Pediatrics Flashcards
Pulmonary distress in infants- name disorders
Neonatal RDS, Transient Tachypnea of newborn, and Persistent pulmonary HTN of the newborn
Who is most at risk for neonatal RDS?
Premature infants born less than 28 wks
Cause of neonatal RDS
Deficiency or inactivation of surfactant
Child born just a few minutes ago appearing blue with periods of not breathing. There is decreased urine output. Baby is in respiratory distress marked by grunting, nasal flaring, tachypnea, and shallow respirations. Diagnosis?
Neonatal RDS
Dx evaluation for neonatal RDS?
ABG for oxygen levels, CBC, CRP to r/o sepsis, Xray showing atelactasis and ground glass appearance, low lung volume
Tx for neonatal RDS
Supplemental oxygen, nasal CPAP, intubation for ventilation and surfactant- GENTLE. Surfactant can be given as prophylaxis in infants born at less than 27 weeks
Most likely complications of neonatal RDS
Due to therapeutic interventions, like invasive intubations. Chronic complication= bronchopulmonary dysplasia.
Prognosis of RDS
Worsens for 2-4 days after birth and slow improvement thereafter. If death occurs, most often between day 2-7.
Prevention for RDS
PREVENT PREMATURE BIRTH.
When are antenatal steroids given?
To pregnant women at risk of having preterm delivery
Most common CHRONIC childhood disorder
Asthma
What would make you suspicious of a child having asthma?
If family history, lower respiratory symptoms in 1st year of life such as coughing, wheezing triggered easily, and eczema in early months of life
2 year old child with eczema and 2 older sisters with asthma presents to you with wheezing, cyanosis, lethargy, tachycardia, dyspnea, cough, and diaphoresis. How would you diagnose this?
Young child- impulse oscillometry- passive technique to spirometry. If this is not helpful, trial with asthma medications and check for resolution of symptoms.
DDx for asthma
Cystic fibrosis- sweat chloride test to r/o. GERD- barium swallow to r/o.
Classifications of asthma in pediatric population
Intermittent- sx of wheezing and coughing 2 or less times a week, and 2 or less night episodes per month. Mild, moderate, persistent: Episodes of sx more than 2 times a week and more than 2 nighttime episodes per month
Classic triad of symptoms in FB aspiration
Wheezing, coughing, diminished breath sounds. May be complete, partial, or chronic obstruction. Complete will present with acute onset of choking, cyanosis, inability to cough or vocalize
Dx for FB aspiration
Rigid bronchoscopy
Tx for FB removal
Attempt removal with back blows and chest compressions in infants, heimlich maneuver in older children. Intubate until bronchoscopy can be performed. Nebulizers and chest physiotherapy after removal.
Epiglottitis causes
Infectious- H. infuenza B, staph, or strep. Non-infectious: thermal injury, FB or caustic ingestions, allergic reactions
7 year old boy presents with high fever, sore throat and in distress. He is drooling and is having difficulty eating with a “hot potato” voice. Appears toxic, with “sniffing” or “tripod” posture. How would you treat this?
Admit asap. Maintain patient airway. 3rd generation cephalosporings and antistaph agent active against MRSA, corticosteroids, supportive care.
Causes of bronchiolitis
RSV, rhinovirus
Population most often affected with bronchiolitis
Infants less than age 2
1 year old child presents to you in January with symptoms of nasal congestion and cough. He has a fever and cough, with associated otitis media. Auscultation shows wheezing upon exhalation and fine and coarse crackles. Hyperresonant percussion sounds, and hyperexpanded chest. You notice nasal flaring and grunting. Tachypnea is present. Child looks dehydrated. What is the diagnosis?
Bronchiolitis- inflammation of the smaller airways. Common in kids less than 2, often in winter months
Diagnosis of Bronchiolitis
Usually done clinically. can order CBC and CXR in more severe cases
Tx of Bronchiolitis
Admit if hypoxemia, cyanosis, dehydrated, lethargy. Otherwise, trial of inhaled bronchodilators.
