L15: Respiratory diseases in children

Question 1

What is breathing like for baby born before 36 weeks (23-27) - called Respiratory distress syndrome

Answer 1

In the saccular stage. Baby has increased work of breathing. Sucking in rib cartilage/soft tissue = indrawing to very negative pressure in pleural space

• Stiff lungs
• Thickened gas transfer tissue causing low O2 and high CO2 which causes hyperventilation.
• Less surfactant: resistance to alveoli inflation, poor gas exchange.

Question 2

What is the respiratory support for respiratory distress syndrome baby

Answer 2

-Intubation of trachea - through mouth or nose (long term)
-Positive pressure ventilation for 2 weeks
Initially high pressures and 100% O2

Question 3

What condition results from high pressures and 100% O2 ventilation

Answer 3

Damage to cells (mechanical (baro/volutrauma) and oxygen toxicity)
which can cause bronchopulmonary dysplasia: persistent increased work of breathing, abnormal xray changes

This is also related to pulmonary oedema and inflammation

Question 4

What are the features of Bronchopulmonary dysplasia/ Chronic lung disease of prematurity. For baby <32 weeks

Answer 4

Early:

• areas of alveolar collapse (atelectasis) and emphysema
• hyperplasia of airway epithelium
• interstitial oedema

Late

• interstitial fibrosis
• hypertrophy of airway smooth muscle
• pulmonary arteriolar musculature hypertrophy

Question 5

What could be causing a paraoxysmal cough - repetitive coughing for 30s- in a young baby 6 months

Answer 5

-Whooping cough which can occur even in immunised child who got it before 6 weeks. Child will appear well between coughs (if not, pneumonia).
(also foreign body)

Question 6

What are the symptoms of Pneumonia in a baby - (needs treatment for oxygen and antibiotics)

Answer 6

Cough and breathing difficulty, with increased respiratory rate, indrawing (breathing difficult) but not wheezing

Question 7

What are the causes of wheezing and coughing in young children (1 yr)

Answer 7

Bronchiolitis and Asthma.

Question 8

What are the downsides of delivering asthma medicine using a spacer (corticosteroids/bronchodilator)

Answer 8

• Introduction of Bacteria if dirty

- Opens to the nose which can reduce dose administered due to filtering/blocked and can cause nasal irritation

Question 9

What are the possible causes of repeated bouts of wet productive cough, crackles heard with stethoscope in her chest that don’t clear

Answer 9

Bronchiectasis:
Cystic Fibrosis
Retained foreign body
TB

Question 10

What is bronchiectasis and how is it treated

Answer 10

Damaged airway walls- widened, scarred = worse mcc & obstructive pressure volume loop.
Treated by antibiotic course and sputum clearance techniques with positive expiratory pressure