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some details will be outdated, but the teamwork and process is the same.

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CXR examples of neonatal conditions

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Presentation1.pptx, radiological imaging of neonatal lung disease.

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Radiological imaging of Neonatal Lung Diseases. Dr/ ABD ALLAH NAZEER. MD.

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This breaks the causes down nicely. Its a great reference!

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Published on

Neonatal Respiratory Distress

1. 1.  Respiratory Distress in Newborn

2. 2. Neonatal Respiratory Distress Signs and symptoms  Tachypnea (RR > 60/min)  Nasal flaring  Retraction  Grunting  +/- Cyanosis  +/- Desaturation  Decreased air entry

3. 3.  Down score

4. 4.  Neonatal Respiratory Distress Etiologies Pulmonary Transient tachypnea of the newborn (TTN) Respiratory distress syndrome (RDS) Pneumonia Meconium aspiration syndrome (MAS) Air leak syndromes Pulmonary hemorrhage Systemic Metabolic (e.g., hypoglycemia, hypothermia or hyperthermia) metabolic acidosis anemia, polycythemia Cardiac * Congenital heart disease; cyanotic or acyanotic * Congestive heart failure * Persistent pulmonary hypertension of the newborn (PPHN) Neurological (e.g., prenatal asphyxia, meningitis) Anatomic Upper airway obstruction Airway malformation Rib cage anomalies Diaphragmatic disorders (e.g., congenital diaphragmatic hernia, diaphragmatic paralysis)

5. 5. Pulmonary  1- Transient tachypnea of newborn  2- Hyaline membrane disease  3- Meconium aspiration syndrome (MAS)  4- Pneumonia  5- Air Leak Syndromes

6. 6. TransientTachypnea of Newborn  TTN (known as wet lung) is a relatively mild, self limiting disorder of near-term or term  Delay in clearance of fetal lung fluid results in transient pulmonary edema. The increased fluid volume causes a reduction in lung compliance and increased airway resistance.

7. 7. TransientTachypnea of Newborn Risk factors:  Maternal asthma  C- section  Macrosomia, maternal diabetes  Prolonged labor, Excessive maternal sedation  Fluid overload to the mother,Delayed clamping of the umbilical cord .

8. 8. TransientTachypnea of Newborn  Usually near-term or term  Tachypnea immediately after birth or within 6 hrs after delivery, mild to moderate respiratory distress.  These manifestations usually persist for 12-24 hrs, but can last up to 72 hrs  Auscultation usually reveals good air entry with or without crackles  Spontaneous improvement of the neonate is an important marker of TTN.

9. 9. TransientTachypnea of Newborn Chest x-ray :  Prominent perihilar streaking (due to engorgement of periarterial lymphatics)  Fluid in the minor fissure  Prominent pulmonary vascular markings  Hyperinflation of the lungs, with depression of diaphragm  ► Chest x-ray usually shows evidence of clearing by 12- 18 hrs with complete resolution by 48-72 hrs

10. 10. chest X-ray:TransientTachypnea of Newborn Fluid in the fissure Fluid in the fissure

11. 11. General Management of Respiratory Distress  Supplemental oxygen or MV, if needed.  Continuously monitor with pulse oximeter.  Obtain a chest radiograph.  Correct metabolic abnormalities (acidosis,hypoglycemia).  Obtain a blood culture & begin an antibiotic coverage (ampicillin + gentamicin)

12. 12. General Management  Provide an adequate nutrion. Infants with sustained RR >60 breaths/min should not be fed orally & should be maintained on gavage feedings for RR 60-80 breaths/min, and NPO with IV fluids or TPN for more severe tachypnea

13. 13. Pulmonary  1- Transient tachypnea of newborn  2- Hyaline membrane disease  3- Meconium aspiration syndrome (MAS)  4- Pneumonia  5- Air Leak Syndromes

