Neonatal and Pediatric Aerosolized Therapy

Question 0

Factors affecting drug delivery

Answer 0

Inertial impaction (fxn of particle size and velocity)
Gravitational settling (fxn of mass and residence time)
Structural feature of lung (airway diameter, nose breathers

Neonatal/Adult airway parameters
    Trachea diameter: 4mm, 20mm
    Length: 5-6cm, 10-12 cm
    Vt: both 6ml/kg
    RR: 30-40, 12-20
    Ve: 200-300ml/min / 6L/min
    Insp. flowrate: 100ml/sec / 500ml sec

Question 1

Age ranges defining periods from birth to adult

Answer 1

Premature neonate: less than 37 weeks
Neonate: 1st month postnatal life
Infant: 1-12 months
Child: 1-12 years
Adolescent: 12-18
Adult: 18+

Question 2

MDI inhalers

Answer 2

Method of choice for infants and children < 5yo but only when used with appropriate reservoir device

pMDI Autohaler alternative in children >8yo

DPI NOT appropriate for children <5-6 yo

Question 3

Mechanical ventilation delivery

Answer 3

Externally powered Neb may affect:
Volume, Pressure, PEEP, Sensitivity, FIO2
Infants
Placement of pMDI between Y-piece and ETT
SVN placed in inspiratory limb away from Y-piece
Pediatrics
pMDI/spacer with one-way valve = larger inhaled mass
*actuate before inspiration