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Transient Tachypnoea of the Newborn (TTN) ⇒
- Commonest cause of respiratory distress in newborn period. Caused by delayed resorption of fluid in the lungs.
- More common following caesarean sections.
- Fluid in lungs would normally be pushed out due to the force of contractions and length of labour in a vaginal delivery.
- CXR will show hyperinflation of lungs and fluid in the horizontal fissure.
- Mx → supportive care. Supplementary oxygen may be required to maintain oxygen saturations. Usually settles within 1-2 days.
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Neonatal Respiratory Distress Syndrome (NRDS) ⇒
- Deficiency of surfactant.
- Risk Factors → maternal diabetes mellitus (insulin, which is increased in diabetic mothers, inhibits surfactant production and maturation of the fetal lungs), male sex, caesarean section, second born of premature twins.
- Common if born <28 weeks gestation .
- Sx → high RR, laboured breathing, nasal flaring, expiratory grunting.
- CXR will show ‘ground glass’ appearance. (Bilateral diffuce granular opacities with air bronchograms).
- Mx → antenatal: corticosteroids + tocolytics (give steroids 24 hours to work). Postnatal: supportive → oxygen and ventilation.
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Persistent Pulmonary Hypertension ⇒
- Result of high pulmonary vascular resistance. Usually associated with birth asphyxia, meconium aspiration, sepitcaema or RDS.
- Sx → cyanosis after birth, signs of heart failure.
- Mx → oxygen, NO, sildenafil, ventilation.
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Chronic Lung Disease of Prematurity (Bronchopulmonary Dysplasia) ⇒
- Occurs when infection, barotrauma or iatrogenic injury causes chronic lung problems.
- Premature infants who require mechanical ventilation and oxygen therapy for respiratory distress.
- Peristent oxygen requirement at 36 weeks (typically affects those born <30 weeks).
- Sx → 23-26 weeks progresses from ventilation to CPAP to supplementary oxygen.
- Ix → CXR: widespread opacification.
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Cyanosis in the Neonatal Period ⇒
- In first 10 minutes of life, subomptimal SpO2 readings can be expected from a healthy neonate.
- APGAR scores are assessed at 1 min, then reassessed at 5 and 10 minutes.
- Nitrogen Washout Test → distinguish between cardiac and non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease.
- Cyanotic CHD → tetralogy of Fallot (TOF), transposition of the great arteries (TGA), tricuspid atresia.
- Management → prostaglandin E1 (maintains a patent ductus arteriosus until definitive diagnosis and surgical correction).