14. 14. Respiratory Distress Syndrome  Also called as hyaline membrane disease  Most common cause of respiratory distress in premature infants, correlating with structural & functional lung immaturity.  primarily affects preterm infants; its incidence is inversely related to gestational age and birthweight.  15-30% of those between 32-36 weeks' gestation, in about 5% beyond 37 weeks' gestation

15. 15. Physiologic abnormalities  Surfactant deficiency- increase in alveolar surface tension.  Lung compliance decreased to 10-20% of normal  Atelectasis...areas not ventilated  Decrease alveolar ventilation  Reduce lung volume  Areas not perfused

16. 16. Normal Expiration With Surfactant Surfactant Function Abnormal Respiration Without Surfactant

17. 17. 17 Compliance Pressure Volume Opening pressures Maximal volume

18. 18. Risk factors  Prematurity  Maternal diabetes  Multiple births  Elective cesarean section without labor  Perinatal asphyxia  Cold stress  Genetic disorders

19. 19. Decreased risk Chronic intrauterine stress Prolonged rupture of membranes Antenatal steroid prophylaxis

20. 20. Clinical Manifestations  Appear within minutes of birth may not be recognized for several hours in larger preterm  Tachypnea (>60 breaths/min), nasal flaring, subcostal and intercostal retractions, cyanosis & expiratory grunting  Breath sounds may be normal or diminished and fine rales may be heard  Progressive worsening of cyanosis & dyspnea. BP may fall; fatigue, cyanosis and pallor increase & grunting decreases.  Apnea and irregular respirations are ominous signs  In most cases, symptoms and signs reach a peak within 3 days, after which improvement occurs gradually.

21. 21. Findings can be graded according to the severity:  Grade 1 (mild cases): the lungs show fine homogenous ground glass shadowing  Grade 2: widespread air bronchogram become visible  Grade 3: confluent alveolar shadowing  Grade 4: complete white lung fields with obscuring of the cardiac shadow Chest x-ray:

22. 26. Management Prevention:  Lung maturity testing: lecithin/sphingomyelin (L/S) ratio  Tocolytics to inhibit premature labor.  Antenatal corticosteroid therapy: ► They induce surfactant production and accelerate fetal lung maturation. ► Are indicated in pregnant women 24-34 weeks' gestation at high risk of preterm delivery within the next 7 days. ► Optimal benefit begins 24 hrs after initiation of therapy and lasts seven days.

23. 27. Prevention  Antenatal corticosteroid therapy consists of either : □ Betamethasone 12 mg/dose IM for 2 doses, 24 hrs apart, or □ Dexamethasone 6 mg/dose IM for 4 doses, 12 hrs apart  Early surfactant therapy: prophylactic use of surfactant in preterm newborn <27 weeks' gestation.  Early CPAP administration in the delivery room.

24. 28. Treatment  Administer oxygen  Initiate CPAP as early as possible in infants with mild RDS  Start MV if respiratory acidosis (PaCO2 >60 mmHg, PaO2 <50 mmHg or SaO2 <90%) with an FiO2 >0.5, or severe frequent apnea.  Administer surfactant therapy: early rescue therapy within 2 hrs after birth is better than late rescue treatment when the full picture of RDS is evident.

25. 29. Types of Surfactant Natural Surfactants: contain appoproteins SP-B & SP-C  Curosurf (extract of pig lung mince)  Survanta (extract of cow lung mince)  Infasurf (extract of calf lung) Synthetic Surfactants:do not contain proteins  Exocerf  ALEC  Lucinactant (Surfaxin)

26. 30. 30 SurfactantTherapy for RDSSurfactantTherapy for RDS Improvement in compliance, functional residual capacity, and oxygenation Reduces incidence of air leaks Decreases mortality

27. 31. Mode of administration of Surfactant  Dosing may be divided into 2 alliquots and adminitered via a 5-Fr catheter passed in the ET

