L18 Respiratory Disease in children Flashcards
Pre-eclampsia
dangerous for both mum and baby
-has to have c section
Apgar
score developed to measure the health of a new born
Canalicular Stage
16-26 wks
not promoting gas exchange yet
Saccular Stage
26-36 wks
alveoli are thinning down and some gas exchange can occur
What would her breathing have been like in the first few days?
-need a machine/otherwise laboured
Lungs stiff: causes increased work of breathing
Thickened gas transfer tissue: causes low oxygen and high carbon dioxide
Less surfactant: causes collapse of ‘alveoli’
-adds to stiffness and poor gas exchange
What is the name of the condition with stiff lungs, thickened gas transfer tissue and less surfactant?
Respiratory Distress Syndrome
-artificial surfactant has only just been made available
hence now baby was more likely to develop a severe form of RDS
What support would a baby with RDS need?
Machine: Ventilator
- CPAP Continuous Positive Airway Pressure: help to keep the airways open (overcome lack of surfactant) + deliver a high concentration of oxygen
- Negative: if RDS is quite severe you need to use high pressures
Intubation
tube put down the trachea as a conduate to the ventilation that is going to occur
-too sick for CPAP
Ventilation
delivering Oxygen under pressure
- if positive pressure ventilation, involves putting positive pressure in
- if the baby is sick, means it will need oxygen too to alleviate the hypoxia
Negatives to high pressures and 100% oxygen
- if the amount of oxygen in the blood stream goes too high it can cause blindness = retrolental fibroplasia
-must monitor very carefully - barotrauma: can cause trauma to the little lungs developing
- decreased respiratory drive?
- Oxygen toxicity to the lung: the very thing being used to save the baby from death, may actually harm her lungs
Note: less risky now as have more sophisticated ventilation approaches and use artificial surfactant. now Normal or only a few developmental defects.
Case study’s outcome/harm that came from high pressure and 100% oxygen treatment
CLD: She developed Chronic Lung disease of prematurity
(Bronchopulmonary Dysplasia, BPD)
-if stop ventilation and oxygen when child gets better, the harm stops as well, so baby can recover as the lung grows
Features of CLD are?
Chronic Lung disease of Prematurity
- Early changes:
- areas of atelectasis and emphysema
- hyperplasia of airway epithelium
- interstitial oedema - Late changes:
- interstitial fibrosis
- hypertrophy of airway smooth muscle
- pulmonary arteriolar musculature
Definition of Chronic Lung Disease of Prematurity (CLD)/BPD
Definition:
- Persistent increased work of breathing (indrawing and increased respiratory rate)
- abnormal chest radiograph (XRay) changes
- For babies born
Indrawing
depression of the tissues in the rib
- lungs squished up as they’re stiff because they have more tissue in them and less air
- takes more negative pressure to try and open them
- then negative uses suction to try pull lungs open
- results in the soft tissues around the chest wall get pulled in
- -> classical signs of lung disease is indrawing. can get an idea how stiff the lungs are and how much pressure is going in to try and expand them.
- muscles b/w the ribs get sucked in becuase theyre soft
- spaces can be sucked in as well
- very severe diaphragm gets sucked up as weak and tired (paradox)
- pressure in the pleural cavity
- try to breathe so hard that
CLD histologically
post term alveoli
- increased cells in alveoli and interstitium
- inflammation and scarring (from barri trauma and oxygen toxicity)
