Respiratory Flashcards
What is bronchopulmonary dysplasia?
a form of chronic lung disease that affects newborns, most often those who are born prematurely and need oxygen therapy. In BPD the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli)
Abnormal pul development,
Prolonged mechanical ventilation
↓alveoli no, interstitial thickening, abnormal pul vasculature development, pul oedema + atelectasis.
Features of bronchopulmonary dysplasia?
Severe retractions
Audible rales, crackles
Intermittent expiratory wheeze if airway narrow from scar formation, constriction, mucus retention, collapse/ oedema.
O2 desats during feeds
Asthma in childhood
Complications of bronchopulmonary dysplasia?
Resp distress Ventilator dependence, pul hypotension, subglottic stenosis Feeding problems poor weight gain Severe bronchiolitis, GORD Low IQ > CP
Investigations for bronchopulmonary dysplasia?
O2 ↓ test, need for O2 supplementation. O2 sats <90% within 60 mins of being placed in room air.
CXR: diffuse haziness, exudative fluid, multicystic sponge like, areas pf alternating oedema, pul scarring emphysema, Hyperinflation, rounded radiolucent mass alternating with thin denser lines
Histology: necrotising bronchiolitis with alveolar fibrosis
Management of bronchopulmonary dysplasia?
Supportive
Nutritional supplementation
Fluid restriction
Diuretics
O2
Gentle ventilation low vol/ O2 conc
Steroids
Surfactant
Almost all weaned by 1 yr ↑ risk of bronchiolitis > give palivizumab monthly + LT risk of COPD
What is neonate respiratory distress syndrome?
happens when a baby’s lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies.
not enough surfactant, so lungs collapsing, progressive + diffuse atelectasis
Damage of epithelial cells can be permanent
24-28 wks deffo. 50% at 32 wks
RF - premature, mother DM, LBW, lungs not properly developed, 2nd twin, CS, 2’ to other pulmonary pathology > meconium, perinatal asphyxia, pul hypoxia
Features of neonate respiratory distress syndrome?
Worsening tachypnoea >60/min 1st 4 hrs of birth
↑inspiratory effort
Grunting
Flaring of nostrils
Intercostal recession
Cyanosis
Resp failure, reinfilation between breaths makes baby very tired.
Complications of neonate respiratory distress syndrome?
Death
Pneumothorax: prolonged pressure from ventilation
Hypoglycaemia, acidosis + systemic compromise.
Chronically: BPD, IVH, retinopathy of prematurity
Investigation and management of neonate respiratory distress syndrome?
CXR: diffuse granular patterns, air bronchograms, low lung volume, ground glass, heart border indistinct Pneumothoraxes.
ABG: hypoxaemia, hypercapnia
Prevention: beta/dexamethasone prenatally. If postnatal risk of GI bleed, intestinal perf, hypoglycaemia, HBP, HCM, poor growth.
CPAP, intubation, intratraceal surfactant therapy
What is pulmonary hypoplasia?
a condition in which the lungs are abnormally small, and do not have enough tissue and blood flow to allow the baby to breathe on his or her own.
Causes - Oligohydramnios, PROM, congenital diaphragmatic hernia
Underdeveloped lungs, ↓no/ size of bronchopul seg/ alveoli
Potter’s: bilat renal agenesis, oligohydramnios, low set ears, beaked nose, ↓lung expansion, ↓mechanical stretching
SOL: diaphragmatic hernia, congen cyst adenomatoid formation, fetal hydronephrosis, mediastinal tumour, caudal regression syndrome, dextrocardia, sacrococcygeal teratoma.
Features of pulmonary hypoplasia?
Infants with persistent tachypnoea ± feeding difficulties
Poor fetal movement, AF leakage, oligohydramnios
Asymptomatic
Severe resp distress
Small bell shaped chest
Heart displacement
↓/absent BS
Investigations and management of pulmonary hypoplasia?
Fetal USS
Amnioinfusion: instilling isotonic fluid into amniotic cavity
Amniopatch: intra-amniotic injection of plt cryoprecipitate, seal amniotic fluid leak
Resp support
What is croup?
a form of upper respiratory tract infection seen in infants and toddlers.
It is characterised by stridor which is caused by a combination of laryngeal oedema and secretions.
Parainfluenza viruses account for the majority of cases. Other causes - RSV, adenovirus, Diptheria
6m-3yrs
more common in autumn
Features of croup?
stridor
barking cough (worse at night)
fever
coryzal symptoms
Severity of croup?
Mild
Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play
Moderate
Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings
Severe
Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemi
When to admit a child with croup?
Moderate or severe croup
< 6 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
Investigations for croup?
the vast majority of children are diagnosed clinically
however, if a chest x-ray is done:
a posterior-anterior view will show subglottic narrowing, commonly called the ‘steeple sign’
in contrast, a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
Westley scale 0-17 - mainly for research, not clinically
3-7: moderate
8-11: severe
12+: resp failure
Management of croup?
CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
prednisolone is an alternative if dexamethasone is not available
humidified O2
fluids, antipyretics
Emergency treatment
high-flow oxygen
nebulised adrenaline
intubation if impending respiratory failure
