Paediatric respiratory

Question 1

What is a neonate?

Answer 1

Baby in the first 28 days of life

Question 2

What is a ‘term baby’?

Answer 2

Baby born between 37 and 42 weeks gestation

Question 3

What is the normal respiratory rate and heart rate for a neonate?

Answer 3

RR = 30-50
HR = 120-160

Question 4

What is a UAC and a UVC?

Answer 4

Umbilical artery catheter

Umbilical venous catheter

Question 5

What are the sigsn of respiratory distress syndrome in a neonate?

Answer 5

Tracheal tug, expiratory grunting and marked sternal recession (as the bones are not fully ossified)

Question 6

What might the CXR of a neonate with RDS show?

Answer 6

Opaque lung fields as there is fluid on the lungs and some alveolar collapse

Question 7

What causes RDS in the neonate?

Answer 7

Surfactant deficiency. Type 2 pneumocytes develop between 24 and 34 weeks gestation.
Premature babies may nt have produced sufficient surfactant

Question 8

How often does RDS occur?

Answer 8

Effects 1% of all births but more common in premature births

Question 9

What is the function of surfactant?

Answer 9

To reduce alveolar surface tension to prevent alveolar collapse

Question 10

What does surfactant contain?

Answer 10

Phospholipid and apoproteins

Question 11

What happens when not enough surfactant is produced in the neonate?

Answer 11

Atelectasis and impaired gas exchange

Question 12

If a mother presents in premature labour, what can be done to prevent or reduce RDS?

Answer 12

Given 2 steroid injections, preferably 12 hours apart, which stimulates surfactant production.

Question 13

At what stage in gestation will babies always be incubated?

Answer 13

<29 weeks and they will have artificial surfactant delivered to the lungs

Question 14

What is ventilation?

Answer 14

Breathing for someone and controlling the rate, volume and pressure entering the lungs

Question 15

What are the risks of ventilating a neonate and in what forms of ventilation are these risks greater and how can you prevent them?

Answer 15

Pneumothorax as you are forcing air into the lungs
Greater risk with intermittent positive airway pressure (IPPV), Continuous positive airway pressure (CPAP)
Prevent risks by limiting ventilation, flow and pressure

Question 16

In what percentage of vaginal births does a pneumothorax occur spontaneously and when does this require treatment?

Answer 16

1%

Only when it’s tension pneumothorax and you would insert a chest drain

Question 17

What is ‘chronic lung disease’ in a neonate?

Answer 17

An oxygen requirement beyond 36 weeks corrected gestational age with evidence of pulmonary parenchymal disease on CXR

Question 18

What often causes ‘chronic lung disease’ in a neonate?

Answer 18

Following RDS due to barrotrauma, volume trauma or high inspire oxygen

Question 19

What is the treatment for ‘chronic lung disease’ in a neonate?

Answer 19

Given oxygen- carried around in a cinder. Corrects itself as lungs grow and develop over 2-3 years but can be restrictive and children are wheezy

Question 20

What is dextrocardia?

Answer 20

Heart on the right hand side of the body

Question 21

What is a diaphragmatic hernia?

Answer 21

Where some of the gut develops in the thorax

Question 22

How often does a diaphragmatic hernia occur?

Answer 22

1 in 2400 births

Question 23

What are the associated problems with a diaphragmatic hernia and what is the most common type?

Answer 23

Problems: the lungs have not had space to develop as the gut is in the way => pulmonary hypoplasia
Most common: posteriolateral left sided

Question 24

How is a diaphragmatic hernia corrected?

Answer 24

Surgical correction

Question 25

What treatment should not be given to babies with a diaphragmatic hernia and why?

Answer 25

Must avoid bag mask IPPV as when you push air into the mouth some will go into the oesophagus and small bowel making the diaphragmatic hernia worse. Must insert a tube into the trachea instead

Question 26

When is transient tachypnoea of the newborn most likely and why?

