Lecture 18- Respiratory Distress in Children Flashcards
What happens if you have pre-eclampsia?
Emergency Caesarean. It is high BP and proteinuria.
If Mere was born 27 weeks, what does this mean about her lung development stage?
She is in early saccular stage, only a little surfactant produces, alveolar walls thinning and a little gas exchange can occur, high work of breathing
Apgars?
A quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the doctor how well the baby is doing outside the mother’s womb
Since Mere was born so early, what would her breathing have been like?
Lungs stiff: increased work of breathing
Thickened gas transfer tissue- Low O2 and high CO2
Less surfactant:
- causes collapse of alveoli
- adds to stiffness and poor gas exchange
What does Mere have?
Severe Respiratory Distress Syndrome (she was before the days of artificial surfactant)
Respiratory support for RDS babies?
Intubation: tube put down trachea for ventilation to occur.
Positive pressure Ventilation at initially high pressure and 100% oxygen
For two weeks
CPAP?
CPAP: continuous positive air pressure.
Keeps airways open, but doesn’t help with the surfactant loss.
((She was actually to sick for CPAP, as the pressure was too high.))
What are the issue of 100% O2 and high pressures?
Oxygen: if too high in bloodstream, can cause blindness
-Oxygen toxicity to the lungs
Trauma: from the high pressure in the tiny alveoli
Therefore we need to make a choice!
Chronic Lung Disease (CLD) of prematurity /(bronchopulmonary dysplasia) features?
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
CLD / bronchopulmonary dysplsia is due to
This is due to the pommeling pressure and high oxygen content given to newborns.
1) Persistent increased work of breathing (indrawing and increased resp rate)
2) Abnormal chest radiograph xray changes
3) For babies born
Indrawing?
Chest indrawing is the inward movement of the lower chest wall when the child breathes in, and is a sign of respiratory distress.
Lungs squished and stiff, no air, more negative pressure, and the soft muscles between the ribs (sometimes even the diaphragm) gets drawn in by that negative pressure
What would histology of CLD look like?
increased cells in alveoli and interstitium - inflammation and scarring
Causativesymptoms of CLD
Lung immaturity with
- inc susceptability to damage from Oxygen, barotrauma and volutraum
- surfactant def.
- immature antioxidant defences
Oxygen toxicity
Barotrauma and volutrauma
pulmonary oedema
Inflammation
Benefit of nasal prongs
Better access to baby/babies head
paroxysmal cough?
Cluster of very loud coughing you cannot stop, usually lasts for many seconds.
A premature baby with a paroxysmal cough is likely to have?? …
Whooping cough
Whooping cough (Pertussis)
- distressing paroxysmal cough
- No history of foreign body
- Child appears well between coughs
- May occur in immunised child (or before immunisation)
- may cough for 3-4 months
Tachpnoea (fast breathing)
Indrawing
not wheezing
cough / breathing difficulty
What could this be?
Pneumonia
baby gets so tired diaphragm can’t keep up. Sign of sever pneumonia
Common causes of wheezing and coughing in young children
1) Bronchiolitis
2) Asthma
Bronchiolitis symptoms
- Expiratory wheezing
- cough
- rapid breathing
- increased work of breathing
- Irritable
- Crying (obscures expiratory wheeze)
Drugs used to treat asthma? Delivery?
Inhaled corticosteroids and bronchidilator.
A metered dose inhaler with a spacer. A young child doesn’t have the coordination to use the metered dose by itself.
Spacer: easy to use, big particles don’t go down airways/ get swallowed orally.
Babies can’t properly seal, so a mask is used
Downsides of using masks with spacer
Aversion
Nose breathing: filters the larger particles of the drug, bad drug delivery. Lose about 35% of dose. ASAP dtop using mask
Repeated bouts of wet productive cough
crackles heard
Possible causes?
Wet= sputum
1) Bronchiectasis (due to her primary prior issues
2) Cystic Fibrosis
Bronchiectasis
damaged airway walls, useally from repeated damage.
Dilated scarring/damage can be seen on CT
Treatment : AB and sputum clearing techniques (Positive expiratory pressure)
Sputum clearance with Positive expiratory pressure
kids breath against pressure (pores of kohn) cleares sputum
