L18 Respiratory Disease in children Flashcards Preview

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Flashcards in L18 Respiratory Disease in children Deck (37):


dangerous for both mum and baby
-has to have c section



score developed to measure the health of a new born


Canalicular Stage

16-26 wks
not promoting gas exchange yet


Saccular Stage

26-36 wks
alveoli are thinning down and some gas exchange can occur


What would her breathing have been like in the first few days?

-need a machine/otherwise laboured
Lungs stiff: causes increased work of breathing
Thickened gas transfer tissue: causes low oxygen and high carbon dioxide
Less surfactant: causes collapse of 'alveoli'
-adds to stiffness and poor gas exchange


What is the name of the condition with stiff lungs, thickened gas transfer tissue and less surfactant?

Respiratory Distress Syndrome
-artificial surfactant has only just been made available
hence now baby was more likely to develop a severe form of RDS


What support would a baby with RDS need?

Machine: Ventilator
-CPAP Continuous Positive Airway Pressure: help to keep the airways open (overcome lack of surfactant) + deliver a high concentration of oxygen
-Negative: if RDS is quite severe you need to use high pressures



tube put down the trachea as a conduate to the ventilation that is going to occur
-too sick for CPAP



delivering Oxygen under pressure
-if positive pressure ventilation, involves putting positive pressure in
-if the baby is sick, means it will need oxygen too to alleviate the hypoxia


Negatives to high pressures and 100% oxygen

1. if the amount of oxygen in the blood stream goes too high it can cause blindness = retrolental fibroplasia
-must monitor very carefully
2. barotrauma: can cause trauma to the little lungs developing
3. decreased respiratory drive?
4. Oxygen toxicity to the lung: the very thing being used to save the baby from death, may actually harm her lungs
Note: less risky now as have more sophisticated ventilation approaches and use artificial surfactant. now Normal or only a few developmental defects.


Case study's outcome/harm that came from high pressure and 100% oxygen treatment

CLD: She developed Chronic Lung disease of prematurity
(Bronchopulmonary Dysplasia, BPD)
-if stop ventilation and oxygen when child gets better, the harm stops as well, so baby can recover as the lung grows


Features of CLD are?

Chronic Lung disease of Prematurity
1. Early changes:
-areas of atelectasis and emphysema
-hyperplasia of airway epithelium
-interstitial oedema
2. Late changes:
-interstitial fibrosis
-hypertrophy of airway smooth muscle
-pulmonary arteriolar musculature


Definition of Chronic Lung Disease of Prematurity (CLD)/BPD

1. Persistent increased work of breathing (indrawing and increased respiratory rate)
2. abnormal chest radiograph (XRay) changes
3. For babies born



depression of the tissues in the rib
-lungs squished up as they're stiff because they have more tissue in them and less air
-takes more negative pressure to try and open them
-then negative uses suction to try pull lungs open
-results in the soft tissues around the chest wall get pulled in
--> classical signs of lung disease is indrawing. can get an idea how stiff the lungs are and how much pressure is going in to try and expand them.
-muscles b/w the ribs get sucked in becuase theyre soft
-spaces can be sucked in as well
-very severe diaphragm gets sucked up as weak and tired (paradox)
-pressure in the pleural cavity
-try to breathe so hard that


CLD histologically

post term alveoli
-increased cells in alveoli and interstitium
-inflammation and scarring (from barri trauma and oxygen toxicity)


5x main aetiological factors

-difficulty with treatment to keep the child alive and to move forward
1. Lung immaturity with...
2. Oxygen toxicity
3. Barotrauma and volutrauma
4. Pulmonary oedema (excessive fluid administration, patent ductus arteriosus)
5.Inflammation (multiple associated biochemical changes)


Aetiological factor of Lung immaturity..

