Respiratory Problems in Children Flashcards
What is the neonatal period?
First 28 days of life
What classes can respiratory problems in children be split into?
- Neonatal and older children
* Acute and chronic
In what ways are infants different from adults?
- Babies respiratory rate is 60 breaths/min
* They can have periodic breathing (really fast then really slow)
What are signs of respiratory distress in newborns?
- Sternal in-drawing
- Tracheal tug (head bobs)
- Grunt when struggling to breathe - essentially giving themselves CPAP
What is respiratory distress syndrome in newborns?
Relative surfactant deficiency
What newborns are affected with respiratory distress syndrome?
- Predominately affects pre-term babies
* 1% of all births
What is the relationship between RDS and gestational age?
As gestational age increases, incidence of RDS decreases
What are components of surfactant?
- Phospholipid
* Apoproteins
What does lack of surfactant result in?
Atelectasis and impairment of gas exchange
How is production of surfactant stimulated in premature infants?
- If suspected pre-mature birth, mother given steroids to promote surfactant production by infant
- Following birth, synthetic surfactant can be delivered down intubation tube into the lungs
What can ventilation lead to in young infants?
Pneumothorax
What are signs of a pneumothorax caused by ventilation of an infant?
- Sudden deterioration requiring increased oxygen
- No breath sounds on one side of chest
- CXR showing black space in lung
What is pneumothorax?
Air in pleural space
What can increase the incidence of pneumothorax in young infants?
- IPPV, CPAP and ventilation
* RDS (stiff lungs)
What percentage of pneumothorax cases are spontaneous?
- Occurs in around 1% vaginal deliveries
* 1.5% caesarean sections
When would intervention be needed for pneumothorax in children?
Tension pneumothorax - a chest drain in required
What is chronic lung disease in children?
- Oxygen requirement beyond 36 weeks corrected gestation
- Evidence of pulmonary parenchymal disease (ILD) on CXR
- Generally follows RDS
What can cause chronic lung disease in infants?
Damage caused by ventilation
- Barotrauma (pressure trauma)
- Volume trauma
- High inspired oxygen
What are the effects of chronic lung disease in infants?
- Often wheezy
* Healing stage associated with continued lung growth over 2-3 years
What is dextrocardia?
Heart points toward right side of chest instead of left side
What condition can mimic dextocardia in children?
Diaphragmatic hernia - guts in baby’s chest can push heart to right side
What are diaphragmatic hernias assorted with?
Pulmonary hypoplasia - lung hasn’t had enough space to develop
What are the commonest types of diaphragmatic hernia?
- Posterolateral (Bochdalek), left-sided
Why should a bag-mask be avoided as treatment for diaphragmatic hernia?
Avoid bag mask as can travel down the oesophagus into bowel causing more problems
What is the treatment for diaphragmatic hernia?
- respiratory support - intubation (not bag mask)
* Surgical intervention
What is the most likely diagnosis of a term baby who was delivered by LUSCS and is grunting shortly after delivery?
Transient Tachypnoea of the Newborn (TTN)
What is Transient tachypnoea of the Newborn?
Lung fluid present in babies
* Occurs in babies delivered through caesarean section as in the womb, lungs are filled with amniotic fluid but the stress of labour pushes fluid out of the lungs
What is the most likely respiratory diagnosis of a 1-year-old child who has a prolonged history of cough, loose stools and failure to thrive?
Cystic fibrosis
What is the most likely diagnosis of a newborn infant with a raised immune-reactive trypsin level on neonatal screening and is also found to be homozygous for the delta-F508 deletion?
Cystic fibrosis
Why is everyone in Scotland screened for CF?
Most common life-limiting illness in caucasians
What is the main cause of death in cystic fibrosis?
Infection
What is cystic fibrosis?
- Autosomal recessive
- Mutations in CFTR gene
- Multisystem disorder
- Recurrent respiratory infections
What are differential diagnoses for cystic fibrosis?
- Immune deficiency
- Ciliary dyskinesia (cilia not moving correctly, build-up of mucous in RT)
- Asthma
- Kartagener’s/immotile cilia syndrome
Why is flucloxacillin given to all kids with CF when they are born?
To prevent staph aureus infection (killer)
What are members of the cystic fibrosis team?
- Clinician
- Specialist nurse
- Clinical psychologist (difficult to have CF)
- Social worker
- Physiotherapist
- Dietician – abnormal pancreas funtion (must gain weight with cystic fibrosis – insulin, CREON)
Why are support groups consisting of many cystic fibrosis sufferers not plausible?
CF sufferers cannot be placed in a room with other CF suffers (e.g. in the case of support groups) as they spread their colonised pathogens to each other
What is the most likely diagnosis of a 7 y/o old child who has a 3-month history of a cough that is worse at night or during active play?
Asthma
What are clinical features that increase probability of asthma diagnosis?
- One or more : wheeze, cough, chest tightness, difficulty breathing
- Atopy (personal or family history)
- Widespread wheeze on auscultation
- Response to Rx
What is the appearance of a flow volume loop in a child with asthma?
(pic)
What is the appearance of a flow volume loop in a restrictive lung disease?
(pic)
What is the appearance of a flow volume loop in restrictive + obstructive pulmonary disease?
(pic)
What does the management of asthma in children include?
- 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 + Leukotriene antagonists
- Stage 4: High dose steroids
What inhalers are used by children?
- Inhaler + spacer
* For older children, breath-activated inhalers are an option
What are the consequences of passive smoking in children?
- Reduces birthweight by 250g
- 4500 pregnancy losses per annum
- 30% increase in Perinatal Mortality
- Teratogenic : airways, cleft lip/palate
- Glue ear
- Carcinogenic
- Increases likelihood of asthma attack
What are the symptoms of acute asthma?
Cough and wheeze worsening over hours or days
What is the treatment for acute asthma?
- Oxygen
- Nebulised bronchodilator
- Oral prednisolone – reduces inflammation
- IV salbutamol
- IV aminophylline
- IV magnesium
- Ventilatory support
What is the most likely diagnosis of a 6-week old who presents with increased work of breathing, possible apnoeas, and URTI symptoms over the last 2 days?
Bronchiolitis
What is bronchiolitis?
A viral infection caused by RSV (respiratory syncytial virus)
What children are at risk of more severe bronchiolitis?
- Younger babies
- Premature
- Family of smokers
What are the symptoms of bronchiolitis in infants?
- Tachypnoea
- Poor feeding
- Irritating cough
- Apnoea in small babies
What is the treatment for bronchiolitis?
Treatment is supportive
What is the most likely diagnosis of a 10 y/o girl who presents with high fever, cough and sputum production? On examination, she showed dullness on percussion, increased vocal resonance and bronchial breathing
Pneumonia
What microorganisms are responsible for pneumonia in neonates?
Group B strep, E.coli, Klebsiella, Staph aureus
What microorganisms are responsible for pneumonia in infants?
Strep pneumoniae, chlamydia
What microorganisms are responsible for pneumonia in school children?
Strep pneumoniae, Staph aureus, Group A strep, Bordetella, Mycoplasma, Legionella
What is croup?
Viral laryngotracheobronchitis
What are the symptoms of croup?
- Stridor
* Barking cough
What is the treatment for croup?
Treatment is oral steroid to reduce inflammation
What are common respiratory problems in children?
- Infant respiratory distress syndrome
- CLD
- Congenital diaphragmatic hernia
- Cystic fibrosis
- Asthma
- Bronchiolitis
- Childhood pneumonias
- Croup
