Common neonatal problems

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Ambestul
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13651
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Common neonatal problems
Updated:
2010-04-08 22:05:41
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peds
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  1. respiratory distress syndrome epidemiology
    more common in pre-term, occurs in 50% of neonates born at 26-28 weeks GA, 20-30% born at 30-31 weeks GA, more common in males
  2. time when sufactant develops
    32 weeks,
  3. main composition of surfactant
    phospholipids, prior to 34 wks phosphatidylcholine (lecithin) and sphingomyelin are present in equal conc, at 34 weeks lecithin incr significantly, ratio should be 2:1 probably at point of maturity, RDS less likely, ratio <2:1 try and delay delivery until lungs mature or accelerate maturity by pharmacologic methods
  4. phophatidylglycerol
    always assoc with lung maturity, not present til 36 wks
  5. tx to delay
    tocolytic therapy, MgSO4 drip or inc endogenous surfactant produ w: betameth (Celestone), dexa, bcuz cortisol is a natural stimulus for lung maturation which increases surfactant production, useful in gest ages 24-34 wks, can give exogenous sufactant via endotracheal tube, probably will need at 24 wks
  6. oldest surfactant on market
    Beractant (Survanta)
  7. monitoring for RSV
    heart rate, color, chest expansion, oximeter, tube patency, admin may necessitate rapid changes in ventilator settings!!
  8. apnea
    not breathing for 10-20 sec, can occur early but usually 5-10 days of life, inverse relationship with gest age and wt, does not predict occurrence of SIDS,usually resolved by 36-38 wks but can persist longer
  9. central apnea
    complete cessation of breathing, imm CNS,dec sensitivity of resp center to CO2
  10. obstructive apnea
    absence of nasal airflow despite resp efforts, lack of coordination of breathing, sucking and swallowing, decreased pharyngeal tone
  11. diagnosis of apnea of prematurity
    resp rate, HR, Osat
  12. tx of apnea
    manual stimulation, positiong, methylxcanthines-inc sens to CO2, imp skeletal muscle contration, usually caffeine citrate
  13. ductus venosus
    allows blood to bypass hepatic circ and enter inf vena cava
  14. foramen ovale
    allows most of the blood from the inf vena cava to bypass the rt atrium (and the pulm circ) and enter the lft atrium
  15. ductus arteriosus
    allows blood from rt vent to bypass the pulm circ and enter the descending aorta (pulm artery to aorta), closes based on local PGs conc
  16. left to right shunt
    oxygenated blood from lungs is returned to the rt atrium, rt vent, or the pulm artery rather than going to the aort via the left vent and left atrium-acyanotic heart disease
  17. right to left shunt
    exists when dexoygenated blood (systemic venous return) travels to the left atrium, left vent, or aorta instead of to the lungs for oxygention-cyanotic heart disease
  18. ventricular septal defect(VSD)
    acyanotic congenital heart disease-abn opening btwn rt and lt ventricle, shunting from lt to rt occurs during systole, if pulm vascu resistance produces pulm htn, shunt is reversed from rt to lt w cyanosis resulting
  19. atrial septal defect
    ayanotic congenital heart disease, abnormal opening btwn rt and lt atria, lt to rt shunting occurs in all atrial septal defects
  20. patent ductus arteriosus (PDA)
    closure of ductus occurs in 90% of neonates w a gest age 36 wks or more 48 hrs after birth, inc incidence w liberal use of fluids in first 24-48 hrs, sx consistent w pulmonary edema and CHF
  21. tx of PDA
    usually closes on own, if it does not occur and left to rt shunt becomes henodynamically unstable (HR>170bpm, RR>70, treat w indomethacin to decrease PG conc
  22. cyanotic congenital heart disease
    typically treated with alprostadil (Prostin VR) want to keep ductus open (Prostaglandin E1=PGE1), need to administer quickly, keep on flood with nurses, palliative tx of ductus dependent lesions until corrective surgery or transplant can occur(easy to fix)

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