Flashcards in Respiratory Problems in Children Deck (59)
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?
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?
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?
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?