28. 32. Insure technique  Intubation-  surfactant-  extubation to CPAP

29. 33. Pulmonary  1- Transient tachypnea of newborn  2- Hyaline membrane disease  3- Meconium aspiration syndrome (MAS)  4- Pneumonia  5- Air Leak Syndromes

30. 34. Risk Factors:  Post-term pregnancy  Pre-eclampsia, eclampsia, maternal hypertension,  Maternal diabetes mellitus  IUGR  Evidences of fetal distress (e.g.,abnormal biophysical profile) Meconium Aspiration Syndrome

31. 35. Clinical Manifestations  Meconium staining amniotic fluid (meconium stained nails, skin & umbilical cord )  Some infants may have mild initial respiratory distress, which becomes more severe hours after delivery.  Pneumothorax and/or pneumomediastinum  PPHN in severe cases  Hypoxia to other organs (e.g., seizures, oliguria)

32. 36. Pathophysiology

33. 37. Chest x-ray: Areas of hyperexpansion mixed with patchy densities and atelectasis

34. 38. Management In the DR or OR:  Visualization of the vocal cords & tracheal suctioning before ambu-bagging should be done only if the baby is not vigorous In the NICU:  Empty stomach contents to avoid further aspiration.  Suction frequently & perform chest physiotherapy.

35. 39. Management  Consider CPAP, if FiO2 requirements >0.4; however CPAP mayaggravate air trapping and must be used cautiously.  Mechanical ventilation: in severe cases (paCO2 >60 mmHg orpersistent hypoxemia (paO2 <50 mmHg).  Correct systemic hypotension (hypovolemia, myocardial dysfunction).  Manage PPHN, if present  Manage seizures or renal problems, if present.  Surfactant therapy in infants whose clinical status continue todeteriorate.

36. 40. Pulmonary  1- Transient tachypnea of newborn  2- Hyaline membrane disease  3- Meconium aspiration syndrome (MAS)  4- Pneumonia  5- Air Leak Syndromes

37. 41. PneumoniaPneumonia Common organisms:  GBS  gram-ve organisms (e.g. E.Coli, Klebsiella,Pseudomonas)  , Staph. aureus, Staph. epidermidis  Candida.  acquired viral infections (e.g., HSV, CMV).

38. 42. Clinical Manifestations  Early manifestations may be nonspecific (e.g., poor feeding, lethargy, irritability, cyanosis, temperature instability  Respiratory distress signs may be superimposed upon RDS or BPD.  In a ventilated infant, the most prominent change may be the need for an increased ventilatory support.  Signs of pneumonia (dullness to percussion, change in breathsounds, rales or rhonchi) are difficult to appreciate.

39. 43. Chest x-rays: infiltrates or effusion

40. 44. 44 Chlamydia pneumonia with features of an interstitial pneumonitis and characteristic widespread interstitial changes.

41. 45. Management Initiate ampicillin and gentamicin IV; modify according to culture results and continue therapy for 14 days. If there is a fungal infection, an antifungal agent is used.

42. 46. Pulmonary  1- Transient tachypnea of newborn  2- Hyaline membrane disease  3- Meconium aspiration syndrome (MAS)  4- Pneumonia  5- Air Leak Syndromes

43. 47. Air Leak Syndromes Risk Factors:  MV,MAS, surfactant therapy without decreasing pressure support in ventilated infants  vigorous resuscitation,  prematurity  pneumonia

44. 48. Clinical Manifestations  Spontaneous pneumothorax may be asymptomatic or only mildly symptomatic (i.e., tachypnea and ↑O2 needs).  In unilateral cases, chest asymmetry is noted, mediastinum shift to the opposite side.  If the infant is on ventilatory support will have sudden onset of clinical deterioration (i.e., cyanosis, hypoxemia, hypercarbia & respiratory acidosis associated with decreased breath sounds and shifted heart sounds).

45. 49. Tension pneumothorax  (a life- threatening condition) → ↓cardiac output and obstructive shock; urgent drainage prior to a radiograph is mandatory.

