Neonatal Hypoxia and Patent Ductus Arteriosus

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What is the result of desaturated blood returning to the right heart?

It mixes with oxygenated blood in the left heart

It becomes oxygenated in the right heart

It is shunted to the systemic circulation (correct)

It goes directly to the lungs for oxygenation

Which of the following is NOT a common diagnosis associated with severe hypoxic respiratory failure in neonates?

Meconium aspiration syndrome (MAS)

Congenital diaphragmatic hernia (CDH)

Pulmonary embolism (correct)

Respiratory distress syndrome (RDS)

What is idiopathic pulmonary hypertension sometimes seen in?

Patients with meconium aspiration syndrome

Patients with minimal or severe lung disease

Patients with no lung disease and clear chest radiographs (correct)

Patients with respiratory distress syndrome

What is a characteristic of the 'other' category of diagnoses associated with hypoxic respiratory failure?

It includes rarer causes of HRF with serious outcomes Signup and view all the answers

What is the result of blood flowing through the patent ductus arteriosus (PDA) and the foramen ovale?

It marks cyanosis Signup and view all the answers

What is the clinical course of infants with PPHN?

Variable, depending on the severity of the underlying disease process Signup and view all the answers

What is the primary goal of pharmacologic vasodilators in the treatment of PPHN?

Decrease pulmonary vascular resistance Signup and view all the answers

What is the main complication of respiratory failure that traditional therapy aims to address?

Persistent pulmonary hypertension of the neonate Signup and view all the answers

According to the International ECMO experience, what percentage of cases involve PPHN/PFC?

48% Signup and view all the answers

What is the name of the medication used as an alternative to traditional therapy for PPHN?

Sildenafil Signup and view all the answers

What is the term used to describe the mismatch between ventilation and perfusion in the lungs?

V-Q mismatch Signup and view all the answers

What is the name of the index used to measure the severity of hypoxic respiratory failure?

Oxygenation index Signup and view all the answers

What can ECMO improve for newborns over a period of days to weeks?

Oxygenation Signup and view all the answers

What is the name of the potent vasodilator that can improve pulmonary blood flow and thus reverse PPHN?

Inhaled nitric oxide (iNO) Signup and view all the answers

What has led to a decline in the number of neonatal ECMO cases over the past 20 years?

Introduction of inhaled nitric oxide (iNO) Signup and view all the answers

Which group of preterm infants may still benefit from inhaled nitric oxide (iNO)?

ELBW infants with PPROM, oligohydramnios, and suspected pulmonary hypoplasia Signup and view all the answers

What remains a serious therapeutic challenge in infants with BPD?

Pulmonary hypertension Signup and view all the answers

What is being studied as alternative pulmonary vasodilators for iNO-resistant newborns?

Sildenafil, milrinone, inhaled prostacyclin derivatives, and bosentan Signup and view all the answers

What is the incidence of spontaneous ICH associated with heparinization in premature infants less than 35 weeks' gestation?

89% Signup and view all the answers

What is the minimum weight for which ECMO management is possible with recent technical refinements?

1800 grams Signup and view all the answers

Which group of infants experienced the highest mortality on ECMO according to the ELSO Registry?

Late preterm infants (34 0/7 to 36 6/7 weeks' gestation) Signup and view all the answers

What is the primary predictor of ICH risk according to recent studies on ECMO management?

Gestational age Signup and view all the answers

What is the mortality rate for full-term infants (390/7 to 426/7 weeks' gestation) on ECMO according to the ELSO Registry?

11.2% Signup and view all the answers

What is the primary reason for the increased risk of bleeding in the immature brain during cardiopulmonary bypass?

Changes in cerebral blood flow patterns Signup and view all the answers

What is the primary reason for ligating the right carotid artery and internal jugular vein at decannulation in most ECMO centers?

To prevent any concern about acute embolic complications associated with vascular reconstruction Signup and view all the answers

According to the studies, what is the result of reanastomosing the right carotid artery and internal jugular vein in infants who have been on bypass less than 7-10 days?

No difference in neurologic impairment compared to ligated controls Signup and view all the answers

What do magnetic resonance angiograms (MRAs) and Doppler flow studies confirm in the majority of infants who underwent reanastomosis?

Good antegrade flow through the reconstructed carotid artery Signup and view all the answers

What was the finding in a 2006 study of 18 survivors with CDH at 2 years of age?

A 72% occlusion or stenosis of the right common carotid artery Signup and view all the answers

What is the advantage of reanastomosing the right carotid artery and internal jugular vein in infants who have been on bypass less than 7-10 days?

Prevention of future ischemic risks to the developing newborn brain Signup and view all the answers

What was the birth weight of infants in a 2015 study who underwent right common carotid reconstruction (RCCR)?

2.5 kg Signup and view all the answers