What are maternal factors that are related to the health of the fetus and the outcomes of pregnancy?
Prior maternal disease
Maternal drug use
Maternal birth history
What technique would you recommend to assess the state of pulmonary maturity before birth?
Late decelerations are consistent with what conditions?
Uteroplacental insufficiency and umbilical cord compression
What is the weight percentile of an infant receiving neonatal intensive care with the designation "preterm AGA"
The infants weight falls between the 10th and 90th percentile.
What should you suspect when observing a "bounding" peripheral pulse on a newborn infant?
PDA-patent ductus ateriosus
What conclusion is consistent with the observation of paradoxical breathing?
WoB-Work of breathing is increased
What conclusion could be reached from observations of drawing (reactions) of chest-wall muscle and tissue between the ribs, and above/below the sternum, all occuring during inspiration?
Lung compliance (CL) is decreased
What is the relationship between oxygen toxicity and growing lungs versus adult lungs?
Growing lungs are more sensitive to oxygen toxicity than the adult lung
The most probably explanation for the "flip-flop" phenomenon in the newborn is?
reactive pulmonary vasoconstriction
What conditions may bronchial hygiene therapy be considered for infants or children?
Foreign body aspiration
bronchopulmonar dysplasia (BPD)
What vacuum seting would you use to perform nasopharyngeal or nasotracheal suctioning of a 5-year old child?
-80 to -100 mm Hg
What FIO2 should be used in neonates prior to endotracheal suctioning?
FIO2 10% to 15% higher than FIO2 set in the ventilator
During resuscitation of a newborn, after 15 to 30 seconds of positive-pressure ventilation what should the clinician do?
Evaluate the heart rate
What are signs of infant respiratory distress that indicate a potential need for continuous positive airway pressure (CPAP)?
radiograph indicating hyaline membrane disease or respiratory distress syndrome
What is considered a limitation of the high-flow nasal cannula?
The amount of airway positive pressure cannot be measured
What initial inspiratory time range would you suggest for a term newborn infant being placed on time-cycled, pressure-limited ventilation?
0.25 to 0.30 second
What mean airway pressure is considered potentially deleterious when applying posiive airway pressure?
15 cm H2O
In high-frequency ventilation (HFV), CO2 elimination depends mainly on which of the following?
What may indicate a decrease in systemic vascular bloodflow during high-frequency ventilation?
Decreased mean arterial pressure (MAP)
What are the major factors in the pathophysiology of RDS?
Qualitative surfactant deficiency
Increased small airways compliance
presence of the ductus arteriosus
In preterm infants, adequate amounts of surfactant are present... what complication makes the surfactant unusable?
They are trapped in type II cells
What finding on a CXR is not typical for RDS?
Hyperinflation-this indicates broncho pulmonary dysplasia
What should be done when a infant utilizing a nasal CPAP deteriorates suddenly into severe hypoxemia on an FIO2 of 60%?
Intubate the infant and begin mechanical ventilation
What is the maximum PIP that should be used with mechanical ventilation of larger premature infants to prevent volutrauma?
30 cm H2O
Rescue surcanctant administration is indicated for what types of infants?
Infants diagnosed with RDS
What is believed to be the cause of transient tachypnea of the newborn (TTN)?
delayed clearance of fetal lung fluid
What is common in mothers of infants with transient tachypnea?
They tend to have longer labor intervals and a higher incidence of failure to progress in labor
What treatment usually causes improvement in the initial treatment of transient tachypnea of the newborn
oxygen with low FIO2
What treatment may improve lung fluid clearance in the infant with transient tachypnea?
Frequent turning of the infant
What are basic characteristics of TTN?
Have similar clinical sighs of neonatal pneumonia
There is a rare need for mechanical ventilation
Small chance of persistent pulmonary hypertension
IV administration of antibiotics should be considered
What blood gas alteration is usually seen in meconium aspiration syndrome?
hypoxemia and mixed respiratory and metabolic acidosis
What should be done early in the treatment of the non-vigorous infant with meconium aspiration syndrome?
What has been implicated in the origin of pronchopulmonary pysplasia (BPD)
What therapy has little effect on long-term outcome such as mortality and duration of O2 therapy in infants with BPD?
