Childhood Respiratory Disease

Views:
 
Category: Education
     
 

Presentation Description

A case based presentation on common Paediatric and Neonatal respiratory disease

Comments

Presentation Transcript

Respiratory Disease In Childhood:

Respiratory Disease In Childhood Dr S Sen Consultant Paediatrician Ormskirk & District Hospital 8/27/2012 1 Paediatric Respiratory Diseases/Dr S Sen

Respiratory problems in Children:

Respiratory problems in Children Neonatal respiratory problems Respiratory problems in older children Acute Chronic 8/27/2012 2 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario :

Case Scenario An infant born at 30 weeks gestation develops respiratory distress at age 2 hours 8/27/2012 3 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 4 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 5 Paediatric Respiratory Diseases/Dr S Sen

Surfactant Deficient Lung Disease:

Surfactant Deficient Lung Disease Surfactant deficiency 1% all births Predominantly in preterm – inverse relationship with gestation 8/27/2012 6 Paediatric Respiratory Diseases/Dr S Sen

Surfactant:

Surfactant Phospholipid Apoproteins Secreted at 30-32/40 Lack of surfactant results in atelectasis and impairment of gas exchange Production stimulated by antenatal steroids 8/27/2012 7 Paediatric Respiratory Diseases/Dr S Sen

SDLD relative to gestational age:

SDLD relative to gestational age 8/27/2012 8 Paediatric Respiratory Diseases/Dr S Sen

Further problems:

Further problems Ventilated Sudden deterioration requiring increased oxygen No breath sounds on the right side of chest 8/27/2012 9 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 10 Paediatric Respiratory Diseases/Dr S Sen

Pneumothorax:

Pneumothorax Air in pleural space Increased incidence with IPPV, CPAP and ventilation Other risk factors – RDS (stiff lungs) Spontaneous - occurs in around 1% vaginal deliveries, 1.5% caesarean sections 8/27/2012 11 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 12 Paediatric Respiratory Diseases/Dr S Sen

Chronic Lung Disease of Prematurity :

Chronic Lung Disease of Prematurity Oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease on CXR Generally follows Surfactant Deficient Lung disease Barotrauma, volume trauma, high inspired oxygen Healing stage associated with continued lung growth over 2-3 years – often wheezy 8/27/2012 13 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario New born full-term infant with severe breathing difficulty after birth 8/27/2012 14 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 15 Paediatric Respiratory Diseases/Dr S Sen

Diaphragmatic Hernia:

Diaphragmatic Hernia Incidence:1/2400 Associated pulmonary hypoplasia Commonest- Posterolateral (Bochdalek), left-sided Avoid bag-mask IPPV Respiratory support Surgical 8/27/2012 16 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 17 Paediatric Respiratory Diseases/Dr S Sen

Older Children:

Older Children 8/27/2012 18 Paediatric Respiratory Diseases/Dr S Sen

Clinical Examination:

Clinical Examination Weight(length/height)..plotted! Clubbing Palpation Percussion Auscultation ENT examination 8/27/2012 19 Paediatric Respiratory Diseases/Dr S Sen

Pulmonary Function tests:

Pulmonary Function tests 8/27/2012 20 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 21 Paediatric Respiratory Diseases/Dr S Sen

Acute problems:

Acute problems Acute Asthma Croup Bronchiolitis 8/27/2012 22 Paediatric Respiratory Diseases/Dr S Sen

Acute Asthma:

Acute Asthma Cough and wheeze worsening over hours or days 8/27/2012 23 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 24 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 25 Paediatric Respiratory Diseases/Dr S Sen

Treatment:

Treatment Oxygen Nebulised bronchodilator Oral prednisolone/IV Hydrocortisone IV Magnesium IV Salbutamol IV Aminophylline Ventilatory support 8/27/2012 26 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario 6 week old presented with increased work of breathing and possible apnoeas URTI symptoms over last 2 days 8/27/2012 27 Paediatric Respiratory Diseases/Dr S Sen

Bronchiolitis:

Bronchiolitis Viral infection – RSV Usually under 18 months old More severe in younger babies, ex prem, family of smokers Tachypnoea, poor feeding, irritating cough Apnoea in small babies Treatment is supportive Increased incidence of wheezing episodes 8/27/2012 28 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario :

Case Scenario 10 year old girl with cough, high fever and sputum production Previously very well Clinical examination: Dullness on percussion Vocal fremitus and resonance Bronchial breathing 8/27/2012 29 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 30 Paediatric Respiratory Diseases/Dr S Sen

Pneumonia:

Pneumonia Neonates: GBS, E.coli, Klebsiella, Staph aureus Infants: Strep pneumoniae, Chlamydia School age: Strep pneumoniae, Staph aureus, Gr A strep, Bordetella, Mycoplasma, Legionella 8/27/2012 31 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario A 2-year old child presenting with barking cough and difficulty in breathing of sudden onset 8/27/2012 32 Paediatric Respiratory Diseases/Dr S Sen

