RESPIRATORY CONDITIONS

Monday, January 4, 2021 6:36 PM

SURFACTANT
• Present and homogenates at 20wks AOG.
• Present in amniotic fluid at 28 and 32wks AOG.
• Mature levels: 35wks AOG.

APNEA
- cessation of breathing for longer than 20 seconds or for any duration
- MC in preterm
- MCC: Prematurity
- Immediate Mgt:
§ Stimulation + O2 for 30 seconds, if it does not work → § PPV fo
§ CPR anytime if heart rate falls <60bpm
- Methylxanthines (Caffeine or theophylline)
• increase central respiratory drive by lowering the threshold of r
• enhances contractility of the diaphragm and preventing diaphragma

DISORDER RESPIRATORY TRANSIENT BRONCHOPULMONARY

n if accompanied by cyanosis and bradycardia

or 30 seconds, if it does not work → Intubate

response to hypercapnia
atic fatigue

MECONIUM PERSISTENT PULMONARY HYALINE MEMBRANE N

NEONATAL PNEUMONIA
- Methylxanthines (Caffeine or theophylline)
• increase central respiratory drive by lowering the threshold of r
• enhances contractility of the diaphragm and preventing diaphragma

DISORDER RESPIRATORY TRANSIENT BRONCHOPULMONARY

DISTRESS SYNDROME TACHYPNEA OF DYSPLASIA
THE NEWBORN
HISTORY Preterm, tachypnea, Term or Premature,
several minutes preterm, CS, previously treated
after birth: several with RDS.
prominent grunting, minutes after
intercostal an birth Was intubated on
subcostal developed the first day of
retractions, nasal tachypnea, life, given
flaring and retractions, surfactant
cynaNosis. expiratory therapy, and was
grunting. on assisted
ventilation for
two weeks due to
complications.
Subsequently
extubated;
however, oxygen
support was never
completely weaned
off. At 36 weeks,
he could tolerate
oxygen support at
1 lpm via nasal
cannula.
CAUSE Surfactant Slow Chronic lung
deficiency absorption of injury due to
fetal lung hypoxia
fluid
Generation of free
OveraeratioN radicals from
supplemental
oxygenation
Inflammation

Overaeration
response to hypercapnia
atic fatigue

MECONIUM PERSISTENT PULMONARY HYALINE MEMBRANE N

ASPIRATION HYPERTENSION IN THE NEWBORN DISEASE
SYNDROME
Term/ Post term, MAS, prolonged
d labor, aspirated meconium.
Twelve hours after birth, the
neonate was noted to have
grunting, nasal flaring, and
intercostal retractions.
Hypoxemic and tachycardic

Overaeration Persistence of the fetal Underaeration

circulatory pattern of right-
to-left
shunting through the PDA and
e foramen ovale after birth

Maladaptation from acute injury

The result of increased
pulmonary artery medial muscle
thickness and extension of
smooth muscle layers into the
usually non-muscular, more
peripheral pulmonary arterioles
in response to chronic fetal
hypoxia
A consequence of pulmonary
hypoplasia (diaphragmatic
hernia, Potter syndrome)

Obstructive (ex TAPVR,

Polycythemia)
PaO2 or oxygen saturation
NEONATAL PNEUMONIA
BS harsh tubular CBS
quality and on deep
inspiration, fine
crackles
XRAY FINDING Fine reticular Prominent interstitial
granularity of the pulmonary emphysema,
parenchyma and air vascular wandering
bronchograms. markings, atelectasis with
fluid in the con- comitant
Ground Glass intralobar hyperinflation,
opacities, Under- fissures, and cyst formation
aerated,
atelectasis. overaeration, Bubbly Lungs
flat (cystic lucencies)
diaphragms

S/SX Within minutes of Early onset

birth but relieved
with minimal
Grunting oxygen
supplementatio
Progressive n
worsening of
cyanosis and Recovers
dyspnea rapidly within
3 days
Symptoms peak
within 3 days then
improves

TXT Prevent with Supplemental

 A consequence of pulmonary
hypoplasia (diaphragmatic
hernia, Potter syndrome)

Obstructive (ex TAPVR,

Polycythemia)
PaO2 or oxygen saturation
gradient between a preductal
(right radial artery) and a
post-ductal (umbilical artery)
site of blood sampling suggests
right-to-left shunting through
the ductus arteriosus.

PDA is generally acyanotic

because the flow is left to
right. However, in certain
instances where PDA is large
and/or the pulmonary vascular
resistance is high (such as in
PPHN), shunt becomes right to
left and patient therefore
becomes CYANOTIC!

coarse Normal. Finely granular Perihi

streaking lungs
granular May be normal OR depending on Ground glass
pattern of both co-morbid condition appearance
lungs fields
Take Real-time echocardiography
n with Doppler flow instead.

