Paediatrics Flashcards
what is the neonatal period
first 28 days
when is full term
37-42 weeks
when is due date
40 weeks
is a resp rate of 60 normal for neonates
yes
what is periodic breathing in neonates and is it normal
fast then slow, yes
what are signs of a baby in severe respiratory distress
sternal intercostal recession and grunting
how is sternal in drawing feasible
due to flexibility of the ribs
what is CPAP
continuous positive airway pressure, self induced, forced air against closed glottis to maintain breathing and pressure
what is a way to access the circulatory system in neonates that is not possible in adults
via the umbilicus
what causes respiratory distress syndrome
relative surfactant deficiency
how does the prevelance of resp distress syndrome change with gestation
decrease as baby matures, mainly affect pre term babys
at what age is surfactant secreted
30-32/40 weeks
what does a lack of surfactant result in
atelectasis (collapse) and impairment of gas exchange
how is production of surfactant stimulated
steroids
how is respiratory distress syndrome treated
mums in premature labour given steroids, can also give surfactant prophylactically via intubation
what is a pneumothorax
air in pleural space
when is there increased incidence of pneumothorax
pre term, CPAP and ventilated babys
what is the extra risk of a pneumothorax in ventilated babies
tension pneumothorax, chest drain- tube into chest cavity
what is chronic lung disease
when lung tissue is damaged and traps air or collapses and fills with fluid
what does chronic lung disease often follow
respiratory distress syndrome
what are the clinical signs of chronic lung disease
oxygen requirement beyond 36 weeks corrected gestation, evidence of pulmonary parenchymal disease on CXR
describe the healing stage of chronic lung disease in babies
associated with continual lung growth over 2-3 years often wheezy
what is dextrocardia
heart sounds are on wrong side
describe a diaphragmatic hernia in babies
small bowl goes through hole in the diaphragm
what is a diaphragmatic hernia associated with
pulmonary hypoplasia
what is pulmonary hypoplasia
incomplete development of the lungs
why does pulmonary hypoplasia affect lung development
as it exerts pressure on lung bud
what should be avoided in a diaphragmatic hernia
avoid bag mask- IPPV as don’t want to blow air into gut
how is a diaphragmatic hernia treated
surgery and resp support
describe transient tachypnoea of a newborn
short lasting increased breathing rate
how is fluid in the lungs removed during labour
stress causes re-absorption of fluid
why is infection a worry in neonates
as not many ways so showing deterioration- grunting can have many causes
why is hard to test children breathing abilities
find it hard to do tests and values change with age
what are chronic respiratory problems associated with older children
cystic fibrosis and asthma
what are some differential diagnosis of CF
immune deficiency, ciliary dyskinesia (cilia not moving right), asthma, kartagener’s/immotile cilia syndrome (cilia beat the wrong way)
what can be seen on a CXR of cystic fibrosis
consolidation, patchy infiltrates/ nodules
why does a CF patient need a dietitian
pancreas doesn’t break down food, cant get calories to grow
what clinical features increase the probability of an asthma diagnosis
wheeze, cough, chest tightness, difficulty breathing, atopy (personal or family history), WIDESPREAD WHEEZE ON AUSCULTATION, response to Rx
what is a wheeze
an expiratory noise
what happens if diagnosis of asthma unsure
watchful waiting, spirometry, Rx and evaluate
in flow volume rates what does flow show
how fast your breathing
describe the shape of an obstruction and restriction loop
obstruction- hard to breath out fast due to airway obstruction
restriction- low volume of air exhaled
what are acute respiratory problems seen in older children
acute asthma, croup, childhood pneumonia, bronchiolitis,
describe acute asthma
cough and wheeze worsening over hours and days
how is acute asthma treated
oxygen, nebulised bronchodilator, oral prednisolone steroid,, IV salbutamol (bronchodilator), IV aminophylline (bronchodilator), IV magnesium ( smooth muscle relaxation), ventilatory support
what is an apnoea
pause in breathing up to 20 seconds
what is a bronchiolitis
viral infection, usually respiratory syncytial virus (RSV)
what are the symptoms of bronchiolitis
tachypnoea, poor feeding, irritating cough, apnoea in small babies
what organisms cause pneumonia in neonates
GBS (group B streptococcal), E.coli, klebsiella, staph aureus
what organisms cause pneumonia in infants
strep. pneumoniae, chlamydia
what organisms cause pneumonia in school age children
strep. pneumoniae, staph. aureus, Gr A strep, bordetella, mycoplasma, legionella
what are the differential diagnosis of pneumonia
inhaled foreign body, laryngomalacia, epiglottitis and bacteria tracheitis, allergy, croup
what is croup
viral laryngotracheobronchitis (resp. infection)
what are the symptoms of croup
stridor, barking cough
how is croup treated
oral steroid to reduce inflammation
