![Page 1: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/1.jpg)
Respiratory Respiratory Disease In Disease In ChildhoodChildhood
Nick ConnollyNick ConnollyPaediatric SpRPaediatric SpR
NHS TaysideNHS Tayside
![Page 2: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/2.jpg)
Respiratory problems in Respiratory problems in childrenchildren
Neonatal respiratory problems Respiratory problems in older children
Chronic Acute
![Page 3: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/3.jpg)
Scenario Scenario
An infant born at 30 weeks gestation develops respiratory distress at age 2 hours
![Page 4: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/4.jpg)
![Page 5: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/5.jpg)
![Page 6: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/6.jpg)
Respiratory Distress Syndrome
Relative Surfactant deficiency1% all birthsPredominantly in preterm – inverse
relationship with gestation
![Page 7: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/7.jpg)
Surfactant
PhospholipidApoproteinsSecreted at 30-32/40 Lack of surfactant results in atelectasis and
impairment of gas exchangeProduction stimulated by steroids
![Page 8: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/8.jpg)
Incidence of RDS relative to gestational age
0
10
20
30
40
50
60
70
80
90
100
26 28 30 32 34 36 38 40Gestational Age
% with clinical RDS
![Page 9: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/9.jpg)
Further problems
VentilatedSudden deterioration requiring increased
oxygenNo breath sounds on the right side of chest
![Page 10: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/10.jpg)
![Page 11: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/11.jpg)
Pneumothorax
Air in pleural spaceIncreased incidence with IPPV, CPAP and
ventilation Other risk factors – RDS (stiff lungs)Spontaneous - occurs in around 1% vaginal
deliveries, 1.5% caesarean sections
![Page 12: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/12.jpg)
![Page 13: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/13.jpg)
Chronic Lung Disease
Oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease on CXR
Generally follows RDSBarotrauma, volume trauma, high inspired oxygenHealing stage associated with continued lung
growth over 2-3 years – often wheezy
![Page 14: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/14.jpg)
ScenarioScenario
New born full-term infant with severe breathing difficulty after birth
?Dextrocardia
![Page 15: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/15.jpg)
![Page 16: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/16.jpg)
Diaphragmatic HerniaDiaphragmatic Hernia
Incidence:1/2400Associated pulmonary hypoplasiaCommonest- Posterolateral (Bochdalek),
left-sidedAvoid bag-mask IPPV?Respiratory supportSurgical
![Page 17: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/17.jpg)
![Page 18: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/18.jpg)
Older Children
![Page 19: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/19.jpg)
Examination
Weight(length/height)..plotted!?clubbingChest shapeAuscultation
![Page 20: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/20.jpg)
Breathing testsBreathing tests
![Page 21: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/21.jpg)
![Page 22: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/22.jpg)
Chronic problems
![Page 23: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/23.jpg)
Cystic fibrosisCystic fibrosis
A 1 year-old child presenting with a prolonged history of cough, loose stools and failure to thrive
A newborn infant with a raised immuno-reactive trypsin level on neonatal screening who is also found to be homozygous for the ΔF508 deletion
![Page 24: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/24.jpg)
Cystic Fibrosis
Autosomal recessiveCarrier incidence roughly 1 in 25 peopleMutations in the CFTR geneMultisystem disorderRespiratory infections are prominent
![Page 25: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/25.jpg)
![Page 26: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/26.jpg)
Differential diagnosisDifferential diagnosis
Immune deficiencyCiliary dyskinesiaAsthmaKartagener’s/ immotile cilia syndrome- rare
![Page 27: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/27.jpg)
ScenarioScenario
NM is a 7 month old infant with cystic fibrosis who was admitted with 2 chest infections. He grew Staphylococcus aureus on his respiratory secretions
![Page 28: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/28.jpg)
![Page 29: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/29.jpg)
Cystic Fibrosis TeamCystic Fibrosis Team
ClinicianSpecialist nurseClinical psychologistSocial workerPhysiotherapistDietician
![Page 30: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/30.jpg)
