Pediatric Pulmonary Disorders

  • Possible causes of wheezing in young children.
    • Infants & toddlers have smaller airways
    • RSV
    • Not all wheezing indicates asthma
  • Preferred therapies to treat pediatric asthma
    • Inhaled corticosteroids  (drugs of choice)
      • MDI (w/ or w/o spacer/masks)
      • Nebulizers
    • Leukotriene inhibitors  (singulair-montelukast)
      • Use as an adjunctive or alternative therapy (some parents like these b/c of PO admin)
    • Long-acting beta agonists
      • Adjunct to corticosteroids for prolonged control of symptoms
      • Help w/ nocturnal symptoms
    • Cromolyn/Nedocromil
      • Useful prior to known exposure
      • Prevent release of inflammatory mediators
    • Theophylline
      • Used for nighttime symptoms, but rarely used due DDI, SE, narrow TI
    • Quick relief meds
      • Short-acting beta-2 agonists (an overuse of these may indicate inadequate control of asthma)
      • ipratropium
  • Possible long-term effects of asthma medications.
    • Inhaled corticosteroids:  inhibit growth & density of bones, hypothalamic-pituitary-adrenal suppression
  • Etiology, risk factors, presentation, and treatment of respiratory distress syndrome .
    • Etiology:  the lung can’t produce enough surfactant b/c the lung is underdeveloped & doesn’t have enough type II pneumocytes
      • Surfactant lowers surface tension of alveoli & prevents collapse of lungs
    • Risk factors:  common in infants under 36 weeks (premature), C-section, males, maternal diabetes, second-born twins, perinatal asphyxia, acidosis,
    • Presentation:  may appear normal in first few hours of life but then signs of pallor, cyanosis, edema, reticulogranular pattern on x-ray (ground glass appearance of lungs)
      • It is essential to distinguish RSD from sepsis
    • Treatment:  exogenous surfactant (under 30 weeks give it to all infants routinely, over that mark just give it if signs of distress occur, give via an ET tube into the lungs), fluid restriction, diuretics (furosemide quickly removes fluid from the lungs, drug of choice during acute period of respiratory response b/c of quick onset), want to delay the birth of the premature baby as much as possible, give mom betamethasone, ECMO (oxygenation)
    • Complications of RDS:  neurological impairment, infections, pneumothorax
  • Etiology, presentation, complications, and treatment of bronchopulmonary dysplasia.
    • Etiology:  results from prolonged ventilator therapy as a treatment for RDS**
    • Presentation:  O2 dependent at 36 weeks, slow growth, patent ductus arteriosus (PDA), heart failure (right side), hyperactive airways, pulmonary infections, cardiomegaly
    • Treatment:  supplemental O2, diuretics, corticosteroids, bronchodilators (inhaled or systemic)
      • Diuretics (monitor electrolyte levels closely):  furosemide (watch out for K/Ca loss), HCTZ (Ca sparing), Spironolactone (K sparing)
  • Etiologies and treatment of neonatal apnea.
    • Definition of apnea:  cessation of respiration >20 seconds or < 20 seconds if + bradycardia (HR under 100 bpm) or cyanosis
    • Etiology:  immaturity of the respiratory system in the brain that can be life threatening, may be caused by hypoxemia, hypoglycemia, electrolyte disorders, sepsis, intracranial hemorrhage, drugs, temp, obstruction, vagal stimulation or decreased hematocrit
    • Treatment:  correct underlying problem, mechanical ventilation, caffeine**–stimulates CNS respiratory center (10mg/kg LD followed by 2.5 mg/kg MD)
  • Risk factors associated with neonatal infections.
    • Neonatals have an immature immune system
    • Both humoral & cellular components are deficient
    • Risk factors:  maternal infection, premature rupture of membranes, vaginal delivery, respiratory distress, IV lines
  • Most common organisms infecting neonates and appropriate treatment.
    • Group B strep** (40% of women) & **E.Coli account for 85% of infections in newborns
      • Onset is rapid & it can cause death in less than 24 hours
      • Treatment:  **Ampicillin + Gentamicin** for at least 48 hours.  Vancomycin may be added if condition doesn’t improve
        • Life threatening conditions should also be treated w/ oxygen therapy
  • Etiology, complications, and treatment of patent ductus arteriosus.
    • Presentation:  respiratory distress, increased need for ventilation, murmur, Echocardiogram
    • Treatment:  indomethacin or IBU (inhibit PG’s to close duct).
      • Monitor renal function
      • May need to surgically close if drugs don’t work
  • Conditions which require maintenance of ductal patency and how this is accomplished.
    • Cyanotic heart lesions require ductal patency
      • Use PGE1drugs like prostadil
  • Treatment of pulmonary hypertension
    • Only use nitric oxide for pulmonary hypertension (don’t want to do systemic vasodilation)
  • if a premature baby comes in give them surfactant, ampicillin & gentamicin (the latter 2 should be given for at least 48 hours)

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