ventilation |
| Wilson-Mikity Syndrome is also know as | pulmonary dysmaturity |
| Wilson-Mikity syndrome is | a disease of functional and structural pulmonary changes seen in premature neonates with no apparent underlying lung disease |
| The etiology of wilson-mikity syndrome is | unkown and linked to low birth weight (<1500g), lung immaturity, maternal bleeding and asphyxia |
| The pathosphysiology of wilson-mikity syndrome | presents similar to stage 3 and 4 CBD except the neonate has not been ventilated. |
| The early signs and symptoms of Wilson-Mikity Syndrome appear by the end of the first week and are | hyperpnea expiratory grunting, nasal flaring, retractions hypoxemia transient cyanosis (comes and goes) |
| The acute phase of wilson-mikity syndrome appears after the first week and presents like | RDS poor feeding and vomiting CXR: similar to stage 3 and 4 CBD changes |
| The treatment of wilson-mikity syndrome is | support treat like bpd |
| What is the prognosis of Wilson-Mikity Syndrome? | 2/3s of neonates survive and recover by age 2 |
| Pulmonary insufficiency in prematurity includes | premature infants <1200gms normal lung function in 1st 2 days Lung function deterioration by day 7 |
| CPIP (CHronic pulmonary insufficiency of prematurity) | Required supplemental 02 with apneas but normal CXR findings |
| The mortality of CPIP in the 1970's was | 20% |
| The mortality of CPIP today is | 0% with current standards of Care |
| CBD classic bronchopulmonary displasia "aka" the old bronchopulmonary displasia etiology is | unknown but most incidences follow treatment of RDS with mechanical ventilation and oxygen |
| The pathophysiology of BPD is | characterized by thickening of the alveolar membrane, necrosis of the alveolar tissues, and fibrotic changes in the interstitial spaces |
| air bronchograms appear as | fluid filled tubes |
| CBD Stage 1 (Days 2-3) | granular pattern, air bronchograms, small volume |
| CBD stage 2 (4-10) | opacification |
| CBD Stage 3 (10-20) | small areas of lucency, alternating w/areas of irregular density small cyst formation, visible cardiac sillhouette |
| Stage 4(<30 days) | large cysts, hyperinflation, interstitial fibrosis, and cardiomegaly. |
| The New BPD clinical presentation of | hyperinflation cystic emphysema persistent oxygen requirements may suffer complications from PDA/Sepsis |
| The pathosphysiology of the new BPD is linked to 5 factors | surfactant deficiency/inactivation oxidative stress (oxygen toxicity) inflammation/infection mechanical ventilation (barotrauma) Barotrauma and air block syndromes |
| In BPD the ABG will show | chronic respiratory failure and hypoxemia |
| BPD signs/symptoms | cor pulmonale (right vent. hypertrophy) pulmonary functions: increased minute ventilation requirement, increased airway resistance, decreased lung compliance |
| The criteria of BPD diagnosis include | 36 weeks corrected gestational age need for supplemental 02 or 8wks since birth and still requires supplemental 02 |
| What is the tx of BPD | prevention ventilatory support long term, low flow oxygen airway clearance bronchodilator therapy neoprofen; higher incidence of cld maintain fluid and nutrition status vitamen e therapy- increased risk of sepsis/NEC |
| What is the prognosis of BPD? | increased risk of asthma and growth suppression. |
| Retinopathy of prematurity is also known as | Retrolental fibroplasia (RLP) (ROP) |
| ROP is defined as | disordered vascularization and fibrovascular changes in retinas or preterm infants |
| With ROP scar tissue forms | behind the lens of the eye |
| What is the etiology of ROP? | Primary factor: 02 use/hyperoxia it occurs in <36% if 501-1500gm birth weight |
| What is the pathophysiology of ROP? | High Pa02 leads to constriction of retinal vessels. Constriction leads to necrosis of vessels; called vaso-obliteration vessels hemorrhage which leads to scar formation |
| What are some factors associated with ROP? | Preterm birth, RDS, Mechanical ventilation, Chorioamnionitis, apnea, hypercarbia, surfactant deficiency, pneumonia, sepsis, CLD |