46. 50. Chest x-ray: Right-sided pneumothorax

47. 51. Right-sided tension pneumothorax with mediastinal shift. Both lungs demonstrate opacification of alveolar collapse.

48. 52. Left-sided pneumothorax under tension.There is pulmonary interstitial emphysema in the right lung and a small basal right pneumothorax.

49. 53. Others Pneumomediastinum  It can occur with aggressive ETT insertion, Ryle's feeding tube insertion, lung disease, MV, or chest surgery (e.g., TEF). Pneumopericardium Pneumoperitoneum Subcutaneous emphysema Systemic air embolism

50. 54. Chest x-ray with Pneumomediastinum

51. 55. Massive Pneumoperitoneum in MV neonate

52. 56. Chest x-ray with pneumopericardium

53. 57. Severe bilateral PIE affecting the right more than the left lung; there is gross cardiac compression. A chest drain is in situin the right hemithorax.

54. 58. Management  Conservative therapy: close observation of the degree of respiratory distress as well as oxygen saturation, without any other intervention aiming at spontaneous resolution and absorption of air.  Needle aspiration should be done for suspected cases of pneumothorax with deteriorating general condition until intercostal tube is inserted.  Decompression of air leak according to the type (intercostal tube insertion in case of pneumothorax).

55. 59. Thank You ... Thank You ...

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Published on Neonatal Respiratory Distress 1.  Respiratory Distress in Newborn 2. Neonatal Respiratory Distress Signs and symptoms  Tachypnea (RR > 60/min)  Nasal flaring  Retraction  Grunting  +/- Cyanosis  +/- Desaturation  Decreased air entry 3.  Down score 4.

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Baby breathing noises and motions

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Don't be at all surprised if your child seems to be a noisy breather. Infants can only breathe through their noses in the first couple of months of life, which can cause them to make all sorts of sounds-from snorts and grunts to gurgles and whistles-as they inhale and exhale.

This shouldn't necessarily cause concern. However, pay attention to other signs of respiratory distress ﻿﻿ and contact a doctor immediately if your baby:

Turns blue all over or in areas that get a lot of blood flow (the lips, tongue, and the vagina, for example). Note: Bluing of the hands and feet can be fairly common due to an infant's immature circulatory system. This alone is not a cause for concern, so long as it is only in those areas.

Has a significantly increased breathing rate (more than 60 breaths per minute)

Struggles to breathe, which can be spotted by the nostrils persistently flaring and the chest retracting unusually

Is feeding poorly

Is lethargic

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Is Your Newborn Baby Breathing Normally?

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Don't be at all surprised if your child seems to be a noisy breather. Infants can only breathe through their noses in the first couple of months of life, which can cause them to make all sorts of sounds-from snorts and grunts to gurgles and whistles-as they inhale and exhale.

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Respiratory Distress in the Newborn - scholarly article

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Respiratory Distress in the Newborn - scholarly article

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The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy. Intervention with oxygenation, ventilation, and surfactant replacement is often necessary.

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more in depth look by physician

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Baby circulation right after birth | Circulatory system physiology | NCLEX-RN | Khan Academy

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The Cardiovascular System: The Heart Part B

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The Cardiovascular System: The Heart Part B

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toward the end it has heart development information

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powerpoint ® lecture slides prepared by barbara heard

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atlantic cape community college c h a p t e r © 2013 pearson education

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PowerPoint ® Lecture Slides prepared by Barbara Heard, Atlantic Cape Community College C H A P T E R © 2013 Pearson Education, Inc.© Annie Leibovitz/Contact. - ppt download

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This is a clinical training workbook

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Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus

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Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus

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Study of the effects of different 🤬 and nicotine on the fetus and subsequent baby.

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good organization & tech

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from the AAP

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AAP/AHA. (2011). Neonatal Resuscitation. 6th Edition.

Cornblath, M., Hawdon, J. M., Williams, A. F., Aynsley-Green, A., Ward-Platt, M. P., Schwartz, R., & Kalhan, S. C. (2000). Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics, 105(5), 1141-1145.

