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Flashcards in Lung Diseases Deck (45)
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1

3 Main Pediatric Lung Diseases

Respiratory Distress Syndrome (RDS)
Sudden Infant Death Syndrome (SIDS)
Cystic Fibrosis (CF)

2

What is another name for RDS?

Hyaline membrane disease

3

Define RDS

Lung disease in a preterm infant resulting from insufficient surfactant

4

What is the major cause of morbidity & mortality in infants born prior to 30 weeks gestation?

RDS

5

What product has changed clinical course & decreased morbidity & mortality rates in RDS?

Exogenous surfactant

6

Epidemiology of RDS

Incidence decreases over 35 weeks
More severe in male infants
More severe & common in white infants

7

Increased Incidence Risk Factors of RDS

Low gestation
Male sex
White race
Maternal DM (decreased lung development & surfactant production)
C-section pre-onset of labor
Perinatal asphyxia
Maternal HTN

8

Decreased Incidence Risk Factors of RDS

Prolonged rupture of membranes
Chronic congenital infections
Maternal substance abuse
Antenatal corticosteroid exposure

9

2 Major Issues in RDS

Immature lungs
Lack of surfactant

10

Reasons for Immature Lungs

Born before lung development
Born before surfactant production

11

At what stage can true gas exchange occur?

Saccular stage
Alveolar ducts present

12

Reasons for Lack of Surfactant

Production begins at 23-24 weeks
Adequate amounts not produced until 35 weeks

13

What does surfactant do?

Reduces surface tension in alveoli
Facilitates lung expansion
Prevents alveolar collapse

14

Other Issues in RDS

Excessively compliant chest walls
Weakness of respiratory muscles
Alveolar collapse

15

Pathophysiology of RDS

Alveolar collapse alters V/Q
Pulmonary shunting
Arterial hypoxemia
Metabolic acidosis
Vasoconstriction
Pulmonary HTN
May have R to L shunting
Increased pulmonary blood flow
Pulmonary edema

16

How do the lungs appear in hyaline membrane disease?

Solid & congested with diffuse atelectasis

17

What are hyaline membranes made from?

Plasma proteins leaked from damaged capillaries

18

PE findings in RDS

Progressive tachypnea
Retractions
Grunting
Cyanosis
Decreased breath sounds

19

Diagnostics of RDS

CXR
ABGs

20

Findings with CXR in RDS

Increased density of lung fields
Reticulogranular infiltrates
Air bronchograms
Elevation of diaphragm

21

ABG Findings in RDS

Hypoxemia
Hypercarbia
Metabolic acidosis

22

How does exogenous surfactant drastically change the course of RDS?

Decreased need for oxygen
Decreased mechanical ventilation
Reduce incidence of gas leaks

23

What needs to be done for babies with RDS?

Stabilization
Cardiopulmonary function monitoring
Adequate respiratory support
Proper thermal, metabolic, & nutritional support

24

Prevention of RDS

Prevention of premature delivery
Antenatal corticosteroids

25

What do antenatal corticosteroids do?

Improve lung compliance
Increase lung volume
Decrease capillary protein leak

26

Complications of RDS

Hemorrhagic pulmonary edema
Capillary rupture & interstitial fluid
May be seen with exogenous surfactant
First 5-7 days of life
Rapidly fatal

27

Define SIDS

Sudden unexpected death of an infant less than 1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including a complete autopsy & review of the circumstances of death & clinical history

28

Age and time of death in SIDS

Sparing in 1st month
Increases in 2nd month
Peak incidence at 3 months
Occurs during the night

29

Possible Maternal Risk Factors for SIDS

Young age
Multiparity
Smoking & drug abuse during pregnancy
Previous fetal deaths
Anemia during pregnancy
Placenta previa
Premature rupture of membranes
Low social class
Low family income
Short inter-pregnancy interval
Unmarried mother
Partner unemployed
Late attendance of antenatal clinic
Postnatal depression
Attendance to psychiatrist
UTI in pregnancy

30

Possible Infantile Risk Factors in SIDS

Male
Low birth weight
Premature
Blood type B
Low APGAR scores
Low hematocrit @ 48 hours
Not using a pacifier
Prone/side sleeper
Bed-sharing
Overheating
Formula fed
Siblings in family
Sleeping in own room
Previous SIDS in family
Previous cyanotic episode