Respiratory disease in childhood

Question 1

What is a normal respiratory rate for neonates and babies?

Answer 1

It can be 60 and they show periodic breathing

Question 2

What causes respiratory distress syndrome?

Answer 2

Relative surfactant deficiency

Question 3

What is surfactant?

Answer 3

A phospholipid that increases surface tension preventing atelectasis collapse

Question 4

What can stimulate surfactant production?

Answer 4

Steroids

Question 5

What is a pneumothorax and how can it happen?

Answer 5

Air in the pleural space that can occur with IPPV, CPAP and ventilation. Other risk factors include RDS
In ventilation there is an increased constant pressure

Question 6

What is chronic lung disease?

Answer 6

If a premature baby still needs supplemental oxygen after 36 weeks with evidence of pulmonary parenchymal disease on CXR then there is chronic lung disease
It generally follows RDS, barotrauma, volume trauma and consistent high inspired oxygen

Question 7

What is dextrocardia?

Answer 7

When the heart is on the wrong side of the body (RHS)

Question 8

What are some consequences of a congenital diaphragmatic hernia?

Answer 8

Pulmonary hyperplasia (lung bud has not had space to develop in utero)
When babies with diaphragmatic hernias are ventilated by just a face mask then some of the air will go onto the small intestine

Question 9

What is transient tachypnoea of the newborn (TTN)?

Answer 9

The stress of labour causes babies to reabsorb fluid from the lungs but in c-sections these babies don’t have the stress of labour so they can be born with lung fluid present making them more prone to infections

Question 10

What is CF?

Answer 10

Autosomal recessive genetic disorder that is multisystem.

Question 11

What is ciliary dyskinesia?

Answer 11

When the cilia don’t move properly so mucus isn’t moved out of the lungs resulting in chest infections

Question 12

What is Kartagener’s syndrome?

Answer 12

Every organ is mirror image so the cilia beat the wrong way

Question 13

What is the treatment plan of asthma?

Answer 13

Stage 1: Treat with inhaled beta-agonists when needed
Stage 2: Treat with regular inhaled steroids
Stage 3A: Regular inhaled steroids + Long Acting Beta Agonists
Stage 3B: Stage 3A + Leukotrine antagonists
Satge 4: High dose steroids

Question 14

What is the treatment of an acute asthma attack?

Answer 14

O SHIT MAn! 
Oxygen
Salbutamol (nebulised)
Hydrocortisone IV or Prednisolone PO
Ipratroprium Bromide (nebulised hourly)
Theophylline IV or aminophyline IV
Magnesium sulphate
Call an anaesthetist

Question 15

What is bronchiolitis?

Answer 15

Viral infection caused by RSV usually in under 18mnth olds
Tachypnoea, poor feeding, irritating cough
Apnoea in small babies, treatment is supportive

Question 16

What causes pneumonia in neonates?

Answer 16

GBS
E.coli
Klebsiella
Staph aureus

Question 17

What causes pneumonia in infants?

Answer 17

Strep pneumoniae, chlamydia

Question 18

What causes pneumonia in school age children?

Answer 18

Strep pneumoniae, staph aureus, Gr A Strep, bordetella, mycoplasma, legionella

Question 19

What is croup?

Answer 19

Viral laryngotracheobronchitis
Stridor, barking cough
Treatment is oral steroid to reduce inflammation

Question 20

What are common respiratory problems in children?

Answer 20

Infant respiratory distress syndrome 
CLD - chronic lung disesae 
Congenital diaphragmatic hernia
CF
Asthma
Bronchiolitis
Childhood pneumonia
Croup