Treatment of premature infants with apnea includes?
What physiologic abnormalit is believed to be the cause of persistent pulmonary hypertension in the newborn (PPHN)?
High pulmonary vascular resistance
What are fundamental pathophysiologic events that explain PPHN?
increased muscle wall thickness
decreased cross-sectional area
What factors may stimulate pulmonary vascular spasm and cause persisent pulmonary hypertension in the newborn
What is common in infants with persistent pulmonary hypertension?
Hypoxemia out of proportion to the lung disease detected by radiography
The pathophysiologic abnormalities associated with congenital diaphragmatic hernia does NOT include
malformation of the left ventricle
Clinical findings associated with congenital diaphragmatic hernia includes?
decreased breath sounds
displaced heart sounds
What is the mortality rate for infants with conenital diaphragmatic hernia?
Mortality rate is usually HIGH
What are common neuromuscular defects that affect infants?
Spinal muscular atrophy
congenital myasthenia gravis
What is the most likely diagnosis in the newborn with severe cyanosis at birth?
Transposition of the great vessels
What is NOT true regarding ventricular septal defects in infants?
usually cause right-to-left shunting
In left ventricular outflow obstructions, what does systemic blood flow depend on?
The patency of the ductus ateriosus
What is true about infants with hypoplastic left heart syndrome?
They need to be supported with mechanical ventilation
In what defect is heart transplantation an accepted option for treatment.
Hypoplastic left heart syndrome
What is the most common cause of death in infants under the age of 1 year?
Sudden infant death syndrome (SIDS)
What is NOT a maternal characteristic associated with an increased frequency of SIDS?
history of asthma
What is death from SIDS commonly confused with?
Intentional suffocation due to its difficulty to differentiate the characteristics
According to the American Academy of Pediatrics what sleepling position should an infant be placed in?
Supine or side-lying position for the first 6 months
What criteria is used to diagnose GERD?
esophageal pH testing
upper GI contrast studies
What disease is NOT commonly associated with bronchiolitis most likely to result in respiratory failure?
What groups of infants should receive passive immunization for RSV?
Chronic lung disease
Infants born less than 32 weeks gestational age
Infants with congenital heart disease
What therapy is considered controversial in the management of infant with severe bronchiolitis?
What are characteristics of croup?
Caused by viral organism
Most common form of airway obstruction in children aged 6 months to 6 years
Causes subglottic swelling and obstruction
Most often caused by parainfluenza virus
What clinical findings suggests the child with croup should be hospitalized?
Stridor at rest
cyanosis on room air
harsh breath sounds
What treatment is LEAST likely to be needed in the treatment of he child with croup?
What modality is believed to be the cause of a decrease in the reported incidence of epiglottitis over the past decade?
What are common complications in patients with cystic fibrosis?
trouble with digestion of fats
Fat-soulable vitamin deficiency
What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis?
What therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis?
high doses of ibuprofen
What parameter is not considered accurated enough to treat a patient when analyzing CAP gasses?
The time to switcha a patient from CPAP to mechanical ventilation is indicated by?
CPAP of 8-10 cm with a PaO2 of less than 50 torr.
FiO2>80% resulting in a PaO2 of less than 50 torr.
what happens if you increase the PEEP without increasing the inspiratory pressure by the same amount?
Tidal volume will decrease
Persistent fetal circulation is represented by the presence of?
patent foramen ovale
patent ductus ateriosus
The effect of the expiratory grunt in a newborn who is in respiratory distress would be to?
What are common characteristics of croup?
affects children under the age of 6
inspiratory and expiratory stridor are common
presence of a harsh, barking cough
What are common characteristics of meconium aspiration syndrome?
Fetal asphyxia precedes aspiration
gasping respiratory efforts by fetus
post-birth, successive intubations and suctioning are required
When using high frequency ventilation in the neonate the parameter that will increase tidal volume is?
amplitude or driving pressure
Mechanical ventilation of the neonate includes what?
using tidal volumes of 5-7 ml/kg
using I times of 0.3 to 0.7 seconds
using PIPs less than 30 cmH2O