PAEDIATRIC RESPIRATORY
INCOMPLETE fusion of tracheoesophageal folds in 4th
week leads to TEF – recurrent pneumonitis
Embryological Defects
QUICK QUESTIONS
What is one outcome of the lack of lymphatics
in Reinke’s space?
Ø Tumours don’t metastasise
Difference between nasal cavity respiratory
and olfactory epithelium
Ø No goblet cells
Ø No cilia
Do bronchioles have hyaline cartilage?
Ø No
What is the difference between terminal and
respiratory bronchioles?
Ø Respiratory bronchioles have alveoli
for gas exchange
Risk Factors of Respiratory Distress in the Newborn
, RESP H+E
• Age important (< 3/12 most vulnerable to apnoea)
• Feeding + drinking Hx: sig. changes?
• Activity levels + sleeping: Quiet or clingy
Reason for young age:
• PMHX:
o Pattern of wheeze (assoc. w/ bronchiolitis) OR 1) Soft cartilage (easier
Resp.
collapse)
o FHx of atopy (eczema, asthma, hayfever) 2) Narrower airways
• Red-flags: ? 3) May be unvaxxed
Hx
o fevers, 4) Immature immune system
o pre-term, NICU,
o Hx of apnoea, CV or resp. diseases
o parents report sig. change
o stridor at rest
o quiet chest
1) ?Level of alertness – interactive/playful ® agitated ® lethargic/tired
2) Check for any vomit ® aspiration pneumonia?
3) ?Posture – propped up (easier to breathe) or lying down
Inspect 4) ?Ability to speak – normal ® short sentences ® cannot speak or
complete sentences
5) Body / facial dysmorphia
Petechiae due to heavy chronic cough
Clubbing in Children
• Hereditary clubbing
• Cyanotic heart disease URTI LRTI
• Infective endocarditis • Coryza • Productive cough
Hands
• Cystic fibrosis • Wheeze • Crackles
• Tuberculosis • Stridor • ↓air-entry
• Inflammatory bowel disease bilaterally
• Liver cirrhosis
Check with child’s age to determine if tachycardic, tachypnoeic
Ø Tachypnoea ® late sign (bradypnea) ® resp. arrest
VITALS
Ø Detect hypoxia early (i.e. before it fall below 90% -- prevent decompensation)
o Supp. oxygen given if sats < 92% ® NP, HM, NRBM, CPAP
• Rib recession (mild-mod-severe) – tracheal tug, supraclavicular, sternal (=severe), intercostal, subcostal
Exam
WoB o Younger children show recession more frequently, due to their softer chest walls
• Accessory muscles ® head bobbing (SCM = severe), abdominal breathing, nasal flaring
(ABCDE) • Coryza (runny nose) – common in URTIs, bronchiolitis and well infants!
• Wheeze (exp.) – narrowed lower airways during expiration – asthma, bronchiolitis, viral-induced wheeze
• Stridor (insp. + exp.) – upper airway obstruction
Abnormal o Acute stridor è croup (+ hoarseness), anaphylaxis, FB inhalation
airway
noise
o Chronic stridor è laryngomalacia, subglottic stenosis
o *THE SOFTER THE STRIDOR – THE WORSE THE NARROWING
• Grunting (exhaling while glottis is partially closed creating PEEP) OR crying in prolonged expiration – closed glottis to keep alveoli
open - infants with severe respiratory distress
• Hot potato voice = laryngitis
• Cushingoid -= steroid usage
• Nasal flaring/grunting è increased WoB è congenital cyanotic HD or HF
• Micrognathia (undersized jaw) è genetic issue (e.g. Marfan, Noonan, Pierre-Robin),
• Ears = tympanic membrane (otitis media – URTi), hearing loss (primary ciliary dyskinesia)
• Throat = tonsiillitis, pharyngitis, quinsy (trismus), EBV (white exudates), poor dentition (caries)
• Audible wheeze (e.g. croup, viral-induced wheeze, bronchiolitis)
Auscult • WET Crepitations (secretions = infection) è RHONCHI
• Bronchial breathing (consolidation due to pneumonia) – coarse sound
• VITALS, FiO2, • Sputum sample
• UA (nephrotic, subacute bacterial endocarditis) • PEFR + inhaler technique
Ix • VBG • Measure + plot height and weight on growth chart
• CXR
• ECG (3-lead)
INCOMPLETE fusion of tracheoesophageal folds in 4th
week leads to TEF – recurrent pneumonitis
Embryological Defects
QUICK QUESTIONS
What is one outcome of the lack of lymphatics
in Reinke’s space?
