Respiratory Diseases in Children Flashcards
What are some features of the respiratory system in babies?
They have a - High anterior larynx Obligate nose breathers Airways are narrower High respiratory rate Fewer alveoli Higher oxygen requirement
What are the three kinds of respiratory problems in paeds?
Neonatal respiratory problems
Chronic respiratory problems
Acute respiratory problems
What is respiratory distress syndrome?
This is a condition that affects premature babies. Their lungs cannot produce surfactant therefore they have difficulty breathing and alveolar collapse.
What is surfactant?
This is used to reduce alveolar surface tension. This coats the lungs and is composed of phospholipids and apoproteins.
It begins to be secreted at about 32 weeks.
What cells secret surfactant?
Type 2 pneumocytes
What does a lack of surfactant lead to?
Atelectasis and impairment of gas exchange.
How can we stimulate the production of surfactant?
We can give mothers 2 doses of steroids is she is in premature labour.
How can we manage respiratory distress syndrome?
Keep the baby warm. NCPAP Intubation and Ventilation (only if nescesary) Surfactant delivery by tube or NCPAP Permissive hypercarpnia
What is a pneumothorax?
Air in the pleural space. The incidence of this is increased with IPPV, CPAP and ventilation
How do we remove a pneumothorax in infants?
We use the seldinger technique. We would find the 2nd intercostal space on the midclavicular line, put in a wire and put a catheter over it.
What is chronic lung disease?
This is when a baby requires oxygen beyond 36 weeks and has evidence of pulmonary parenchymal disease on CXR.
What are causes of chronic lung disease?
Stress, infection, RDS, barotrauma, poor nutrition, inflammation etc.
What are some symptoms of chronic lung disease?
High infection risk
Wheezing
Abnormal airways
Growth and developmental issues
What is a diaphragmatic hernia?
This is where there is a hernia in the diaphragm and the gut enters the thoracic cavity.
What is associated with diaphragmatic hernia?
Pulmonary hypoplasia - where the gut pushes on the lung while it develops.
How do we treat diaphragmatic hernia?
We would surgically reposition the gut and sew up the diaphragm
Why would we avoid bagging a diaphragmatic hernia patient`/
If we bag them some of the air will go into the oesophagus causing it to inflate. This will cause problems.
What is transient tachypnoea of the newborn?
This is a delay in clearance of foetal lung fluid shortly after birth. It will correct itself.
What doe we look for on a paediatric respiratory assessment?
History from the parents and child. Weight Chest shape Ausculatation Heart sounds Finger clubbing and signs of chronic respiratory illness
What is cystic fibrosis?
This is caused by a autosomal recessive mutation in the CFTR gene.
There are problems with the patients exocrine glands causing them to secrete sticky mucus in the lungs, gut and pancreas.
What is Kartagener’s Syndrome?
This is where the patients organs are inverted onto the opposite side.
What are some of the clinical features of asthma?
Wheeze, dry cough, chest tightness, difficulty breathing, atopy, responsiveness to bronchodilators
What are the stages of asthma treatment?
Stage 1 - inhaled beta agonitsts when needed and regular ICS
Stage 2 - Regular ICS + long acting beta agonists
Stage 3 - Stage 2 + leukotriene antagonists
Stage 4 - High dose steroids
Also consider, antihistamines.
How do we treat acute astma?
- Oxygen and salbutamol inhaler
- Nebulised bronchodilator
- Oral prednisalone
- IV Salbutamol
- IV aminophylline
- IV magnesium
- Ventilatory support
What is bronchiolotis?
This is most commonly caused by RSV and occurs in babies under 18 months old. This is a seasonal diagnosis due to the fact that it is a virus.
What are the symptoms of bronchiolitis?
Tachypnoea, poor feeding, irritating cough, grunting, apnoea in small babies
How do we treat bronchiolitis?
Treatment is supportive, therefore there is no direct medicine
What are some of the causes of pneumonia in neonates?
Group B strep, E. coli, Klebsiella, staph aureus
What are some of the causes of pneumonia in infants?
Strep pneumoniae, chlamydia
What are some of the causes of pneumonia in school age children?
Strep pneumoniae, staph aureus, Group A strep, bordetella, mycoplasma, legionella
What is croup?
Viral larygnotracheobronchitis.
This is essentially where there is a narrowing of the air column.
What are some of the symptoms of croup?
Stridor, barking cough
What is the treatment for croup?
Oral steroids to reduce the inflammation, this is generally only one dose.
