By Dara Brodsky MD, Elizabeth G Doherty MD
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Extra info for Neonatology Case-Based Review
Example text
Her clinical course had been complicated by severe lung disease requiring prolonged intubation. The infant had self-extubated a few minutes prior to the resident’s arrival. Upon examination, the resident notices that the infant has biphasic stridor and respiratory distress. The resident asks the nurse to page the neonatologist. The neonatologist then intubates the infant after the second attempt, and an otolaryngologist evaluates the infant. 3. Bronchospasm B. Pulmonary edema C. Subglottic stenosis CASE 4 Surfactant deficiency A pregnant woman presents at 32 weeks’ gestation with premature rupture of membranes.
Preferentially improve the surface tension of collapsed alveoli After surfactant therapy, the infant’s ventilator support decreases significantly and the infant is extubated to continuous positive airway pressure (CPAP) at ∼8 hours of age. The infant’s chest radiograph at 15 minutes of age is shown in Figure 1. 4. Of the following, the least likely strategy to decrease the severity of respiratory distress syndrome in preterm infants is: A. Antenatal steroid administration B. Avoidance of supplemental oxygen in the delivery room C.
1 After birth, the medical team reports an infant’s Apgar score by assessing the infant’s color, heart rate, reflex irritability, tone, and respiratory effort. This assessment occurs at 1 and 5 minutes of age; if the Apgar score is less than 7 at 5 minutes of age, the scoring is continued every 5 minutes until the score is 7 or greater for up to 20 minutes. The team provides a score of 0, 1, or 2 for each of the five clinical signs, as shown in Figure 1. Apgar Scoring Chart Score Sign 0 1 2 Heart rate Absent Slow (<100) >100 Respiratory effort Absent Slow, irregular; weak cry Good; strong cry Muscle tone Flaccid Some flexion of extremities Well flexed No response Grimace Cough or sneeze No response Grimace Cry and withdrawal of foot Blue, pale Body pink, extremities blue Completely pink Reflex irritability Response to catheter in nostril or slap of sole of foot Color FIGURE 1.