Common neonatal problems

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

32 weeks,

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

always assoc with lung maturity, not present til 36 wks

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

Beractant (Survanta)

heart rate, color, chest expansion, oximeter, tube patency, admin may necessitate rapid changes in ventilator settings!!

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

complete cessation of breathing, imm CNS,dec sensitivity of resp center to CO2

absence of nasal airflow despite resp efforts, lack of coordination of breathing, sucking and swallowing, decreased pharyngeal tone

resp rate, HR, Osat

manual stimulation, positiong, methylxcanthines-inc sens to CO2, imp skeletal muscle contration, usually caffeine citrate

allows blood to bypass hepatic circ and enter inf vena cava

allows most of the blood from the inf vena cava to bypass the rt atrium (and the pulm circ) and enter the lft atrium

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

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

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

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

ayanotic congenital heart disease, abnormal opening btwn rt and lt atria, lt to rt shunting occurs in all atrial septal defects

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

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

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)