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CVPR: Pulmonary > Pediatric Lung Disease > Flashcards

Flashcards in Pediatric Lung Disease Deck (14)
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Upper airways: children vs. adults

  • Child airway anatomy is smaller: 4mm vs. 8mm (adult)
  • larynx is higher, more anterior
  • epiglottis is floppy
  • Cricoid is narrowest part of airway (just below vocal cords vs. adult is @ vocal cords)


Extrathoracic airway obstruction: dangerous signs

  • usually presents with barking cough and stridor
  • "4 Ds":
  • dyspnea
  • drooling
  • dysphagia
  • distress


Mild upper airway diseases + characteristics

  • laryngomalacia = congenital disorder; most common cause of persistent stridor (some variable severity)
    • seen w/in first 6 weeks
  • Viral croup (some variable severity)
    • parainfluenza virus
    • edema in subglottic space
    • low-grade/absent fever
    • neck image = steeple sign
    • tx: supportive + sometimes: nebulized epinephrine, glucocoritcoids


Severe upper airway diseases + characteristics

  • Epiglottitis
    • cause: usually H. influenzae
    • supraglottic inflammation
    • sudden onset high fever
    • 4 Ds
    • Tx: intubation + IV antibiotics
  • Bacterial Tracheitis
    • cause: usually Staph aureus
      • mucosal invasion of bacteria
    • initially ~viral croup but w/out improvement ==> higher fever, toxicity
    • Tx: intubation + suctioning secretions + IV antibiotics


Pediatric vs. Adult lower airway

  • Airways are smaller and the cross sectional area is lower 

  • Infant chest walls have:

    • Weak intercostal muscles 

    • Ribs are horizontal (not slanted like in adults).  This means that infants rely mostly on their diaphragm for increased tidal volume. 

    • Diaphragm is flat limiting the change in tidal volume and fatigues easily 




Congenital disorders or intrathoracic airway obstruction

  • Tracheomalacia and bronchomalacia 

  • Tracheoesophageal fistula 

  • Vascular Rings, Pulmonary slings, and other vascular anomalies that can cause airway compression


Common acquired causes of intrathoracic airway obstruction

  • bronchiolitis
  • asthma


Bronchiolitis characteristics/dx/tx

  • =most common serious acute respiratory illness in infants/young children
  • Characterized by acute onset tachypnea, labored breathing, and/or hypoxia.
  • Irritability, poor feeding.
  • Wheezing and crackles on chest auscultation.
  • common cause: RSV (respiratory syncytial virus)
  • Tx: prevention (hand-washing, monoclonal Ab in high-risk), supplemental O2, some hospitalization


Asthma characteristics/dx/tx


  • Most common chronic pediatric condition
  • Recurrent symptoms of airway obstruction: cough, shortness of breath, chest tightness, wheezing
  • At least partial reversal of bronchospasm and symptom relief with a bronchodilator (e.g. a beta agonist such as albuterol)
  • All other diagnoses ruled out
  • cause: airway inflammation ==> increased mucous production, bronchial hyperreactivity, airway edema
  • Dx usually clinical, occasionally PFTs
  • Tx: inhaled beta-agonist; inhaled corticosteroids




Bronchopulmonary dysplasia general characteristics + typical features

  • BPD = most significant sequelae of acute respiratory distress @ NICU
  • disorder characterized by decreased SA for gas exchange, reduced inflammation, dysmorphic vascular structure
  • Acute respiratory distress in the first week of life.

  • Required oxygen therapy or mechanical ventilation, with persistent oxygen requirement at 36 weeks gestational age or 28 days of life.

  • Persistent respiratory abnormalities, including physical signs and radiographic findings.


Pathogenesis of BPD

  • premature lung rpduces insufficient functional surfactant + reduced antioxidant defense
  • early inflammation and hypercellularity ==> fibrosis
  • structural immaturity, surfactant deficiency, atelectasis, and pulmonary edema—as well as lung injury secondary to hyperoxia and mechanical ventilation—lead to further abnormalities of lung function


Risk factors for development of BPD

  • pre-term infants
  • full term w/: meconium aspiration, diaphragmatic hernia, pulmonary HTN
  • prolonged ventilator support


BPD clinical course/prognosis

  • variable course: mild increased O2 requirement w/resolution ==> tracheostomy + mechanical ventilation X 2yrs
  • generally favorable long-term outlook
  • lung fxn may be altered for life


BPD sequelae/resulting conditions

  • persisent hypoxemia 

  • airway hyperreactivity 

  • exercise intolerance 

  • pulmonary HTN 

  • increased risk for COPD 
  • abnormal lung growth
  • abnormal neurodevelopmental abnormalities