Chapter 27: Alterations of Pulmonary Function in Children

upper airway infection

acute laryngotracheobronchitis

common in children from 6 months - 5 years

commonly caused by virus (parainfluenza, influenza A or RSV) - causes subglottic edema

usually occurs after rhinorrhea, sore throat, and fever

**causes seal-like barking cough

self-limiting within 24-48 hours

upper airway infection

similar hoarseness, cough, and stridor to croup

occurs in older children (5+)

deomonstrates sudden onset (usually at night) with no previous viral illness

resolves quickly (self-limiting)

Croup - occurs in children 6 months-5 years; occurs after illness

spasmodic croup - occurs in older children (5+); occurs without previous illness

upper airway infection

severe, rapidly progressive, life-threatening infection of epiglottis and srrounding area

usually caused by Haemophilus influenzae type B (HIB vaccination decreased incidences)

EMERGENCY AIRWAY TREATMENT AND ANTIBIOTICS REQUIRED

high fever

sore throat

inspiratory stidor

severe respiratory distress

voice sounds muffled

**drooling and dysphagia (difficulty swallowing and talking due to swelling)

EMERGENCY AIRWAY TREATMENT AND ANTIBIOTICS REQUIRED

partial or completel upper airway obstruction during sleep

disrupts normal ventilation and sleep patterns

treatment = tonsillectomy and adenoidectomy, or CPAP (ventilation mask)

adenotonsillar hypertrophy

significant cause of neonatal morbidity and mortality

*almost exclusively in premature infants

caused by poor lung structure and lack of adequate surfactant

causes widespread atelectasis, respiratory distress, and pulmonary hypertension (pushing blood into collasped lung tissue)

the lungs are the last system to develop and surfactant has not yet developed

surfactant usually maintains lung inflation, lungs collapse and infants need ventilation and synthetic surfactant

appears within minutes of birth (some require immediate resuscitation)

tachypnea, expiratory grunting, nasal flaring (trying to get air), poor color (pale, cyanotic)

*prevention of preterm births (stop contractions)

mechanical ventilation

surfactant administration

glucocorticoid administration to women in preterm labor (help with development of lung tissue)

autosomal recessive multisystem disease (2 carrier parents)

-defective epithelial chloride ion transport

exocrine or mucus-producing glands are increased in number and size and secrete abnormally thick mucus (defective epithelial ion transport)

Chronic inflammation leads to hyperplasia of goblet cells, bronchiectosis, pneumonia, hypoxia, fibrosis (scar tissue)

respiratory failure

thick secretions obstruct the bronchioles and predispose the lungs to chronic infection

(loss of cilia = increases risk of respiratory infection)

-persistent cough or wheeze and recurrent or severe pneumonia

-barrel chest (rounded chest - ribs stay expanded due to increased expansion of chesk due to difficult breathing) and digital clubbing

-pathognomic for CF is meconium ileus at birth

-failure to thrive (thin and small (lack enzymes to break down food))

sweat test - reveals increased chloride concentration

looks for increased amount of Na+ and Cl- in sweat

(disease of unknown cause)

-lower during 1st month of life, increases in 2nd month, peaks 3-4 months

-more common in males

-almost always occurs during nighttime sleep

higher frequencies during winter months

possible relationship to respiratory infections

prone sleeping (back is best)

sleeping on soft surface (firm mattress to prevent obstruction of airway)

overheating (dont cover, cool room)

maternal smoking, young maternal age, less prenatal care, illict drugs

*no blankets, toys, or bumpers in bed (anything that can decrease respirations/sufficate)