Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal respiratory distress — diagnostic approach — branching viva
Branching viva from the recognition of neonatal respiratory distress through the three-way diagnostic split, the surfactant decision in the preterm infant, the meconium management trap, and the duct-dependent cardiac lesion.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar on the postnatal ward. The midwife asks you to review three newborns with respiratory distress of differing gestation and birth circumstances. The examiner releases information in stages about a preterm infant, a meconium-stained term infant and a cyanotic term infant.
Station opening
Examiner: "Define neonatal respiratory distress and list the clinical signs you would look for." [5]
Strong candidate (must-hit)
- Defines it as laboured breathing after birth with tachypnoea above 60 per minute, recession, grunting, nasal flaring and cyanosis, with hypoxaemia or hypercapnia; explains grunting as physiological positive end-expiratory pressure to splint alveoli open. [5]
Weak candidate
- "It's when the baby is breathing fast." [5]
References6ShowHide
- [1]Sweet DG; Carnielli VP; Discenza M; et al European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology, 2023.PMID 36863329
- [3]Finer NN; Carlo WA; Walsh MC; et al Early CPAP versus surfactant in extremely preterm infants. N Engl J Med, 2010.PMID 20472939
- [4]Härtel C; Hartz A; Kribs A; et al Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants. JAMA Netw Open, 2022.PMID 35943742
- [5]Aziz K; Lee CHC; Escobedo MB; et al Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [6]Madar J; Roehr CC; Ainsworth S; et al European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021.PMID 33773829
- [7]Katheria A; Reister F; Essers J; et al Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA, 2019.PMID 31742630