Mcq 5 : Surfactant deficient lung disease

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5) Mark True or False regarding Surfactant deficient lung disease
a) Leads to increased lung volume
b) Is prevented by intra-partum infusion of dexamethasone to the mother
c) Is common in infants of GDM mothers
d) Is treated with continuous positive airways pressure ventilation
e) Results in respiratory alkalosis
Answers : F T T T F



Surfactant is a mixture of phopholipids and proteins which is produced by type II pneumocytes from 24 weeks of gestation onwards.
Surfactant has the following functions:
  • reduction of surface tension, preventing collapse of alveoli
  • facilitation of gas transport between air and fluid phases
Surfactant deficient lung disease is a form of respiratory distress usually occurring within 4 hours of birth and persistently worsening for 48 to 72 hours. If not fatal, it resolves by 72 hours.
Surfactant deficiency results in high alveolar surface tension;lead to collapse of alveoli, with each breath the baby must reinflate the collapsed alveoli. Thus every breath is like the first - a large effort for relatively poor expansion.
predisposing factors
  • prematurity
  • small for dates
  • male sex
  • maternal diabetes mellitus
  • hypothermia
  • perinatal asphyxia

Management:
  • Treatment with raised ambient oxygen is required, which may need to be supplemented with continuous positive airway pressure (delivered via nasal cannulae) or artificial ventilation via a tracheal tube. The ventilatory requirements need to be adjusted according to the infant's oxygenation (which is measured continuously), chest wall movements and blood gas analyses. Artificial ventilation may be synchronised as far as possible with the infant's respiration, or the infant's breathing may be partially or completely suppressed with sedatives and muscle relaxants. Mechanical ventilation may be with intermittent positive pressure ventilation or high-frequency oscillation.Illustrated Textbook of Paediatrics : pages 150 - 152
Prevention:
  • avoiding preterm delivery where possible
  • careful control of diabetes in pregnancy
  • administration of dexamethasone to mothers before preterm deliveries
  • avoidance of hypothermia after delivery
Complications of RDS include intraventricular hemorrhage, periventricular white matter injury, tension pneumothorax, bronchopulmonary dysplasia, sepsis, and neonatal death. Intracranial complications have been linked to hypoxemia, hypercarbia (high Co2 =acidosis ), hypotension, swings in arterial BP, and low cerebral perfusion


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