Peds Pulm Flashcards
Of the pulm diseases that cause respiratory distress at birth, which disease is most likely to occur in newborns who are: premature, term, post term?
premature: ARDS
term: Transient tachypnea
post term: meconium aspiration
What causes ARDS?
prematurity results in impaired lung surfactant synthesis -> hypoxemia
CXR of ARDS
low lung volume, ground glass appearance (diffuse atelectasis), air bronchograms
delayed clearance of fetal lung fluid causes __________.
transient tachypnea in newborns (TTN)
CXR shows hazy bilateral perihilar streaking and ABG normal
TTN
Pathophysiology of meconium aspiration
meconium passed while still in utero and aspirated
What is meconium?
newborn’s first stool; dark green tarry stool normally passed after birth
What conditions does the meconium not passed within 24 hrs of birth?
Hirschsprung
Cystic fibrosis
Post term newborn delivered with green nail and skin staining. Why?
baby passed meconium before delivery; risk of aspiration
TTN treatment
self-resolves in 0-3 days
- nasal cannula
- O2 hood; CPAP
When should abx be added to treatment of newborn respiratory distress?
if pneumonia suspected
Which newborn respiratory distress condition presents with only mild sxs of quiet tachypnea w/o retractions?
TTN
Meconium aspiration syndrome treatment
- suction trachea ASAP to prevent aspiration (if no meconium do not repeat)
- gentle ventilation
- surfactant and nitric oxide for hypoxia
How can ARDS be prevented?
antenatal corticosteroids
ARDS management
Keep O2 sat 80-90%
Give surfactant and nitric oxide
Prognosis of newborns with ARDS
40% mortality
Many that survive will develop chronic lung disease
High alert for _________ with meconium aspiration as it is a common complication.
pneumothorax
Pulmonary findings suggesting asthma
wheezing, prolonged expiratory phase, hyper-expansion, cough worse at night
Atopy
genetic tendency to develop classic allergic diseases - atopic dermatitis, allergic rhinitis, and asthma
spirometry results of asthma patient
decreased FEV1 (expiratory volume in 1 sec) normal FVC
improve with use of bronchodilator (reversible)
Chronic treatment of asthma
Mild intermittent: SABA (Albuterol)
Mild persistent: add daily low dose ICS (beclomethasone)
Moderate persistent: increase to medium dose ICS, add LABA (Salmeterol)
Severe persistent: increase to high dose ICS, add systemic steroids
How are acute exacerbations of asthma treated?
SABA (Albuterol)
If patient is unresponsive to Albuterol treatment x 3 and O2 sats still < 92%, then…
Supplemental oxygen
Racemic epinephrine
Admit
What factors increase risk of asthma in infant?
Parental asthma Eczema Allergic rhinitis Wheezing apart from colds Eosinophilia >4% Food allergen sensitization
uncontrolled vs controlled asthma
uncontrolled - every 4 weeks
controlled - every 3-6 months
If using LABA for asthma, then patient must also be on ________.
ICS
New onset of wheezing in < 2 month old infant born premature?
Bronchiolitis
Recurrent wheezing and coughing in small for age child who has been seen multiple times for pneumonia and sinus infections.
cystic fibrosis
AAP Bronchiolitis treatment
- supplemental oxygen if sat < 90%
- bronchodilator therapy (don’t continue if no response)
- light nasal suction and saline drops
Common infection of bronchiolitis
RSV
AAP Guideline prevention of bronchiolitis
hand washing, alcohol-based rubs, avoid smoke exposure, infants should be breastfed, Palivizumab for high risk (chronic lung dz, premature, congenital heart dz)
Defect in gene responsible for Cystic Fibrosis (CFTR protein) causes what?
- increased salty secretions from sweat glands
- dehydration and thickening of mucus, more adherent to bacteria
When to screen for elevated sweat chloride?
any child with nasal polyps, pseudomonas pneumonia, and rectal prolapse
Cystic fibrosis treatment
pancreatic enzyme supplements
mucolytics
abx (Cipro)
multi-vitamins
Pulmonary exam of pneumonia
crackles, decreased breath sounds, wheezing
Bacteria that cause pneumonia in neonates
Group B strep
Listeria
G- rods (E. coli, Klebsiella)
How to treat bacterial pneumonia in neonates?
parental ampicillin and gentamicin, +/- Cefotaxime
admit immediately if febrile!!!
How is wheezing of pneumonia different than asthma?
pneumonia more focal; asthma diffuse
Bacteria that cause pneumonia in 1 mon to 5 yrs old
strep pneumo, H-flu
Bacteria that cause pneumonia in children over 5 yo
Mycoplasma, step pneumo
Viruses that cause pneumonia in neonates and children
RSV, influenza A/B
Viral pneumonia most common, except when patient what age?
< 3 months old
Bacterial pneumonia treatment
Admit if < 4-6 months or toxic-appearing
IV cefuroxime/cefotax
High dose amoxicillin
+5 yo: macrolide for mycoplasma
Treatment for cough in children < 6 yo
NO cough suppressants
supportive: humidified air, suction, nasal saline
When to admit bronchiolitis?
diminished breath sounds < 90% sats inability to clear secretions severe retractions/flaring \+ 70 bpm risk factors (premature, < 24 mon)