Frazier, M. D., & Werthammer, J. (2007). Post-resuscitation complications in term neonates. J Perinatol, 27(2), 82-84. doi: 10.1038/sj.jp.7211644

Gopel, W., Kribs, A., Ziegler, A., Laux, R., Hoehn, T., Wieg, C., . . . Herting, E. (2011). Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet, 378(9803), 1627-1634. doi: 10.1016/s0140-6736(11)60986-0

Hemway, R. J., Christman, C., & Perlman, J. (2013). The 3:1 is superior to a 15:2 ratio in a newborn manikin model in terms of quality of chest compressions and number of ventilations. Arch Dis Child Fetal Neonatal Ed, 98(1), F42-45. doi: 10.1136/archdischild-2011-301334

Iliodromiti, S., Mackay, D. F., Smith, G. C., Pell, J. P., & Nelson, S. M. (2014). Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet, 384(9956), 1749-1755. doi: 10.1016/s0140-6736(14)61135-1

Kattwinkel, J., Perlman, J. M., Aziz, K., Colby, C., Fairchild, K., Gallagher, J., . . . Zaichkin, J. (2010). Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(18 Suppl 3), S909-919. doi: 10.1161/circulationaha.110.971119

Khalak, R., Cummings, J., & Dexter, S. (2015). Maternal obesity: significance on the preterm neonate. Int J Obes (Lond). doi: 10.1038/ijo.2015.107

Lawn, J. E., Cousens, S., & Zupan, J. (2005). 4 million neonatal deaths: when? Where? Why? Lancet, 365(9462), 891-900. doi: 10.1016/s0140-6736(05)71048-5

Peerzada, J. M., Richardson, D. K., & Burns, J. P. (2004). Delivery room decision-making at the threshold of viability. J Pediatr, 145(4), 492-498. doi: 10.1016/j.jpeds.2004.06.018

Saini, S. S., Gupta, N., Kumar, P., Bhalla, A. K., & Kaur, H. (2012). A comparison of two-fingers technique and two-thumbs encircling hands technique of chest compression in neonates. J Perinatol, 32(9), 690-694. doi: 10.1038/jp.2011.167

Stanley, C. A., Rozance, P. J., Thornton, P. S., De Leon, D. D., Harris, D., Haymond, M. W., . . . Wolfsdorf, J. I. (2015). Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. J Pediatr, 166(6), 1520-1525 e1521. doi: 10.1016/j.jpeds.2015.02.045

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NRP Study Guide - National CPR Association

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AAP/AHA. (2011). Neonatal Resuscitation. 6th Edition. Cornblath, M., Hawdon, J. M., Williams, A. F., Aynsley-Green, A., Ward-Platt, M. P., Schwartz, R., & Kalhan, S. C. (2000). Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics, 105(5), 1141-1145. Frazier, M. D., & Werthammer, J. (2007). Post-resuscitation complications in term neonates.

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Using Narcotics for Pain Relief During Childbirth

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Using Narcotics for Pain Relief During Childbirth

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talks about medications used and the effect on the baby.

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Using Narcotics for Pain Relief During Labor: Types & Side Effects

Many women end up relying on some type of method to reduce the physical pain of childbirth. As you prepare for labor, it is important to become familiar with the pain medications that are available, how they work, their risks and their benefits.

The method you choose for pain relief will depend on your personal preference, your health care provider's recommendation, and the availability of medications at your birthing facility.

What are Opiates?

Opiates are a type of analgesic given to relieve pain. When used during childbirth, opiates are considered the first option after natural methods for pain relief such as labor in water, deep breathing, and massage.

Opiates are given in small doses and usually administered during the early stages of labor in an attempt to avoid potential side effects for both the mother and baby.

What are the advantages of using opiates during childbirth?

