Childhood Respiratory Disease

Question 1

What respiratory condition affects children commonly after a preterm birth?

Answer 1

Relative Surfactant deficiency

Question 2

When is surfactant normally secreted?

Answer 2

Between 30-32/40 weeks gestation

Question 3

How is surfactant production stimulated in preterm babies?

Answer 3

Steroids

Question 4

Relative surfactant deficiency causes what symptoms in babies?

Answer 4

• Lack of surfactant results in atelectasis (lung collapse)

=> impairment of gas exchange

Question 5

What increases the risk of a pneumothorax in neonates?

Answer 5

• IPPV, CPAP and ventilation

- Relative surfactant deficiency (stiff lungs)

Question 6

How often are babies born with a pneumothorax?

Answer 6

• occurs in around 1% vaginal deliveries

- 1.5% caesarean sections

Question 7

How is chronic lung disease in children defined?

Answer 7

• O2 requirement beyond 36 weeks gestation
• Evidence of parenchymal disease on CXR
• Generally follows surfactant deficiency

Question 8

How long does it take for chronic lung disease to heal in young children?

Answer 8

• Healing stage over 2-3 years as lung grows

- children remain wheezy during this time

Question 9

What is a diaphragmatic hernia and when does it usually present?

Answer 9

• Bowel taking up space where lung should be expanding
  => lung doesn’t develop properly (pulmonary hypoplasia)
• Usually presents with severe breathlessness just after birth
• Most common Posterolaterally (left-sided)

Question 10

How is a diaphragmatic hernia treated?

Answer 10

Respiratory support

- surgery

Question 11

How does Transient Tachypnoea of the Newborn usually present?

Answer 11

• Term baby delivered by C-Section
• without vaginal delivery, baby does not expel fluid from lungs
• Baby begins grunting after delivery

Question 12

Describe how Cystic Fibrosis usually presents in young children?

Answer 12

prolonged history of:

• cough
• loose stools
• failure to thrive

Question 13

CF patients are known to get recurrent chest infections. What organisms are commonly grown on culture?

Answer 13

Staph Aureus

Pseudomonas may be grown

Question 14

How does asthma usually present in children?

Answer 14

cough worse at night OR during active play

other symptoms:

• Atopy (personal / FHx)
• Wheeze on auscultation

Question 15

What effect does passive smoking have on children?

Answer 15

• Reduces birthweight
• pregnancy los
• Teratogenic to airways + cleft lip/palate
• Glue ear
• Carcinogenic
• Increase likelihood of asthma attack

Question 16

If a child has an acute asthma attack, how is this treated?

Answer 16

• Oxygen
• Nebulised bronchodilator
• Oral prednisolone
• IV salbutamol
• IV aminophylline
• IV magnesium
• Ventilation

Question 17

What is the most common cause of bronchiolitis in children and how is it treated?

Answer 17

• Viral infection – RSV

=> Tx = supportive

Question 18

When does Bronchiolitis usually present?

Answer 18

• <18 months old

- More severe in younger babies family of smokers

Question 19

How do babies normally present with bronchiolitis?

Answer 19

• Tachypnoea
• poor feeding
• irritating cough

Question 20

How does pnuemonia commonly present in children?

Answer 20

• cough
• high fever
• sputum production
• previously well

O/E

• Dullness on percussion
• Bronchial breathing

Question 21

Which pneumonia organisms commonly infect each age group (Neonates, Infants, School Age)?

Answer 21

Neonates: E.coli, Klebsiella, Staph aureus

Infants: Strep pneumoniae, Chlamydia

School age: Strep pneu., Staph aureus, Group A strep, Bordetella, Mycoplasma, Legionella

Question 22

If a 1 y/o child was to present with a barking cough and difficulty in breathing of sudden onset, what owuld be your differential diagnoses?

Answer 22

Inhaled foreign body
Epiglottitis
Allergy
Croup

Question 23

What is croup and how is it treated?

Answer 23

• Viral laryngotracheobronchitis
  Symptoms:
• Stridor
• barking cough

Treatment = oral steroid to reduce inflammation