Pulmonary Considerations for Pediatrics

Question 1

Antibodies

Answer 1

• transplacentally derived antibodies gone by 3-4 months old

- after 3-4 months, increased risk of disease until they form own antibodies (by getting exposed to pathogens)

Question 2

O2 Consumption of Newborn

Answer 2

• 2x higher than adult
• 6-6.7 ml O2/Kg min

(3.5 adult)

Question 3

Children have decreased _____ which prevents infant from _____

Answer 3

• muscle strength

- stabilizing rib cage and using diaphragm efficiently

Question 4

Newborn HR

Answer 4

• 120 bpm average

- Range: 70-190 bpm

Question 5

Newborn BP

Answer 5

-SBP: 40-70

Question 6

Increased # of alveoli=

Answer 6

increased surface area for O2 diffusion

Question 7

Kids Ribcage

Answer 7

• circular and horizontal until sit/stand & gravity pull it down
• causes flat diaphragm and decreased efficiency of accessory Mm

Question 8

Kids’ small airways=______, which leads to ______

Answer 8

• greater airflow resistance

- increased work of breathing and increased risk of obstruction

Question 9

Pulmonary System Development

Answer 9

• begins @ 24-26 DAYS gestation
• alveoli still forming until age 8-10 YEARS
• Surfactant mature at 35 WEEKS gestation

Question 10

Surfactant is mature at ____

Answer 10

35 weeks gestation

Question 11

alveoli at birth

Answer 11

25 million

Question 12

alveoli as adult

Answer 12

300 million

Question 13

Surfactant

Answer 13

• enough to survive at 26-28 weeks gestation (but still sensitive)
• mature at 35 weeks gestation

Question 14

Infant Diaphragm Fibers

Answer 14

-25% are Type I

adults 50% Type I

Question 15

Neonate Respiratory Pattern

Answer 15

• irregular
• with apnea 5-10 sec
• True apnea= >20 sec

Question 16

Collateral Ventilation Mechanisms

Answer 16

• Pores of Kohn
• Lambert’s Canals

(alternate airway paths in case one is blocked)

Question 17

Signs of Respiratory Distress/Failure in Infant/Toddler

Answer 17

• nasal flaring
• head bobbing
• cyanosis
• pallor
• audible expiratory grunting
• stridor on inspiration
• tachypnea
• tachy/bradycardia
• fatigue
• excessive sweating
• HTN/hypotension
• Hypoxemia
• hypercapnia
• acidosis
• seizures/coma
• restless/irritable
• headache

Question 18

Infant PaO2 & PaCO2

Answer 18

Lower than adults

Question 19

Infants compensate for breathing problems by _______ instead of _______ b/c they have little ___

Answer 19

• increasing RR
• increasing tidal volume
• pulmonary reserve

Question 20

Pores of Kohn

Answer 20

• interconnections between alveoli

- (form at age 1-2 years)

Question 21

Lambert’s Canal

Answer 21

• connect ternimal/respiratory bronchioles to alveoli

- (form age 6-8 years old)

Question 22

Newborn RR

Answer 22

30-60/min