A 7-year child presents to your A 7-year child presents to your clinic with a 3-month history of clinic with a 3-month history of cough worse at night or during cough worse at night or during
active playactive play
Diagnosis: ASTHMA
![Page 31: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/31.jpg)
Asthma – Diagnosis in ChildrenSIGN 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 auscultationResponse to Rx
![Page 32: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/32.jpg)
Asthma – Diagnosis in Children
SIGN Guideline May 2008
High Probability – diagnosis of asthma likely(trial of Rx – further Ix if poor response)
Low Probability – consider Ix & ? Referral
Intermediate Probability: ?watchful waiting ?spirometry(response) ? Rx & evaluate
![Page 33: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/33.jpg)
Asthma – Diagnosis in Children
![Page 34: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/34.jpg)
ManagementManagement
Stage 1: Treat with inhaled beta-agonists when needed
Stage 2: Treat with regular inhaled steroidsStage 3A: Regular inhaled steroids + Long
acting beta agonistsStage 3B: Stage 3A + Leukotriene
antagonists
![Page 35: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/35.jpg)
![Page 36: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/36.jpg)
Passive Smoking
Reduces birthweight by 250g4500 pregnancy losses p.a.30% increase in Perinatal MortalityTeratogenic : airways, cleft lip/palateGlue ear Carcinogenic4 million children live with smoking
parentIncrease likelihood of asthma attack
![Page 37: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/37.jpg)
Acute problems
![Page 38: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/38.jpg)
Acute asthmaAcute asthma
Cough and wheeze worsening over hours or days
![Page 39: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/39.jpg)
![Page 40: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/40.jpg)
TreatmentTreatment
OxygenNebulised bronchodilatorOral prednisoloneIV salbutamolIV aminophyllineIV magnesiumVentilatory support
![Page 41: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/41.jpg)
![Page 42: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/42.jpg)
Scenario
6 week old presented with increased work of breathing and possible apnoes
URTI symptoms over last 2 days
![Page 43: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/43.jpg)
Bronchiolitis
Viral infection – RSVUsually under 18 months oldMore severe in younger babies, ex prem,
family of smokersTachypnoea, poor feeding, irritating coughApnoea in small babiesTreatment is supportiveIncreased incidence of wheezing episodes in
the next ?10 years
![Page 44: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/44.jpg)
Scenario 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
![Page 45: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/45.jpg)
![Page 46: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/46.jpg)
PneumoniaPneumonia
Neonates: GBS, E.coli, Klebsiella, Staph aureus
Infants: Strep pneumoniae, ChlamydiaSchool age: Strep pneumoniae, Staph
aureus, Gr A strep, Bordetella, Mycoplasma, Legionella
![Page 47: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/47.jpg)
ScenarioScenario
A 2-year old child presenting with barking cough and difficulty in breathing of sudden onset
![Page 48: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/48.jpg)
Differential DiagnosisDifferential Diagnosis
Inhaled foreign bodyLaryngomalaciaEpiglottitis and bacterial tracheitisAllergyCroup
![Page 49: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/49.jpg)
![Page 50: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/50.jpg)
![Page 51: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/51.jpg)
Croup
Viral laryngotracheobronchitisStridor, barking coughTreatment is oral steroid to reduce
inflammation
![Page 52: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/52.jpg)
Scenario Scenario
9 month old infant from developing country with irritability, neck rigidity, afebrile
![Page 53: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/53.jpg)
![Page 54: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/54.jpg)
Pulmonary TuberculosisPulmonary TuberculosisMycobacterium tuberculosisNotifiable disease1/3 of World Population!Droplet infectionPrevention(of severity): BCGDrug treatment: 2 mths- Isoniazid, Rifampicin, Pyrazinamide 4 mths- Isoniazid, Rifampicin
![Page 55: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/55.jpg)
Common respiratory Common respiratory problems in childrenproblems in children
Infant respiratory distress syndromeCLDCongenital diaphragmatic herniaCystic fibrosis AsthmaBronchiolitisChildhood pneumoniasCroupTuberculosis
![Page 56: Respiratory Disease In Childhood Nick Connolly Paediatric SpR NHS Tayside](https://reader030.vdocument.in/reader030/viewer/2022032705/56649dc85503460f94abd14c/html5/thumbnails/56.jpg)
FINISHED