Paediatric respiratory Flashcards
What is a neonate?
Baby in the first 28 days of life
What is a ‘term baby’?
Baby born between 37 and 42 weeks gestation
What is the normal respiratory rate and heart rate for a neonate?
RR = 30-50 HR = 120-160
What is a UAC and a UVC?
Umbilical artery catheter
Umbilical venous catheter
What are the sigsn of respiratory distress syndrome in a neonate?
Tracheal tug, expiratory grunting and marked sternal recession (as the bones are not fully ossified)
What might the CXR of a neonate with RDS show?
Opaque lung fields as there is fluid on the lungs and some alveolar collapse
What causes RDS in the neonate?
Surfactant deficiency. Type 2 pneumocytes develop between 24 and 34 weeks gestation.
Premature babies may nt have produced sufficient surfactant
How often does RDS occur?
Effects 1% of all births but more common in premature births
What is the function of surfactant?
To reduce alveolar surface tension to prevent alveolar collapse
What does surfactant contain?
Phospholipid and apoproteins
What happens when not enough surfactant is produced in the neonate?
Atelectasis and impaired gas exchange
If a mother presents in premature labour, what can be done to prevent or reduce RDS?
Given 2 steroid injections, preferably 12 hours apart, which stimulates surfactant production.
At what stage in gestation will babies always be incubated?
<29 weeks and they will have artificial surfactant delivered to the lungs
What is ventilation?
Breathing for someone and controlling the rate, volume and pressure entering the lungs
What are the risks of ventilating a neonate and in what forms of ventilation are these risks greater and how can you prevent them?
Pneumothorax as you are forcing air into the lungs
Greater risk with intermittent positive airway pressure (IPPV), Continuous positive airway pressure (CPAP)
Prevent risks by limiting ventilation, flow and pressure
In what percentage of vaginal births does a pneumothorax occur spontaneously and when does this require treatment?
1%
Only when it’s tension pneumothorax and you would insert a chest drain
What is ‘chronic lung disease’ in a neonate?
An oxygen requirement beyond 36 weeks corrected gestational age with evidence of pulmonary parenchymal disease on CXR
What often causes ‘chronic lung disease’ in a neonate?
Following RDS due to barrotrauma, volume trauma or high inspire oxygen
What is the treatment for ‘chronic lung disease’ in a neonate?
Given oxygen- carried around in a cinder. Corrects itself as lungs grow and develop over 2-3 years but can be restrictive and children are wheezy
What is dextrocardia?
Heart on the right hand side of the body
What is a diaphragmatic hernia?
Where some of the gut develops in the thorax
How often does a diaphragmatic hernia occur?
1 in 2400 births
What are the associated problems with a diaphragmatic hernia and what is the most common type?
Problems: the lungs have not had space to develop as the gut is in the way => pulmonary hypoplasia
Most common: posteriolateral left sided
How is a diaphragmatic hernia corrected?
Surgical correction
What treatment should not be given to babies with a diaphragmatic hernia and why?
Must avoid bag mask IPPV as when you push air into the mouth some will go into the oesophagus and small bowel making the diaphragmatic hernia worse. Must insert a tube into the trachea instead
When is transient tachypnoea of the newborn most likely and why?
In babies born by C section because the stress of labour causes babies to reabsorb some of the fluid on the lungs but C section babies do not get this => poor gas exchange, tachypnoea and a greater risk of infection
What are the challenges with doing spirometry with children and what would you examine on children?
The reference values change with age
Only children over 7/8 can follow instructions and understand what they are doing
Examination = height and weight, chest shape and auscletation
What are the signs of CF in a newborn?
Prolonged history of cough, loose stool and failure to thrive
Raised immune reactive trypsin levels
All babies are screened at 6 days old using the heel prick blood test
What are the differential diagnoses of CF in a newborn?
Immune deficiency, ciliary dyskinesia, asthma, Kartagner’s syndrome, citis invertis
If a babies has CF, what treatment are they given?
Flucloxacillin from birth to prevent S. aureus infection
What are the clinical features that increase the probability of asthma in children?
One or more of: wheeze, cough, chest tightness, difficulty breathing
Atopy- personal or family history
Widespread wheeze on auscultation
Responsive to treatment (salbutamol inhaler)
What should be done if there is a high probability the child has asthma?
Trial treatment and further investigations if the response is poor
What should be done if there is a intermediate probability the child has asthma?
Watchful waiting, ?Spirometry if the child is old enough and ?treatment trial and evaluate
What should be done if there is a low probability the child has asthma?
Investigations and referral to a specialist paediatric team
What are some of the consequences of passive smoking around children?
Asthmatic children are 4 times more likely to die of an asthma attack
What are the consequences of smoking in pregnancy?
Reduced birth weight by 250g 4500 Miscarriages 30% increase in perinatal mortality Tetratogenic: airways, cleft lip/palate Glue ear Carcinogenic
What is the treatment for a child having an acute asthma attack?
High flow oxygen and nebulised bronchodilator
Oral prednisalone
IV salbutamol, aminophyline and magnesium (smooth muscle relaxant)
Ventelatory support
What is bronchiolitis and what is the most common aetiological organism?
Viral infection usually caused by RSV and children are usually under 18 mouths old
When is bronchiolitis more severe?
More severe in younger babies, premature babies and if family smokes
What are the clinical signs of bronchiolitis?
Tachyponea, poor feeding, irritating cough
Apneoa in small babies- not breathing for 20 seconds
What is the treatment for bronchiolitis?
Supportive. If hypoxic = oxygen. If not feeding = NG tube. If coughing = cough syrup. If fever = calpol
What organisms cause pneumonia in neonates?
GBS, E. coli, Klebsiella, Staph aureus
What organisms cause pneumonia in infants?
Strep pneumoniae, Chlamydia
What organisms cause pneumonia in school aged children?
Strep pneumoniae, Staph aureus, Bordatella, Mycoplasma, Legionella and group A strep
What are the signs of pneumonia in children?
Cough, high fever, sputum, dull percussion and bronchial breathing
What are the differential diagnosis of a sudden onset cough and difficulty breathing in children?
Inhaled foreign body, Laryngomalacia, eppiglottitis/bacterial trachitis, allergy, croup
What is croup and what are the symptoms?
Viral larygnotracheobronchitis
Stridor and cough
What is the classical sign on a CXR of croup?
Steeple sign (hypopharynx distention and narrowing of air column)
What is the treatment for croup?
Oral steroids
