Lung Diseases Flashcards

1
Q

3 Main Pediatric Lung Diseases

A

Respiratory Distress Syndrome (RDS)
Sudden Infant Death Syndrome (SIDS)
Cystic Fibrosis (CF)

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2
Q

What is another name for RDS?

A

Hyaline membrane disease

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3
Q

Define RDS

A

Lung disease in a preterm infant resulting from insufficient surfactant

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4
Q

What is the major cause of morbidity & mortality in infants born prior to 30 weeks gestation?

A

RDS

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5
Q

What product has changed clinical course & decreased morbidity & mortality rates in RDS?

A

Exogenous surfactant

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6
Q

Epidemiology of RDS

A

Incidence decreases over 35 weeks
More severe in male infants
More severe & common in white infants

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7
Q

Increased Incidence Risk Factors of RDS

A
Low gestation
Male sex
White race
Maternal DM (decreased lung development & surfactant production)
C-section pre-onset of labor
Perinatal asphyxia
Maternal HTN
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8
Q

Decreased Incidence Risk Factors of RDS

A

Prolonged rupture of membranes
Chronic congenital infections
Maternal substance abuse
Antenatal corticosteroid exposure

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9
Q

2 Major Issues in RDS

A

Immature lungs

Lack of surfactant

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10
Q

Reasons for Immature Lungs

A

Born before lung development

Born before surfactant production

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11
Q

At what stage can true gas exchange occur?

A

Saccular stage

Alveolar ducts present

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12
Q

Reasons for Lack of Surfactant

A

Production begins at 23-24 weeks

Adequate amounts not produced until 35 weeks

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13
Q

What does surfactant do?

A

Reduces surface tension in alveoli
Facilitates lung expansion
Prevents alveolar collapse

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14
Q

Other Issues in RDS

A

Excessively compliant chest walls
Weakness of respiratory muscles
Alveolar collapse

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15
Q

Pathophysiology of RDS

A
Alveolar collapse alters V/Q
Pulmonary shunting
Arterial hypoxemia
Metabolic acidosis
Vasoconstriction
Pulmonary HTN
May have R to L shunting
Increased pulmonary blood flow
Pulmonary edema
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16
Q

How do the lungs appear in hyaline membrane disease?

A

Solid & congested with diffuse atelectasis

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17
Q

What are hyaline membranes made from?

A

Plasma proteins leaked from damaged capillaries

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18
Q

PE findings in RDS

A
Progressive tachypnea
Retractions
Grunting
Cyanosis
Decreased breath sounds
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19
Q

Diagnostics of RDS

20
Q

Findings with CXR in RDS

A

Increased density of lung fields
Reticulogranular infiltrates
Air bronchograms
Elevation of diaphragm

21
Q

ABG Findings in RDS

A

Hypoxemia
Hypercarbia
Metabolic acidosis

22
Q

How does exogenous surfactant drastically change the course of RDS?

A

Decreased need for oxygen
Decreased mechanical ventilation
Reduce incidence of gas leaks

23
Q

What needs to be done for babies with RDS?

A

Stabilization
Cardiopulmonary function monitoring
Adequate respiratory support
Proper thermal, metabolic, & nutritional support

24
Q

Prevention of RDS

A

Prevention of premature delivery

Antenatal corticosteroids

25
What do antenatal corticosteroids do?
Improve lung compliance Increase lung volume Decrease capillary protein leak
26
Complications of RDS
``` Hemorrhagic pulmonary edema Capillary rupture & interstitial fluid May be seen with exogenous surfactant First 5-7 days of life Rapidly fatal ```
27
Define SIDS
Sudden unexpected death of an infant less than 1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including a complete autopsy & review of the circumstances of death & clinical history
28
Age and time of death in SIDS
Sparing in 1st month Increases in 2nd month Peak incidence at 3 months Occurs during the night
29
Possible Maternal Risk Factors for SIDS
``` Young age Multiparity Smoking & drug abuse during pregnancy Previous fetal deaths Anemia during pregnancy Placenta previa Premature rupture of membranes Low social class Low family income Short inter-pregnancy interval Unmarried mother Partner unemployed Late attendance of antenatal clinic Postnatal depression Attendance to psychiatrist UTI in pregnancy ```
30
Possible Infantile Risk Factors in SIDS
``` Male Low birth weight Premature Blood type B Low APGAR scores Low hematocrit @ 48 hours Not using a pacifier Prone/side sleeper Bed-sharing Overheating Formula fed Siblings in family Sleeping in own room Previous SIDS in family Previous cyanotic episode ```
31
What is the most important preventable risk factor for SIDS?
Maternal smoking
32
Risks to child from maternal smoking include
Fetal hypoxemia Inhibition of airway growth and development Decreased ability to arouse to noxious stimuli Increased susceptibility to respiratory tract infections
33
How do pacifiers help to prevent SIDS?
Reduce arousal threshold | No evidence to discourage pacifier use
34
Why is a prone position a risk to develop hypercapnia?
Rebreathing of expired air Hypoxemia Upper airway closure Arousal deficit
35
Pathology of SIDS
Intrathoracic petechial hemorrhages Frothy secretions around mouth & nose Evidence of URI Hypoxic tissue markers Abnormalities in brain stem serotoninergic system
36
Monitored events of SIDS have shown
Apnea, bradycardia, unlikely primary mechanism No arousal reaction Gasping occurs in majority of victems
37
Prevention of SIDS
``` Supine sleeping Firm sleep surface Soft objects out of crib Don't sleep with infant Smoke-free environment Pacifier at nap & bedtime Avoid overheating ```
38
Define Cystic Fibrosis
Syndrome of chronic sinopulmonary infections, malabsorption & nutritional abnormalities
39
Organ Dysfunction in CF
``` Sinuses: sinusitis, nasal polyps Lungs: endobronchitis, bronchiectasis Pancreas: exocrine insufficiency, CF DM Intestine: meconium ileus, constipation Liver: focal sclerosis Vas Deferans: failure to develop Sweat gland: salt-losing dehydration ```
40
CF Related Complications
``` Stunting, wasting Micronutrient deficiencies Steatorrhea Intestinal obstruction Intussusception Hypoelectrolytemia Airway infection Progressive obstructive lung disease Bronchiectasis DM Rectal prolapse Sinusitis Vasculitis Non-alcoholic steatohepatitis Male infertility ```
41
Genetics of CF
Large gene on chromosome 7 Carrier rate high Autosomal recessive
42
Diagnostics of CF
One or more symptoms Positive "newborn screen" CFTR dysfunction- sweat chloride Emphasis on the process
43
"End Stage" Lung Disease in CF
Bronchiectasis Infection Inflammation Mucous plugging
44
Physiologic Abnormalities in CF
Severe airflow obstruction | Increased RV, FRC
45
Treatment for CF
``` Airway clearance therapy Antibiotics Inhaled mucolytics Bronchodilators Enzyme replacement Fat soluble vitamins Azithromycin Ibuprofen ```