Lecture 18

Question 1

What would the breathing of a premature baby be like in the first few days?

Answer 1

Stiff lungs - this would cause an increased work of breathing. There would be thickened gas transfer tissue - causes low oxygen and high carbon dioxide. There would be less surfactant: there would be collapsing of the alveoli and added stiffness and poor gas exchange.

Question 2

What respiratory support would a baby with respiratory distress syndrome need?

Answer 2

Intubation and ventilation (delivering oxygen under pressure).

Question 3

What are the downsides to 100% oxygen?

Answer 3

If the amount of oxygen gets too high, it can cause blindness, barotrauma and can oxygen toxicity to the lung.

Question 4

What can you develop if you have had high ventilation and oxygen?

Answer 4

Chronic Lung Disease (CLD) - bronchopulmonary dysplasia. The moment you stop ventilation it will stop.

Question 5

What are the features of CLD?

Answer 5

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.

Question 6

What is the definition of CLD?

Answer 6

1. Persistent increased work of breathing (undraping and increased respiratory rate).
2. Abnormal chest radiograph (XRAY) changes.
3. For babies born

Question 7

What are the etiological factors of CLD?

Answer 7

1. There is lung immaturity with:
   - Increased susceptibility to damage from oxygen, barotrauma and volutrauma.
   - Surfactant deficiency.
   - Imamture antioxidant defences.
2. Oxygen toxicity.
3. Barotrauma and volutrauma.
4. Pulmonary oedema (excessive fluid administration, patent ductus arteriosus).
5. Inflammation (multiple associated biochemical changes).

Question 8

Describe Whooping Cough?

Answer 8

1. Distressing paroxysmal cough.
2. No history of foreign body.
3. Child appears well between coughs.
4. May occur in immunised child.
5. May cough for 3-4 months.

Question 9

Describe bronchiolitis?

Answer 9

1. Expiratory wheezing.
2. Cough.
3. rapid breathing.
4. Increased work of breathing.
5. Irritable.
6. Crying (stop hearing the wheezing when they cry).

Question 10

What drugs are used to treat asthma?

Answer 10

Bronchodilator, Beta-2 agonists etc.

Question 11

Why are inhalers hard to use for children?

Answer 11

You have to be very coordinated. Where as using a spacer, you are more likely to get the whole dose, as a child struggles to have a good seal.

Question 12

What are the downsides for masks?

Answer 12

You loose 30% of the dose, as a nose is a filter.

Question 13

What are the possible causes for a wet productive cough?

Answer 13

1. Bronchiectasis.
2. Cystic fibrosis.
3. Retained foreign body.
4. TB.

Question 14

What is bronchiectasis?

Answer 14

Damaged airway walls from repeated or sever pneumonia. Tend to have dilated and scarred bronchi.

Question 15

What is the treatment for bronchiectasis?

Answer 15

Antibiotic courses and sputum clearance techniques (chest physiotherapy).