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Terms in this set (41)What is the normal respiratory rate in the new born? 40-60 bpm What is the normal heart rate in a new born? 140-160 bpm What are the normal findings in the respiratory system of the new born? Rate of 40-60 bpm; irregular breathing with pauses of 5 seconds or less; no dyspnoea or intercostal/subcostal retractions or grunting Define respiratory distress This is increased work of breathing in order to provide enough oxygen for the body's metabolism, and to excrete carbon dioxide What is respiratory failure? Inability of the respiratory system to meet the oxygen requirements of the body, and the need to excrete carbon dioxide. Inability to maintain normal arterial oxygen and carbon dioxide levels What are the types of respiratory failures? Type 1 and type 2 What are the parameters of type 1 respiratory failure? Hypoxia and normal or low carbon dioxide. Carbon dioxide is not built up What are the parameters of type 2 respiratory failure? Hypoxia and increased carbon dioxide. Carbon dioxide is built up because it cannot be eliminated What are the signs of respiratory distress? Central/peripheral cyanosis; inability to speak, nasal flaring, tachypnoea, tracheal tug, accessory muscle use, intercostal indrawing, abdominal breathing, tripoding, tachycardia In the newborn, what are the signs of respiratory distress? In addition to the normal, they have grunting, agitation. If there is gasping respirations, this signifies the most severe extend of respiratory distress In the new born, how may you classify respiratory disorder causes? Pulmonary and extra-pulmonary What are some respiratory disorders in the lungs of the preterm child? Respiratory distress syndrome and pulmonary haemorrhage, meconium aspiration syndrome, pneumonia, pneumothoraxes, transient tachypnoea of the new born; pulmonary hypoplasia, congenital bronchopulmonary malformations What are some respiratory disorders in the lungs of the term child? Meconium aspiration syndrome, pneumonia, pneumothoraxes, transient tachypnoea of the new born; pulmonary hypoplasia, congenital bronchopulmonary malformations What are some extrapulmonary causes of respiratory distress in the new born? CNS and muscular - brain (asphyxia, drugs, haemorrhage), phrenic nerve injury, myasthenia gravis, muscular dystrophies, infections; CVS - CHD, CCF, pulmonary oedema, persistent pulmonary hypertension of the new born; ----------- What is the commonest cause of respiratory distress in the new born? Neonatal respiratory distress syndrome What is the cause of respiratory distress syndrome in the new-born? It is due to a deficiency of surfactant, and structural immaturity of the lungs What is surfactant made of? **** What is the function of surfactant? Surfactant reduces surface tension in the alveoli. It has hydrophobic substaces that oppose the liquid film that lines the alveoli. Reduced surface tension results less pressure to keep the alveoli open. With the first breath of life, if surfactant is there up to 40% of the air is retained How is the lung alveoli affected after each breath if no surfactant is present? With each breath, the alveoli shut back and more force is needed when we breathe to reopen them When is the onset of respiratory distress syndrome? After the onset of breathing What percentage of infants born 28-34 weeks will get respiratory distress syndrome? A third -33% How many new born infants born after 34 weeks will get respiratory distress syndrome? <5% Which sex tends to get respiratory distress syndrome more? Males What is the greatest risk factor for respiratory distress syndrome? Being born preterm. Other risks include perinatal asphyxia or being born to a diabetic mother Why is the infant of a diabetic mother at risk for respiratory distress syndrome? To make surfactant, the foetus needs hormones and growth factors, especially cortisol. Note that anything causing intrauterine stress or foetal growth restriction increases cortisol and so surfactant and so decreases the risk respiratory distress syndrome. Insulin counteracts the effects of the cortisol so no surfactant is made How does labour affect surfactant synthesis? Labour increases it At what gestational age is respiratory distress syndrome most common? Less than 28 weeks What are the risk factors for developing respiratory distress syndrome? Preterm infant, infants of diabetic mothers, perinatal asphyxia. Being male and being delivered by C-section What is the leading cause of death in the preterm infant? Infant respiratory distress syndrome True or false, the incidence of infant respiratory distress syndrome decreases with increasing gestational age? Yes Explain the pathophysiology of infant respiratory distress syndrome There is no surfactant, or there is lung immaturity. This causes atelectasis and therefore V/Q mismatch because no oxygen is going to the area (hypoventilation). Hypoxia and hypercapnia develops, and then respiratory and metabolic acidosis. This whole thing is a shunt so vasoconstriction happens. Eventually, there is impaired endothelial and epithelial integrity. The paradoxical breathing and injuries to the endothelium cause proteinaceous exudates to form, and infant respiratory distress syndrome or as it was called, hyaline membrane disease develops. The hyaline membrane act as a barrier to gas exchange...vicious cycle Why was neonatal respiratory distress syndrome called hyaline membrane disease? There is a deposition of hyaline material in the airspaces of the lungs of the neonates who get this How does the neonate with infant respiratory distress syndrome present? They present within the first six hours of life with the signs of respiratory distress. Initially the respiratory rate is regular then it becomes increased How does the anatomy of the new born further complicate the lack of surfactant if they weren't born with any? On top of their atelectatic lungs, they have paradoxical chest wall movement. This causes the proteinaceous exudate to go into the alveoli What may be the cause of apnoeic episodes in the newborn? Hypoxaemia, respiratory failure, thermal instability or sepsis Describe the uncomplicated course of infant respiratory distress syndrome Progressive worsening of symptoms for 2-3 days, with recovery beginning by day 3. The chance of recovery is excellent How do you diagnose infant respiratory distress syndrome? The clinical manifestations, risk factors and obtain a CXR. Make sure to rule out other causes of respiratory distress What does the chest x-ray of the infant with infant respiratory distress syndrome show? Diffuse reticulogranular pattern in both lung fields with superimposed air bronchograms. Reticulogranular = ground glass appearance (this is the surfactant deficiency) What is the general management of infant respiratory distress syndrome? Administer surfactant and gentle ventilator oxygen support. You need to monitor blood gas status and thermoregulation is important. Antibiotics is indicated in the preterm if an infection is suspected (PROM, maternal infections) - do blood count and culture and if an infection is not present, then stop the antibiotics Do you need to give an iatrogenic preterm delivery antibiotics? No What are the complications of neonatal respiratory syndrome? Those who recover are at risk for developing PDA, necrotising enterocolitis, pneumothorax, infections, chronic lung disease. Iatrogenic - intaventricular haemorrhage, oxygen toxicity (ROP), tracheal lesions from ET tube Students also viewedOB Quiz Questions: 170 terms
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What is the main cause of respiratory distress syndrome?The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream. Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS , as can inhaling (aspirating) vomit or near-drowning episodes.
What is the primary cause of respiratory distress syndrome of the newborn quizlet?Respiratory distress syndrome is a breathing disorder that mainly occurs in premature newborns. This is due to the fact that premature infants have immature lungs that aren't able to produce enough surfactant, which coats the insides of the lungs to keep them from collapsing.
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Why do premature newborns often develop respiratory distress syndrome quizlet?
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