Differential Diagnosis:

Differential Diagnosis Inhaled foreign body Laryngomalacia Epiglottitis Bacterial tracheitis Allergy Croup 8/27/2012 33 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 34 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 35 Paediatric Respiratory Diseases/Dr S Sen

Croup:

Croup Viral laryngotracheobronchitis Stridor, barking cough Treatment is Dexamethasone 150 micrograms/kg Budesonide 2mg nebuliser 8/27/2012 36 Paediatric Respiratory Diseases/Dr S Sen

Chronic problems:

Chronic problems Asthma Cystic Fibrosis Bronchiectasis Ciliary dyskinesia 8/27/2012 37 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario 7-year child presents to your clinic with a 3-month history of cough worse at night or during active play 8/27/2012 38 Paediatric Respiratory Diseases/Dr S Sen

Asthma – Diagnosis in Children SIGN Guideline May 2008 :

Asthma – Diagnosis in Children SIGN Guideline May 2008 Clinical Features that increase probability: One or more : wheeze , cough , chest tightness, difficulty breathing Atopy ( personal or family history) Widespread wheeze on auscultation Response to Bronchodilators 8/27/2012 39 Paediatric Respiratory Diseases/Dr S Sen

Asthma – Diagnosis in Children :

Asthma – Diagnosis in Children 8/27/2012 40 Paediatric Respiratory Diseases/Dr S Sen

Management of Asthma:

Management of Asthma Stage 1: Treat with inhaled beta-agonists when needed Stage 2: Treat with regular inhaled steroids Stage 3A: Regular inhaled steroids + Long acting beta agonists Stage 3B: Stage 3A + Leukotriene antagonists 8/27/2012 41 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 42 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario A 1 year-old child presenting with a prolonged history of cough, loose stools and failure to thrive 8/27/2012 43 Paediatric Respiratory Diseases/Dr S Sen

Cystic Fibrosis:

Cystic Fibrosis Autosomal recessive Carrier incidence roughly 1 in 25 people Mutations in the CFTR gene Multisystem disorder Failure to thrive Respiratory infections are prominent Loose stools 8/27/2012 44 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 45 Paediatric Respiratory Diseases/Dr S Sen A newborn infant with a raised immuno-reactive trypsin level on neonatal screening who is also found to be homozygous for the Δ F508 deletion

Differential diagnosis:

Differential diagnosis Immune deficiency Ciliary dyskinesia Asthma Kartagener’s/ Immotile cilia syndrome- rare 8/27/2012 46 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario:

Case Scenario 7 month old infant with cystic fibrosis who was admitted with 2 chest infections. He grew Staphylococcus aureus on his respiratory secretions 8/27/2012 47 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 48 Paediatric Respiratory Diseases/Dr S Sen

Cystic Fibrosis Team:

Cystic Fibrosis Team Paediatrician Specialist nurse Physiotherapist Dietician Clinical psychologist Social worker 8/27/2012 49 Paediatric Respiratory Diseases/Dr S Sen

Passive Smoking:

Passive Smoking Reduces birthweight by 250g 4500 pregnancy losses p.a. 30% increase in Perinatal Mortality Teratogenic : airways, cleft lip/palate Glue ear Carcinogenic 4 million children live with smoking parent Increase likelihood of asthma attack 8/27/2012 50 Paediatric Respiratory Diseases/Dr S Sen

Case Scenario :

Case Scenario 9 month old infant with 1 month h/o low grade fever,cough,irritability, neck rigidity, 8/27/2012 51 Paediatric Respiratory Diseases/Dr S Sen

PowerPoint Presentation:

8/27/2012 52 Paediatric Respiratory Diseases/Dr S Sen

Pulmonary Tuberculosis:

Pulmonary Tuberculosis Mycobacterium tuberculosis Notifiable disease Droplet infection Prevention(of severity): BCG Drug treatment: 2 mths- Isoniazid, Rifampicin, Pyrazinamide 4 mths- Isoniazid, Rifampicin 8/27/2012 53 Paediatric Respiratory Diseases/Dr S Sen

Common Respiratory problems in Children:

Common Respiratory problems in Children Surfactant Deficient Lung disease CLD of Prematurity Congenital diaphragmatic hernia Asthma Bronchiolitis Croup Cystic fibrosis Childhood pneumonias Tuberculosis 8/27/2012 54 Paediatric Respiratory Diseases/Dr S Sen

Thank you for staying awake:

Thank you for staying awake 8/27/2012 55 Paediatric Respiratory Diseases/Dr S Sen

authorStream Live Help