Lung immaturity with:
1. increased susceptibility to damage from oxygen, barotrauma and volutrauma
2. surfactant deficiency
3. immarture antioxidant defences


"reached term"

Head box oxygen
-no longer has a tube down her lungs
-can breath spontaneously without a ventilator. however does require oxygen
-previously used to deliver oxygen via head box. not deliver oxygen via nasal prongs
-equally good but nasal prongs allow better access to baby (dont need to break oxygen seal if need to do something around the baby's head)


Early Alveolar Stage

36 Weeks
able to exchange gases better


4 months already having RDS and CLD

episodes of spilling and wheezing after feeds
-diagnosed as GORD Gastro-Oesophageal Reflux Disease
-GORD tends to be a common problem in babies with respiratory disease
-manage with positioning and some anti-reflux medical management


Paroxysmal cough

Whooping cough (pertussis)
cluster of very large coughing the cannot stop
-lasts for many seconds (most only last for 1-2 seconds)
-causing alot of distress


Whooping cough

Pertussis (whooping cough)
Distressing paroxysmal cough
No history of foreign body
Child appears well between coughs
May occur in immunised child (may occur prior to 6 week first immunisation)
-try to get govt to fund free gp visit for mothers in first trimester to give pertussis vaccine to mother, protects babies up to 6 wks of age
May cough 3-4 months
-nasal prongs and suction
-not uncommon
-very severe in babies
-most people with whooping cough get completely better but they are life threatening conditions which can die from


What could these symptoms represent?
-cough and breathing difficulty
-Tachypnoea >50 breaths/min
-Not Wheezing

-rapid breathing
-normally babies tummy move out when they move in as diaphragm descends.
Sign of very severe Pneumonia: baby is so sick that the diaphragm cannot keep up with the pace of her breathing that the tummy is moving in when breathing in
-most people with pneumonia get completely better but they are life threatening conditions which can die from (11 children per year)



breathing fast
>50 breaths/min


What are the common causes of wheezing and coughing in young children?

(repeated bouts of wheezing and coughing)
1. Bronchiolitis
2. Asthma



Expiratory wheezing (different to pneumonia)
Rapid breathing
Increased work of breathing
**Crying (obscures expiratory wheeze) (crying is a respiratory sound that is louder than wheezing)
Slight indrawing


What is more common out of Bronchiolitis and Asthma?

Asthma is more common
-asthma itself doesnt cause bronchiectasis
-but all secondary multiple insults can cause damage to the lungs
-bronchiectasis is one of the top concerns with people with a cough


What drugs are used to treat asthma?

1. B2 agonists (Bronchodilator)
2. CorticoSteroids: inhaled


Corticosteroid inhaler delivery: Spacers

Spacer devices with a mask and metre dose inhaler.
-advantage: can quietly breath in and out. alot of the particles are too big to go down the airway, so if in spacer the big particles sit on the side of the spacer and only the right size particles go down your airway (reliable dose of corticosteroids)
-overcomes problem of baby not having a good seal as mask goes over the nose and mask


Negatives to meter dose inhales

-cannot use inhaler alone reliably on a young child as have to be very co-ordinate to use
-shake, deep breath out and then spray as you breath it in
-once child is 3-4 and can seal mouth around inhaler stop using mask (dont lose 30% anymore)


Negatives to Spacer Masks

Aversion: oppressive having a mask on your face (not liking it)
Nose: by using a mask some goes up the nose and some in the mouth. Nose is bad for drug delivery as nose is good at filtering particles so the patient gets less drug. (lose about 30% of the dose)


What are the possible causes of:
Repeated bouts of wet productive cough
Chest Cackles heard with stethescope (and didnt clear)

Reproductive cough: sputum caused by either
1. CF Cystic Fibrosis
2. Bronchiectisis
3. Retained foreign body (inhaled something into lungs, stuck, puss forms)
4. TB



Damaged airway walls from repeated or severe pneumonia
-or multiple secondary insults
-flow volume loop/function showed mild respiratory airflow obstruction (not specific for bronchiectasis)


Bronchiectasis CT scan

Badly damaged lung with dilated scarred airways (bronchi)
Diagnosis: comparing dilated size of bronchi being larger than adjacent artery


Lung Function test for Bronchiectasis Patient

Forced Vital Capacity (FVC) 83%- lower range of normal
Forced expired volume in 1 second (FEV1) 68%- mildly reduced
=mild obstructive picture


Treatment of bronchiectasis

Antibiotics courses
Sputum clearance techniques (chest physiotherapy)


Sputum clearance with PEP

Positive Expiratory Pressure
-pores of chon (tiny pores in alveoli). child breathes against the pressure, the pressure goes through the pores and makes sputum go further forward more proximally
-helps with sputum clearance
-easy to do and can do alone