Respiratory Diseases in Children

Question 1

What are some features of the respiratory system in babies?

Answer 1

They have a - 
High anterior larynx
Obligate nose breathers
Airways are narrower
High respiratory rate
Fewer alveoli
Higher oxygen requirement

Question 2

What are the three kinds of respiratory problems in paeds?

Answer 2

Neonatal respiratory problems
Chronic respiratory problems
Acute respiratory problems

Question 3

What is respiratory distress syndrome?

Answer 3

This is a condition that affects premature babies. Their lungs cannot produce surfactant therefore they have difficulty breathing and alveolar collapse.

Question 4

What is surfactant?

Answer 4

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.

Question 5

What cells secret surfactant?

Answer 5

Type 2 pneumocytes

Question 6

What does a lack of surfactant lead to?

Answer 6

Atelectasis and impairment of gas exchange.

Question 7

How can we stimulate the production of surfactant?

Answer 7

We can give mothers 2 doses of steroids is she is in premature labour.

Question 8

How can we manage respiratory distress syndrome?

Answer 8

Keep the baby warm.
NCPAP
Intubation and Ventilation (only if nescesary)
Surfactant delivery by tube or NCPAP
Permissive hypercarpnia

Question 9

What is a pneumothorax?

Answer 9

Air in the pleural space. The incidence of this is increased with IPPV, CPAP and ventilation

Question 10

How do we remove a pneumothorax in infants?

Answer 10

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.

Question 11

What is chronic lung disease?

Answer 11

This is when a baby requires oxygen beyond 36 weeks and has evidence of pulmonary parenchymal disease on CXR.

Question 12

What are causes of chronic lung disease?

Answer 12

Stress, infection, RDS, barotrauma, poor nutrition, inflammation etc.

Question 13

What are some symptoms of chronic lung disease?

Answer 13

High infection risk
Wheezing
Abnormal airways
Growth and developmental issues

Question 14

What is a diaphragmatic hernia?

Answer 14

This is where there is a hernia in the diaphragm and the gut enters the thoracic cavity.

Question 15

What is associated with diaphragmatic hernia?

Answer 15

Pulmonary hypoplasia - where the gut pushes on the lung while it develops.

Question 16

How do we treat diaphragmatic hernia?

Answer 16

We would surgically reposition the gut and sew up the diaphragm

Question 17

Why would we avoid bagging a diaphragmatic hernia patient`/

Answer 17

If we bag them some of the air will go into the oesophagus causing it to inflate. This will cause problems.

Question 18

What is transient tachypnoea of the newborn?

Answer 18

This is a delay in clearance of foetal lung fluid shortly after birth. It will correct itself.

Question 19

What doe we look for on a paediatric respiratory assessment?

Answer 19

History from the parents and child.
Weight
Chest shape
Ausculatation
Heart sounds
Finger clubbing and signs of chronic respiratory illness

Question 20

What is cystic fibrosis?

Answer 20

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.

Question 21

What is Kartagener’s Syndrome?

Answer 21

This is where the patients organs are inverted onto the opposite side.

Question 22

What are some of the clinical features of asthma?

Answer 22

Wheeze, dry cough, chest tightness, difficulty breathing, atopy, responsiveness to bronchodilators

Question 23

What are the stages of asthma treatment?

Answer 23

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.

Question 24

How do we treat acute astma?

Answer 24

1. Oxygen and salbutamol inhaler
2. Nebulised bronchodilator
3. Oral prednisalone
4. IV Salbutamol
5. IV aminophylline
6. IV magnesium
7. Ventilatory support

Question 25

What is bronchiolotis?

Answer 25

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.

Question 26

What are the symptoms of bronchiolitis?

Answer 26

Tachypnoea, poor feeding, irritating cough, grunting, apnoea in small babies

Question 27

How do we treat bronchiolitis?

Answer 27

Treatment is supportive, therefore there is no direct medicine

Question 28

What are some of the causes of pneumonia in neonates?

Answer 28

Group B strep, E. coli, Klebsiella, staph aureus

Question 29

What are some of the causes of pneumonia in infants?

Answer 29

Strep pneumoniae, chlamydia

Question 30

What are some of the causes of pneumonia in school age children?

Answer 30

Strep pneumoniae, staph aureus, Group A strep, bordetella, mycoplasma, legionella

Question 31

What is croup?

Answer 31

Viral larygnotracheobronchitis.

This is essentially where there is a narrowing of the air column.

Question 32

What are some of the symptoms of croup?

Answer 32

Stridor, barking cough

Question 33

What is the treatment for croup?

Answer 33

Oral steroids to reduce the inflammation, this is generally only one dose.