Med Quizzes

Acute Neonatal Decompensation on CPAP

Neonatal Decompensation Cheatsheet

Key Concept: Sudden acute decompensation in premature neonate on CPAP: asymmetric breath sounds + transillumination brightness + contralateral heart shift = tension pneumothorax. Emergent needle decompression (2nd ICS, MCL on affected side) is the immediate next step — do not wait for CXR.

Diagnosis	Key Features
Tension Pneumothorax	Sudden onset respiratory + hemodynamic collapse Decreased breath sounds on affected side Tracheal/mediastinal shift AWAY from affected side Positive transillumination on affected side Immediate needle decompression (2nd ICS, MCL) Follow with chest tube after needle decompression Risk increased with CPAP/PPV CXR: hyperlucency + collapsed lung (confirm after stabilization)
Surfactant Deficiency	Gradual onset from birth (not sudden decompensation) Bilateral decreased breath sounds Bilateral ground-glass opacity on CXR Worsens progressively over 4-6 hours Treated with exogenous surfactant + CPAP No asymmetry; no transillumination difference Does NOT cause sudden acute decompensation after initial stabilization
Pulmonary Hemorrhage	Risk factors: extreme prematurity, surfactant therapy, PDA Blood-tinged secretions from ETT Bilateral opacification on CXR Treated with PEEP increase + blood products + epinephrine (if cardiac) Bilateral, not unilateral
Duct-Dependent Lesion	Duct-dependent lesions: CoA, AS, HLHS depend on PDA Prostaglandin E1 maintains ductal patency Presents with shock when ductus closes (day 1-7) Weak or absent femoral pulses (with strong upper extremity pulses in CoA) Echocardiogram diagnostic No transillumination asymmetry Not a cause of unilateral lung finding

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Acute Neonatal Decompensation on CPAP

A Tension Pneumothorax

B Surfactant Deficiency

C Pulmonary Hemorrhage

D Duct-Dependent Lesion