Within first 12 hours of

birth.
Cyanosis
Oxygen gradient

Unpredictable course

Supportive
ilar streaking
 cyanosis and Recovers
dyspnea rapidly within
3 days
Symptoms peak
within 3 days then
improves

TXT Prevent with Supplemental

antenatal steroids O2

Surfactant
replacement

PEEP

Respiratory problems rank high among Filipino children. The nature of

The principal agent that causes the common colds is the Rhinovirus.

VIRAL CROUP
3 mos to 3 yrs
88% Stridor
Parainfluenza Virus
Onset prodrome
(1-7 days)
Low grade fever
Epinephr Stridor improves
ine
Barking Cough
Hoarseness
Steeple Sign

Foreign body aspiration

• Sudden onset of respiratory distress and/or noisy breathing in a
obstruction.
• NUTS: most commonly obtained from respiratory tracts of children.
 Unpredictable course

Supportive
Treat underlying cause

f this problem is frequently Infectious.

EPIGLOTTITIS
3-7yrs old
8% Stridot
HIB
Rapid 4-12 hrs

High grade fever

No effect

Muffled voice
Drooling
Thumbprint sign (The thumb sign is a manifestation of an
enlarged epiglottis seen on lateral soft tissue X ray of
projects as a rounded soft tissue structure into the hyp
Leaf sign
A 4 year old male child is brought to the emergency room
breathing. He has high fever of 39°C. 12 hours ago, he s
throat and a mild fever which progressed and prompted co
seen drooling and the neck is slightly held hyperextende
It is one of the common upper airway obstructions in a y

previously well young child (esp. in the 1st 3 years of life) highly signifi

.
n edematous and
f the neck. It
popharynx. )

m due to difficulty
started having sore
onsult. Patient is
ed.
young child.

ies foreign body airway

 obstruction.
• NUTS: most commonly obtained from respiratory tracts of children.

SINUSITIS
□ S. pneumoniae (30%), non-typable H. influenzae (20%), M. □ Bordete
catarrhalis (20%) □ Whoopin
□ Anaerobes are uncommon causes of acute sinusitis in □ Period
children wks aft
□ Anything that impairs mucociliary transport or causes the cat
nasal □ Incubat
□ obstruction predisposes to sinusitis □ 3 stage
□ S/Sx: colds and cough >10-14 days, purulent nasal □ o Catar
discharge for
□ Purely
□ 3-4 consecutive days, headache, tenderness over the exanthe
sinuses crackle
□ X-ray: air-fluid levels, opacification of the sinuses □ A 3-yea
□ Tx: antibiotics x 14 days (Co-Amoxiclav) intermi
□ Complications are abscess, meningitis turns p
□ Maxillary and Ethmoid sinuses at birth. the mot
rhinorr
□ Sphenoid is pneumatized at 4 yo.
□ Buzz ph
□ Frontal begins to develop at 7-8yo. paroxys
paroxys
□ Drug of
Clarith
contact
of
immuniz
.

PERTUSSIS
ella pertussis (gm- coccobacilli)
ng cough
of communicability: from 7 days after exposure to 4
ter onset of typical paroxysms; most infectious during
tarrhal stage
tion period: 3-12 days
es lasting 2 weeks each
rrhal, Paroxysmal, Convalescent
or predominantly cough. Absent fever, malaise,
em, sore throat, hoarseness, tachypnea, wheeze,
es.
ar-old male child was brought to the clinic due to
ittent episodes of continuous coughing until the child
purple followed by a deep loud inspiration, 1 week ago,
ther recalled that he had episodes of sneezing,
rhea,
hrases for a case of pertussis are: intermittent cough,
sms of cough, usually well and active in between the
sms of cough
f choice: Macrolide (Erythromycin or
hromycin) :should be given promptly to all household
ts and other close contacts regardless of age, history
zation, and symptoms.
 Sphenoid is pneumatized at 4 yo.
□ Buzz ph
□ Frontal begins to develop at 7-8yo. paroxys
paroxys
□ Drug of
Clarith
contact
of
immuniz
□ The sam
□ Complic
• Hem
• Sei
• Oti
• Ate
• Pne
hrases for a case of pertussis are: intermittent cough,
sms of cough, usually well and active in between the
sms of cough
f choice: Macrolide (Erythromycin or
hromycin) :should be given promptly to all household
ts and other close contacts regardless of age, history
zation, and symptoms.
me age-related drugs and doses are used for treatment.
cations
morrhage (subconjunctival or intracranial)
izure
itis media
electasis
eumonia