Opiates offer pain relief and do not interfere with a woman's ability to push during labor. Unlike an epidural, an opiate does not numb the pain; it instead helps to take some"edge" off of the pain. Opiates can help reduce anxiety and improve the mother's ability to cope with painful contractions.

What are the potential side effects of opiates?
Mothers can experience the following side effects:

Itching

Sedation

Decreased gastric motility

Loss of protective airway reflexes

Hypoxia due to respiratory depression

How will the opiates affect my baby?
Opiates cross the placenta during labor and can produce the following side effects in the baby:

Central nervous system depression

Respiratory depression

Impaired early breastfeeding

Altered neurological behavior

Decreased ability to regulate body temperature

For these reasons, your baby might need other medication to counteract the effects of the opiate. Naloxone is a medication given in small doses that can reverse the respiratory depression that opiates can cause in a baby. It is usually given intravenously and its effects can be seen within a few minutes and can last up to 2 hours.

What types of opiates are used during childbirth?
The most frequently used narcotic medications are:
Demerol:

Demerol is a popular choice for pain relief during labor. Demerol alters how the mother recognizes the pain she is experiencing by binding to the receptors found in the central nervous system.
The advantages of Demerol include:

Can be given by injection into the muscle, the vein or by a Patient Controlled Analgesia (PCA) pump

Fast acting - starts working in less than 5 minutes

How can Demerol affect me and my baby?

Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypotension (low blood pressure). If injected within 2-4 hours of delivery, Demerol has been found to cause breathing difficulties in some babies.

Morphine:

In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby's ability to breathe.

Stadol:

Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is considered more potent than Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg.
The advantages of using Stadol include:

Starts working in less than five minutes

Is a sedative

Has minimal fetal effects

Causes minimal nausea

How can Stadol affect me and my baby?

Stadol can cause the mother to have respiratory depression, dizziness, and dysphoria (a state of feeling unwell and unhappy). Stadol can cause respiratory depression in the baby.

Fentanyl:

Fentanyl is a synthetic opiate that provides mild to moderate sedation. The advantages of using Fentanyl include:

Begins working quickly (although, usually only lasts 45 minutes)

Minimal sedation

Minimal fetal effects

How can Fentanyl affect me and my baby?

You and your baby can experience some sedation and/or nausea. According to Danforth's Obstetrics and Gynecology, babies born to mothers who used Fentanyl to relieve pain during labor were less likely to need naloxone (medication to help with breathing) than babies born to mothers who used Demerol.

Nubain:

Nubain is an opiate agonist-antagonist comparable to morphine. The advantages of using Nubain include:

Begins working within 5 minutes of administration

Minimal nausea

Minimal fetal effects

How can Nubain affect me and my baby?

Nubain can cause the mother to have sedation and dysphoria (a state of feeling unwell and unhappy).

How will my pain medication be given?
Medication can be given in any of the following ways:

A one-time injection into the spinal column.

IV or Intravenous placement into a vein on the back of the hand or arm. A needle is inserted into a vein with a plastic tube connected to a bag holding fluid that slowly drips into your body. In a hospital setting, an IV is usually placed to help you stay hydrated throughout labor and ensure access to medications if they are needed.

Patient Controlled Analgesia (PCA) pump is a way that a mother can control doses of pain medication during labor by pushing a button. The advantage of having a PCA is that it can give a mother an increased sense of control, and the mother does not have to rely on a nurse to bring pain medication. Fentanyl and Demerol are common narcotics that can be given using a PCA pump. The pump is pre-programmed to provide dosages small enough to relieve pain without releasing too much medication.

Compiled using information from the following sources:
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19. Danforth's Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 3.

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Narcotics for Pain During Labor: Types & Side Effects

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Many women end up relying on some type of method to reduce the physical pain of childbirth. As you prepare for labor, it is important to become familiar with the pain medications that are available, how they work, their risks and their benefits.

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a demo video with explanation

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Neonatal Resuscitation Skill Demo Higher Quality

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A module that teaches NRP thinking.

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Information on updates

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Info about set up and use