| How is ROP diagnosed? | It develops in 5 stages opthalmologic exam |
| How is ROP treated? | Prevention Indirect laser therapy |
| Intraventricular Hemorrhage is also known as | periventricular leukomalacia (PLV) |
| IVH occurs in | 26% in babies with 501-1500gm BW |
| What are the type of bleeds with IVH? | Subdural or subarachnoid bleeding or cerebeller tissue bleeds |
| In subdural or subarachnoid bleeding it can be caused by | trauma or asphyxiation |
| In cerebeller tissue bleeds it is associated with | prematurity |
| What is the pathosphysiology of IVH? | Autoregulation (temperature) absent, puts brain at risk of hemorrhage |
| What are the signs/symptoms of IVH? | Severe, rapid deterioration, apnea, hypotension, decreased hematocrit, flaccidity, bulging fontanelles and posturing |
| How is IVH diagnosed? | CT scan or ultrasound |
| How is IVH classified? | Grade 1 to Grade 4 severe to most severe |
| What is the tx of IVH? | supportive: monitor for hyperbilirubinemia, avoid hypotension, monitor icp Correct blood loss/hypoxemia: administer osmotic agents (volume expander) Possible shunt placement |
| IVH complications: depends on severity of the bleed | neurodevelopmental disability (MR) Posthemorrhagic hydrocephalus (CSF) Vision/Hearing loss contralater himparesis (cerebral palsy) Death |
| How can IVH be prevented | avoid wide fluctuations in BP, Oxygenation, and pH Avoid trendelenburg position |
| Respiratory distress syndrome is also known as | hyaline membrane disease |
| RDS etiology | prematurity of the lung/surfactant deficiency infants <37 weeks gestation |
| What is the pathosphysiology of RDS? | Atelectasis leads to v/q mismatch and low FRC. Results in respiratory failure further hinders surfactant production Worsening atelectasis |
| RDS complications can be associated with | ventilator support (Development of BPD, IVH,ROP, Air leaks, development of reactive airway Disease (RAD), infection, patient ductus arteriosus (PDA), DIC, necrotizing enterocolitis (NEC) |
| What are RDS signs and symptoms | RR > 60 bpm expiratory grunting, nasal flaring, and retractions cyanosis ABG-low pa02, combined acidosis Other-hypothermia, flaccid muscle tone, pallor skin, severe edema (kidneys shut down) |
| In RDS | CXR is a definitive diagnosis |
| IN RDS the CXR will show | underaerated bilaterally, ground glass appearance, air bronchograms, stages 1-4 according to increased severity of disease |
| What is the treatment of RDS? | Prevention:maternal steroid therapy Surfactant replacement CPAP Mechanical ventilation |
| CPAP (nasal prongs) | neonates are obligate nose breathers 4-6 cmh20; if > 40% fi02 is needed intubation is indicated for surfactant tx, extubation within 10 minutes |
| Mechanical ventilation | pac02 40-50 mmhg, ph >7.25, sa02 88-94% VMS allows permissive hypercapnia; 85%-93% |
| Transient Tachypnea of the Newborn (TTN) is also known as | Type II RDS & Wet lung syndrome |
| TTN is more common in | boys and infants with perinatal asphyxia; also common in C-section delivery |
| The etiology of TTN is | unkown, associated with delayed clearing of fetal lung fluid |
| TTN Clinical presentation | tachypnea, breath sounds-rales, cyanosis, grunting, retractions, nasal flairing |
| In TTN the ABG will read as | mild-moderate hypoxemia, hypercapnia, respiratory acidosis |
| With TTN the CXR will present as | pulmonary vascular congestion, perihilar streaking, hyperexpansion, flat diaphragm, mild cardiomegaly, mild pleural effusions, mimics RDS, except better aeration and clears within 24-48 hours) |
| How is TTN diagnosed | R/O other conditions (RDS, Group B strep pneumonia, PPHN) Lab to R/O infection- would see increased WBC w/ infection |
| What is the treatment of TTN? | oxygen therapy and CPAP 02 hood <40%(warmed); 3-5 cmh20 cpap with increased fio2 is required mechanical ventilation antibiotics until infection is ruled out |
Created by:
kparkerlehman
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