Paediatric Respiratory conditions Flashcards
Pathophysiology of Neonatal Infant Respiratory DIstress Syndrome
*Deficiency in surfactant —> collapse of terminal air-spaces (the future site of alveolar development)
*deficiency may by due to inhibition from the insulin (produced in the newborn of diabetic mothers)
X ray changes seen in neonatal respiratory distress syndrome (3)
- ‘Ground glass’ changes -> fine reticular granularity of the lung parenchyma
- ‘white lung’
- decreased lung volumes
Prevention of neonatal RDS
- pregnancy should be prolonged for as long as possible
- Glucocorticoids (antenatal)—> speed up production of surfactant
12mg Bethamethasone 12 hourly -> 2 doses; 2nd dose 12 - 24 hours before birth
What’s a disadvantage of CPAP use (e.g. neonate with RDS)
Positive pressure ventilation can damage the lungs -may lead to chronic bronchopulmonary dysplasia
(BPD) due to over-ventilation or underventilation
Management of neonatal RDS
- oxygen
- CPAP
- IV fluids - to stabilise BM, BP etc
- endotracheal tube (mechanical ventilation) - in severe cases
- antibiotics - to prevent infection
- exogenous surfactant
What’s the management (soon after delivery) of an extremly premature baby?
Usually: baby born at e.g. 28 weeks -> intubated ASAP (often at delivery room) -> surfactant
given through NG into the lungs (resistance will disappear as we administer surfactant) ->CPAP
for short time
What patients is bronchopulmonary dysplasia seen in?
- chronic lung disease
- usually in premature infants who were treated with supplemental oxygen / who required longterm oxygen support
*but improvements in care, prevention - incidence decreased
Cause of bronchopulmonary dysplasia
Prolonged high O2 delivery —> Necrotizing bronchiolitis (acute inflammatory lesion of lower
airway) and alveolar septal injury with inflammation and scarring—> hypoxemia
What’s bronchiolitis?
- usual cause
Infection of the bronchioles (small airway)
Cause: usually Respiratory Syncytial Virus (RSV)
Most common patient (age) in bronchiolitis
- can be diagnosed in children up to 2 years of age
- most common in children under 6 months
What can be heard in bronchiolitis on baby’s chest? (3)
- wheeze
- crackles
- harsh breath sounds
Signs and symptoms of bronchiolitis
- Choryzal symptoms (common cold symptoms – runny / snotty nose, mucus in throat)
- Dyspnoea
- Poor feeding
- Mild fever (<39C)
- Apnoeas
- Signs of respiratory distress (recessions, tracheal tube, nasal flaring, head bobbing)
- Auscultation: wheeze and crackles
Where bronchiolitis is most commonly managed?
At home with safety netting
Reasons for admission with bronchiolitis
- Any pre-existing condition (e.g. prematurity, Downs, cystic fibrosis) predisposes to more severe infection
- Parent not confident in ability to manage at home or difficult access to medical help from home
- <50% of normal intake or clinically dehydrated
- Respiratory rate >70
- Oxygen saturations <94%
- Signs of respiratory distress
Typical management of bronchiolitis
- Typically just supportive management
- Ensure adequate feeding (NG tube if not managing orally)
- Supplementary oxygen if saturations remain <92%
- Rarely ventilatory support (CPAP) is required
- Little evidence for other treatments such as nebulised saline / bronchodilators / steroids / antibiotics and are not routinely used