Complications of bronchiolitis
bronchiolitis obliterans, asthma, secondary bacterial infection, apnea, respiratory failure
RSV Infection - risk factors
Infants less than 6 months, infants born less than 35 week gestation, chronic lung dz or congestive heart dz in kids, innunocompromised, if live at high altitude
Define RSV infection
Virus that causes upper respiratory tract infection, 20-30% of patients will also develop lower respiratory infection (more common in infants/young kids than older children/adults
How is RSV spread
Direct contact and aerosol droplets
It’s January, and a 1 year old child presents to you with rhinitis, sinusitis, nasal congestion, sore throat. Mother says child has not been feeding well and has periods of apnea. Child has fever and looks lethargic. You hear wheezes and crackles, and prolonged expiration. You can feel the spleen and liver on abdominal exam d/t hyperinflation of lungs. Dehydration present. Tachypnea present. What is the diagnosis
infant presents with both upper and lower respiratory tract symptoms. Child is young and it’s winter season. Influenza vaccine taken. RSV infection confirmed by throat and nasopharyngeal swab
Diagnosis of RSV infection
Analysis of respiratory secretions through nasal wash, nasopharyngeal swab, or throat culture. Rapid antigen assay, PCR assay also available.
Tx for RSV infection
Supportive care, beta-agonist therapy if lower airway obstruction to open up bronchioles, DON’T use corticosteroids, ribavirin only used if at risk for severe lower respiratory infection
Most likely to see viral laryngotracheitis?
Children 6 months- 3 years
Cause of viral laryngotracheitis
Parainfluenza virus type 1
3 year old child presents with fever and nasal congestion and coryza x 4 days. You notice respiratory distress, and hoarseness, barking cough, and inspiratory stridor. There is a prolonged inspiratory phase. Appears dehydrated with mild tachypnea. How would you diagnose this?
Suspect viral laryngotracheitis. Often clinical diagnosis- Xray may show “steeple sign” which demonstrates subglottic narrowing
Tx for viral laryngotracheitis
Supportive care, single dose of systemic corticosteroids, nebulized epinephrine (bronchodilator)
Cause of bacterial tracheitis?
Staph or strep
Presentation of bacterial tracheitis
Initial symptoms similar to viral, with nasal congestion and coryza, but appear more toxic.
Diagnostic evaluation of bacterial trachetis
Leukocytosis, Xrays reveal severe subglottic and tracheal narrowing
Tx for bacterial tracheitis?
Supportive care, hospitaliztaion, IV abx
Mother complains of son waking up at night with severe barking cough and inspiratory stridor, and hoarseness. This only happens during the night and duration is short. What is the diagnosis and how to treat?
Spasmodic or frequent recurrent croup- comfort anxious child and administer humidified air
Phases of pertussis
Catarrhal, paroxysmal, convalescent
Catarrhal phase
Nonspecific, 1-2 weeks
Paroxysmal
Persistent coughing attacks lasting 2-6 weeks
Convalescent
Cough decreases over several weeks to months
Mode of transmission of pertussis
Direct contact- most contagious during catarrhal stage and first 2 weeks of paroxysmal stage
Incubation period for pertussis
Takes 7-10 days for symptoms to show
In what kind of people will you see atypical presentation of pertussis?
Vaccinated individuals who get infected, and children
Child presents with whooping cough. Nasopharyngeal and throat cultures are positive for bordatella pertussis. CBC reveals leukocytosis and lymphocytosis. What is the next step of action?
Report pertussis to public health authorities, supportive care. Begin abx therapy if caught early in catarrhal stage- macrolides x 7-14 days. May use bronchodilator therapy, avoid antitussives and opioid cough suppressants- little effect. Child can return to school after 5 days of abx therapy.
Pertussis prevention
Vaccination with DTaP or Tdap. Abx prophylaxis for individuals in close contact of infected individuals- macrolides
2 year old child appears with fever, cough, malaise. PE reveals tachypnea, emesis, decreased breath sounds, bronchial breath sounds, crackles, wheezes, egophony, bronchophony, tactile fremitus increased, dullness to percussion. Also hypoxemic. Very fussy restless, and not feeding well. Diagnosis and tx.
CBC, acute phase reactants. Serum electrolytes for dehydration. Blood and sputum, nasopharyngeal swabs. CXR not needed, but because child is less than 4 years old, use AP view. (PA for above 4).
Pneumonia causes in kids
Neonatal 1-30 days: Group B strep. Less than 5 years, viral more common- measles, varicella, HSV. More than 5 years- Strep, M pneumonia, chlamydophilia
