Disease in Childhood (Respiratory) Flashcards
What is term?
37-42 weeks gestation.
What is the normal breathing rate of a neonate?
60.
How can you tell that a baby is in respiratory distress?
The sternum will depress, they get tracheal tug so heads go forward.
What noise do babies make when they are struggling to breathe and why?
Grunt, due to epiglottis being closed for longer to maintain pressure.
What arterial catheter can you use in babies that you cannot use in adults?
Umbilical arterial catheter.
What is respiratory distress syndrome and when is it predominantly seen?
Relative surfactant deficiency. Preterm.
What is surfactant made of?
Phospholipid, apoproteins.
When is surfactant secreted?
30-32 weeks.
What is the management of respiratory distress syndrome?
Mum in premature labour given steroid injections. Lots will need intubated and artificial surfactant given prophylactically.
What is there an increased incidence of pneumothorax with in the newborn?
IPPV (intermittent positive pressure ventilation), CPAP (continuous positive airway pressure) and ventilation.
What are the risk factors of pneumothorax in the newborn?
Respiratory distress syndrome, stiff lungs.
Why do they try and ventilate babies for as little time as possible?
They could get a tension pneumothorax needing treated with a chest drain.
When would a baby have chronic lung disease?
Oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease of CXR.
What can cause chronic lung disease?
RDS, barotrauma (pressure damage), volume trauma, high inspired oxygen.
What is the healing stage of chronic lung disease?
Continued lung growth over 2-3 years, often wheezy.
What is dextrocardia?
When the heart is on the wrong side.
What is a diaphragmatic hernia?
When the intestines are in the chest.
Why is there associated pulmonary hypoplasia with a diaphragmatic hernia?
Lung doesn’t develop due to pressure on lung bud.
What are the commonest diaphragmatic herniae?
Posterolateral (Bochdalek), left-sided.
Why would you avoid a bag mask IPPV in diaphragmatic hernia?
Some air will go into gut, blow up small bowel and cause more problems, need to put a tube into trachea.
What is transient tachypnoea of the newborn?
Lung fluid present in term babies.
Why does transient tachypnoea of the newborn occur more in C section than vaginal birth?
When a baby goes through labour, the stress causes them to absorb the amniotic fluid in their lungs. Sometimes doesn’t happen in C section.
How is transient tachypnoea of the newborn resolved?
Usually absorb fluid over time but can be quite ill?
What other reason could there be for fluid in the lungs of newborns?
Infection (grunting can be for other reasons than respiratory).
When can you start doing spirometry?
7 or 8 years old.
What is the differential diagnosis of CF in a child?
Immune deficiency, ciliary dyskinesia (cilia aren’t moving right), asthma, Kartagener’s/immotile cilia syndrome (rare).
Who is part of the cystic fibrosis team?
Clinicial, specialist nurse, clinical psychologist, social worker, physiotherapist, dietician.
Why can 2 children with CF not be in the same room together?
They will give each other infections.
What should you do if there is a high, intermediate of low probability of a child having asthma?
High - trial of drugs, further investigations if poor response. Intermediate - watchful waiting, spirometry, drugs and evaluate.
Low - consider investigations and referral.
What are the stages of management of children with asthma?
1: inhaled beta agonists. 2: regular inhaled steroids. 3A: regular inhaled steroids and LABA. 3B: 3A and leukotriene antagonists. 4: high dose steroids.
What virus is bronchiolitis caused by?
RSV (respiratory syncytial virus).
What age range does bronchiolitis affect and when is it more severe?
Under 18 months. More severe in younger babies, ex premature, family of smokers.
What are the symptoms of bronchiolitis?
Tachypnoea, poor feeding, irritating cough, apnoea in small babies.
What do children with bronchiolitis have increased incidence of in the next 10 years?
Wheezing episodes.
What are the common microbes in pneumonia in neonates, infants and school age children?
Neonates: GBS, e.coli, staph aureus.
Infants: strep pneumoniae, chlamydia.
School age: strep pneumo, staph aureus, Gr A strep, Bordetella, mycoplasma, legionella.
