4- paediatric respiratory medicine Flashcards
what are some differences between children and adults? (anatomically)
- little babies have high anterior larynx
- neonates breathe through nose
- airways narrower
- compliant chest, horizontal ribs + diaphragm
- babies tend to increase resp rate as less scope for increasing tidal volume (larger physiological dead space)
- fewer alveoli - develop into adulthood
- higher O2 requirements per kg
what are some signs that a baby is struggling to breathe?
breathe faster, struggle to eat, babies grunt when working hard (grunt suggests respiratory distress and other things)
what are some examples of problems in neonates?
- lack of surfactant = RDS (respiratory distress syndrome)
- tension pneumothorax
- chronic lung disease
- congenital diaphragmatic hernia
- transient tachypnoea of newborn
what is respiratory distress syndrome (RDS)?
common problem of neonates where lack of surfactant, usually secreted at about 32 weeks so neonates haven’t started making yet and can get stiff lungs
what is treatment of lack of surfactant in neonates?
- give surfactant.
- give antenatal steroids if born early, ventilate (but can cause damage as trauma by high pressure ventilating so have to be gentle so run CO2 higher than adults so don’t have to blow off as hard)
- keep newborn babies warm (important as cold = illness)
what is a tension pneumothorax?
tension pneumothorax is air going in when breathe in but not going out when breathe out. →happens quite a lot and they get better. put in chest drain
what is chronic lung disease in neonates?
= if need oxygen after 36 weeks
- lots of causes e.g. infections since born early, if they needed ventilation etc. often RDS can develop into chronic lung disease
= development can catch up but lung function not as good as other their age
- means they are more vulnerable to infections
what is congenital diaphragmatic hernia?
= when hole in diaphragm meaning some organs like bowel, stomach or liver can move into chest cavity
- mostly picked up in delivery and then gone to edinburgh to deliver. not quite as simple as just moving organs back from chest. sometimes they need respiratory support (with mask on face) but you would end up putting air in gut which could cause problem
what is transient tachypnoea of newborn?
when in womb you have fluid in lungs as bathed in amniotic fluid, when in labor body starts to get rid of fluid in lungs, babies should completely get rid of when born by absorbing it into their system but when c-section they get less of signals so more likely to not absorb it and need significant respiratory support
why can breathing tests be hard in paediatrics?
they are tricky for kids - spirometry more useful than peak flow
what are some differences about asthma inhalers in kids and adults?
ame types of inhalers but less choice for children, also more restrictions as some inhalers are tricky to use
- kids (especially teenagers) are not very good at taking inhalers and more likely to take if easier and more pleasant to use
what can be done about passive smoking for kids with CF or severe asthma?
ask parents to stop smoking
what is bronchiolitis?
= viral infection - RSV causing loads of secretions and struggle to breathe
- it’s seasonal, usually babies 1st winter
what are symptoms of bronchiolitis?
- grunting, apnoea, poor feeding, irritant cough, wheezy
- long term episodic wheeze - they could be kids that are likely to get wheeze every time their ill (not asthmatic)
what is treatment for bronchiolitis?
support through illness (help feed, sleep, poo), no medicines make big difference
