Answer
1)Vigorous baby has three criteria
a)Good respiratory effort
b)Heart rate more than 100
c)Good muscle tone
2)Grunting
Grunting is a noise breath heard during the expiratory phase due to partial closure of the vocal cord during expiration. This will maintain high intra-alveolar pressure and limiting the alveolar collapse as well as open up the atelactatic small airway. It could signify respiratory distress in infants.
As compared to an adult, neonate’s elastic recoil of the chest wall is very small and inadequate to ensure small airway remain open in order to maintain adequate functional residual capacity (lung volume at the end of expiration). Therefore, grunting is a compensatory mechanism for maintaining this FRC.
3)Chest X ray shows
a)It is an AP view of the chest with adequate penetration. Identification data is not shown.
b)There are presence of tubing inside the baby (intubation tube with tips just above the clavicle, umbilical artery catheter with tips position at lateral to the left border of the 11th thoracic ribs, femoral artery)
c)Homogenous opacity at the right thorax cavity with a doom shape. Bowel loop also noted to sit at right thorax cavity
d)Mediastinum is shifted to the left. Heart border can be appreciated.
e)Normal lung tissue can be appreciated at the right and left upper zone. No sign of consolidation of the lung
f)No overcrowding of the ribs seen at the right thorax to suggest lung atelactasis.
4)Differential diagnosis
a)Right diaphragmatic hernia
b)Eventration of the right diaphragm
-Right phrenic nerve palsy
-Right diaphragm muscle weakness
c)Bilateral lower lobe lung hypoplasia
d)Right lung collapse
e)Congenital pneumonia.
5)Anticipated complication in this baby
a)Persistent pulmonary hypertension
b)Cardio-respiratory arrest
c)Sepsis
d)Strangulation of the organ that protrudes into the right thorax.
1)Vigorous baby has three criteria
a)Good respiratory effort
b)Heart rate more than 100
c)Good muscle tone
2)Grunting
Grunting is a noise breath heard during the expiratory phase due to partial closure of the vocal cord during expiration. This will maintain high intra-alveolar pressure and limiting the alveolar collapse as well as open up the atelactatic small airway. It could signify respiratory distress in infants.
As compared to an adult, neonate’s elastic recoil of the chest wall is very small and inadequate to ensure small airway remain open in order to maintain adequate functional residual capacity (lung volume at the end of expiration). Therefore, grunting is a compensatory mechanism for maintaining this FRC.
3)Chest X ray shows
a)It is an AP view of the chest with adequate penetration. Identification data is not shown.
b)There are presence of tubing inside the baby (intubation tube with tips just above the clavicle, umbilical artery catheter with tips position at lateral to the left border of the 11th thoracic ribs, femoral artery)
c)Homogenous opacity at the right thorax cavity with a doom shape. Bowel loop also noted to sit at right thorax cavity
d)Mediastinum is shifted to the left. Heart border can be appreciated.
e)Normal lung tissue can be appreciated at the right and left upper zone. No sign of consolidation of the lung
f)No overcrowding of the ribs seen at the right thorax to suggest lung atelactasis.
4)Differential diagnosis
a)Right diaphragmatic hernia
b)Eventration of the right diaphragm
-Right phrenic nerve palsy
-Right diaphragm muscle weakness
c)Bilateral lower lobe lung hypoplasia
d)Right lung collapse
e)Congenital pneumonia.
5)Anticipated complication in this baby
a)Persistent pulmonary hypertension
b)Cardio-respiratory arrest
c)Sepsis
d)Strangulation of the organ that protrudes into the right thorax.