Answer 26

In babies born by C section because the stress of labour causes babies to reabsorb some of the fluid on the lungs but C section babies do not get this => poor gas exchange, tachypnoea and a greater risk of infection

Question 27

What are the challenges with doing spirometry with children and what would you examine on children?

Answer 27

The reference values change with age Only children over 7/8 can follow instructions and understand what they are doing Examination = height and weight, chest shape and auscletation

Question 28

What are the signs of CF in a newborn?

Answer 28

Prolonged history of cough, loose stool and failure to thrive Raised immune reactive trypsin levels All babies are screened at 6 days old using the heel prick blood test

Question 29

What are the differential diagnoses of CF in a newborn?

Answer 29

Immune deficiency, ciliary dyskinesia, asthma, Kartagner's syndrome, citis invertis

Question 30

If a babies has CF, what treatment are they given?

Answer 30

Flucloxacillin from birth to prevent S. aureus infection

Question 31

What are the clinical features that increase the probability of asthma in children?

Answer 31

One or more of: wheeze, cough, chest tightness, difficulty breathing Atopy- personal or family history Widespread wheeze on auscultation Responsive to treatment (salbutamol inhaler)

Question 32

What should be done if there is a high probability the child has asthma?

Answer 32

Trial treatment and further investigations if the response is poor

Question 33

What should be done if there is a intermediate probability the child has asthma?

Answer 33

Watchful waiting, ?Spirometry if the child is old enough and ?treatment trial and evaluate

Question 34

What should be done if there is a low probability the child has asthma?

Answer 34

Investigations and referral to a specialist paediatric team

Question 35

What are some of the consequences of passive smoking around children?

Answer 35

Asthmatic children are 4 times more likely to die of an asthma attack

Question 36

What are the consequences of smoking in pregnancy?

Answer 36

``` Reduced birth weight by 250g 4500 Miscarriages 30% increase in perinatal mortality Tetratogenic: airways, cleft lip/palate Glue ear Carcinogenic ```

Question 37

What is the treatment for a child having an acute asthma attack?

Answer 37

High flow oxygen and nebulised bronchodilator Oral prednisalone IV salbutamol, aminophyline and magnesium (smooth muscle relaxant) Ventelatory support

Question 38

What is bronchiolitis and what is the most common aetiological organism?

Answer 38

Viral infection usually caused by RSV and children are usually under 18 mouths old

Question 39

When is bronchiolitis more severe?

Answer 39

More severe in younger babies, premature babies and if family smokes

Question 40

What are the clinical signs of bronchiolitis?

Answer 40

Tachyponea, poor feeding, irritating cough | Apneoa in small babies- not breathing for 20 seconds

Question 41

What is the treatment for bronchiolitis?

Answer 41

Supportive. If hypoxic = oxygen. If not feeding = NG tube. If coughing = cough syrup. If fever = calpol

Question 42

What organisms cause pneumonia in neonates?

Answer 42

GBS, E. coli, Klebsiella, Staph aureus

Question 43

What organisms cause pneumonia in infants?

Answer 43

Strep pneumoniae, Chlamydia

Question 44

What organisms cause pneumonia in school aged children?

Answer 44

Strep pneumoniae, Staph aureus, Bordatella, Mycoplasma, Legionella and group A strep

Question 45

What are the signs of pneumonia in children?

Answer 45

Cough, high fever, sputum, dull percussion and bronchial breathing

Question 46

What are the differential diagnosis of a sudden onset cough and difficulty breathing in children?

Answer 46

Inhaled foreign body, Laryngomalacia, eppiglottitis/bacterial trachitis, allergy, croup

Question 47

What is croup and what are the symptoms?

Answer 47

Viral larygnotracheobronchitis | Stridor and cough

Question 48

What is the classical sign on a CXR of croup?

Answer 48

Steeple sign (hypopharynx distention and narrowing of air column)

Question 49

What is the treatment for croup?

Answer 49

Oral steroids