Ø Tumours don’t metastasise
Difference between nasal cavity respiratory
and olfactory epithelium
Ø No goblet cells
Ø No cilia
Do bronchioles have hyaline cartilage?
Ø No
What is the difference between terminal and
respiratory bronchioles?
Ø Respiratory bronchioles have alveoli
for gas exchange
Risk Factors of Respiratory Distress in the Newborn
, RESP H+E
• Age important (< 3/12 most vulnerable to apnoea)
• Feeding + drinking Hx: sig. changes?
• Activity levels + sleeping: Quiet or clingy
Reason for young age:
• PMHX:
o Pattern of wheeze (assoc. w/ bronchiolitis) OR 1) Soft cartilage (easier
Resp.
collapse)
o FHx of atopy (eczema, asthma, hayfever) 2) Narrower airways
• Red-flags: ? 3) May be unvaxxed
Hx
o fevers, 4) Immature immune system
o pre-term, NICU,
o Hx of apnoea, CV or resp. diseases
o parents report sig. change
o stridor at rest
o quiet chest
1) ?Level of alertness – interactive/playful ® agitated ® lethargic/tired
2) Check for any vomit ® aspiration pneumonia?
3) ?Posture – propped up (easier to breathe) or lying down
Inspect 4) ?Ability to speak – normal ® short sentences ® cannot speak or
complete sentences
5) Body / facial dysmorphia
Petechiae due to heavy chronic cough
Clubbing in Children
• Hereditary clubbing
• Cyanotic heart disease URTI LRTI
• Infective endocarditis • Coryza • Productive cough
Hands
• Cystic fibrosis • Wheeze • Crackles
• Tuberculosis • Stridor • ↓air-entry
• Inflammatory bowel disease bilaterally
• Liver cirrhosis
Check with child’s age to determine if tachycardic, tachypnoeic
Ø Tachypnoea ® late sign (bradypnea) ® resp. arrest
VITALS
Ø Detect hypoxia early (i.e. before it fall below 90% -- prevent decompensation)
o Supp. oxygen given if sats < 92% ® NP, HM, NRBM, CPAP
• Rib recession (mild-mod-severe) – tracheal tug, supraclavicular, sternal (=severe), intercostal, subcostal
Exam
WoB o Younger children show recession more frequently, due to their softer chest walls
• Accessory muscles ® head bobbing (SCM = severe), abdominal breathing, nasal flaring
(ABCDE) • Coryza (runny nose) – common in URTIs, bronchiolitis and well infants!
• Wheeze (exp.) – narrowed lower airways during expiration – asthma, bronchiolitis, viral-induced wheeze
• Stridor (insp. + exp.) – upper airway obstruction
Abnormal o Acute stridor è croup (+ hoarseness), anaphylaxis, FB inhalation
airway
noise
o Chronic stridor è laryngomalacia, subglottic stenosis
o *THE SOFTER THE STRIDOR – THE WORSE THE NARROWING
• Grunting (exhaling while glottis is partially closed creating PEEP) OR crying in prolonged expiration – closed glottis to keep alveoli
open - infants with severe respiratory distress
• Hot potato voice = laryngitis
• Cushingoid -= steroid usage
• Nasal flaring/grunting è increased WoB è congenital cyanotic HD or HF
• Micrognathia (undersized jaw) è genetic issue (e.g. Marfan, Noonan, Pierre-Robin),
• Ears = tympanic membrane (otitis media – URTi), hearing loss (primary ciliary dyskinesia)
• Throat = tonsiillitis, pharyngitis, quinsy (trismus), EBV (white exudates), poor dentition (caries)
• Audible wheeze (e.g. croup, viral-induced wheeze, bronchiolitis)
Auscult • WET Crepitations (secretions = infection) è RHONCHI
• Bronchial breathing (consolidation due to pneumonia) – coarse sound
• VITALS, FiO2, • Sputum sample
• UA (nephrotic, subacute bacterial endocarditis) • PEFR + inhaler technique
Ix • VBG • Measure + plot height and weight on growth chart
• CXR
• ECG (3-lead)
