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Paediatric Respiratory Disease

Paediatric Respiratory Disease. Rory Brittain. Outline. Airway Anatomy Paediatric Considerations Airway Infections Cystic Fibrosis Asthma. Paediatric Anatomical Variation.

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Paediatric Respiratory Disease

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  1. Paediatric Respiratory Disease Rory Brittain

  2. Outline • Airway Anatomy • Paediatric Considerations • Airway Infections • Cystic Fibrosis • Asthma

  3. Paediatric Anatomical Variation • Intercostal muscles are not fully developed until school age. The muscles of the diaphragm are insert horizontally to the ribs, as opposed to obliquely. • While laying supine neck flexion can obstruct the airway. • Infants and younger children are predominantly nose breathers.

  4. Normal Values Respiratory Rate • Neonates 30-50 Tachypnoea >60 • Infants 20-30 >50 • Young Children 20-30 >40 • Older Children 15-20 >30 Heart Rate • <1yr 110-160 • 2-5yrs95-140 • 5-12yrs 80-120 • >12yrs 60-100

  5. Paediatric Respiratory Distress • Clinical Signs • Tachypnoea • Tachycardia • Increased work of Breathing • Subcostal, intercostal and sternal recessions. • Grunting, nasal flaring • Tracheal Tug and Head bobbing. • Stridor or Wheeze • Cyanosis • Reduced Consciousness • Difficulty Feeding • Poor Respiratory Effort • video

  6. Paediatric Pneumonias • Inflammation of lung Parenchyma • More likely viral in younger children, bacterial in older children • Newborns – Infections from mothers genital tract Group B Streptococcus, g-ve enterococcus. • Infants – RSV, Strep. pneumoniae, Haemophilus influenza • >5yrs – Strep. pneumoniae, mycoplasma pneumoniae, chlamydia pneumoniae. • TB – All age Groups. • Sx – SOB, Cough, Wheeze, Fever, lethargy, Respiratory Distress • Rx – Oxygen, Fluids, Antibiotics

  7. Bronchiolitis • Most common Serious respiratory infection of infancy • Causes – RSV (80%) Parainfluenzaviruses adenoviruses • Winter Epidemics, often preceded by URTIs • Epithelial necrosis and shedding, oedema and airway obstruction • <18ms peak incidence Nov-April • Sx – Breathlessness, Dry Cough, Wheeze • Serious Disease – signs of respiratory distress, hyperinflation of chest, cyanosis • 02 Via nasal cannula • Bronchiolitis Obliterans – Irreversible complication

  8. Whooping Cough • Bordatella pertussis bronchiolitis • Vaccinations - 2m,3m,4m & 40m (This does not provide Immunity!) • Epidemics every 2-3 years. Highly Infectious • Can be fatal in very young. • Typical 6 week course • 1-2weeks Catarrhal phase – coryza • 3-6 Paroxysmal Phase – Spasmodic dry “whooping” cough • May cause vomiting, epistaxis, sub-conjunctivalhaem. • Ix: Nasal Swab, Lymphocytosis • Rx: Erythromycin. Also prophylactically for close contacts.

  9. Laryngotracheobronchitis (Croup) • Mucosal inflammation and swelling due to laryngeal/tracheal infections can cause life threatening obstructions of the airway in children. • Sx– Dyspnoea, Hoarseness, Stridor, Barking cough. Respiratory Distress. • Severity best assessed by degree of chest retractions and stridor. • Do not examine the Throat! • If severe give nebulised epinephrine +/- Steroids • Intubation/ Tracheostomy may be required.

  10. Croup • 95% of Viral larygotracheal infections are due to viral croup – 75% parainfluenzaviruses (also RSV, metapneumovirus and Influenza) • Low threshold for admission <12ms • Oral or nebulised steroids +/- epinephrine • Bacterial Tracheitis or pseudomembranous croup is similar except with high fever, and thick airway secretions. Caused by Staph. aureus. Treat with IV abx and intubation

  11. Acute Epiglotitis • Life threatening emergency • Infection of epiglottis by Haemophilusinfluenzae type B (Hib) • Vaccination at 2,3,4, &12 months. • Most common between 1-6yrs • Important to differentiate from viral croup! • No preceding Coryza • Onset over hours rather than days • Cough absent or much less severe • Softer stridor • Unable to drink • May be drooling • High Fever • Muffled Voice, reluctant to speak • Appear toxic and very unwell • Urgent Intubation and IV cefuroxime

  12. URTIs • 80% of all RTI’s in children, often viral and self limiting. • Can affect feeding in very young children • May cause exacerbations of Asthma • Common Cold (Coryza) – Rhinovirus • Sore Throat (Pharyngitis) – Usually viral, Strep. Pneumoniae • Tonsilitis – 2/3 Viral (EBV) or . β-haemolytic strep. • Sinusitis – Usually Viral • Otitis Media

  13. Cystic Fibrosis • Commonest life-limiting autosomal recessive condition in Caucasians. - 1/2500 births. 1/25 are carriers. • Defective CF transmembrane conductance regulator (CFTR) cAMP dependant chloride channel. • Abnormal ion transport across epithelial cells. Leads to impairtedmucocillary clearance • Chronic Infection - Pseudomonas aerungiosa • Impaired Inflammatory response • Thickening of Meconium- Meconium Ilieus • Blockage of Pancreatic Ducts – Enzyme Deficiency and Malabsorption

  14. CF - Clinical • Majority Picked up on screening – Heel Prick (Guthrie Test) • Recurrent Chest Infections • Bronchictasis and Abcess formation • Poor Growth, Malabsorption • Persistent Productive Loose Cough • Hyperinflation of chest • Crepitations and wheeze • Clubbing • Pancreatic Insufficency • Meconium Ileus • Respiratory Failure

  15. CF Management • Diagnosis – Chloride Sweat Test • Genetic Testing (Immunoreactivetrypsinogen (IRT)) • Physiotherapy • Regular Lung Function Tests (FEV1) • Prophylactic Abx (Flucloxacillin) • IV Abx for Exacerbations • Nebulised DNAase Hypertonic Saline • Lung Transplant • Replace Pancreatic Enzymes • High Calorie Diet 150% • Fat Soluble Vitamins • Manage Complications DM and Liver Failure

  16. Asthma • Affects 15-20% of Children. Commonest Respiratory Condition of childhood. • Can be life threatening. • Reversible airway obstruction associated with atopy. • Bronchial inflammation and airway hyperresponsiveness. • Sx - SOB, wheeze, cough, chest tightness. • Ix – Peak Flow, Spirometry • Inhaler Technique • Transient Early wheeze. <5yrs

  17. Thanks For Listening!

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