Broncho pulmonary dysplasia foreign body aspiration

Broncho-pulmonary Dysplasia
 Foreign Body Aspiration
 Apnea/ALTE
 Lower Respiratory Considerations
o Alveoli maturity 32-36 weeks gestation
o Respiratory smooth muscle more mature after 5 months old
 Bronchiolitis
o Inflammation, mucus filling of smallest airways
o Caused by bacteria or virus, most often by respiratory syncytial virus (RSV )
o Highly contagious
o Increases mucus production
o Cough
o Fever
o Irritability, loss of appetite
o Wheezing, coarse lung sounds
 Bronchiolitis: Respiratory Syncytial Virus
o Season is October-March
o Generally, the younger the child, the more severe the case
o Severity can range from mild cold-like symptoms to respiratory failure
o Symptoms can last up to a month

o Virus can live on surfaces for over 6 hours
o Isolation: Contact/Droplet
o ***BREAST MILK = HUGE protection against RSV and other dx
 Use saline when suctioning babies with wall suction so not to dry out membranes
o RSV is particularly dangerous for:
 Age < 24 months
 History of chronic lung disease
 Congenital heart disease
 Premature birth
 Synagis is an RSV vaccine for those at high risk
 *not really a vaccine – has antibodies to protect against RSV
 Given monthly – costs 1500-2000/month – way cheaper than being admitted to ICU
o Bronchiolitis: Diagnosis
 Nasopharyngeal culture
 Chest x-ray
 Hyperinflation
 Atelectasis
o Bronchiolitis/RSV Treatment
 antibiotics, if indicated (usually viral)
 Frequent saline, suction – only when needed. Causes irritation and swelling
 Suction before they eat (nose breathers)
 If retractions or having problems
 Oxygen, if indicated
 IVFs/tube feeding, if indicated
 Respiratory support – ventilator if needed
 Antipyretics
 Bronchodilators – albuterol not helpful against RSV, will give anyway
 Decongestants? Cough syrups?
 DO NOT GIVE ANYTHING until 6yrs old
 Give Tylenol, motrin, humidifiers,
 Over 12 months of age – can give honey (under = possible botulism)
 Prevention
 Pneumonia
o Inflammation or infection of the bronchioles and alveolar spaces of the lungs
o Can be viral or bacterial or due to aspiration
o Cause fever, cough, abdominal and chest pain, coarse lung sounds
o Pneumonia: Diagnosis
 Based on history and physical
 CXR may show areas of consolidation

o Pneumonia: Treatment
 Oxygen
 Humidification
 Hydration
 Antibiotics
 Antipyretics
 Prevention
 Bronchodilators – albuterol
 Pulmonary Toileting – Incentive spirometer, blowing bubbles
 Pertussis
o “whooping chough”
o Caused by bacteria bordetella pertussis
o Resistant strains are developing and many children are going unvaccinated
o Leads to severe coughing spells , respiratory distress, and apnea
o Starts with 1-2 weeks of mild cold symptoms followed by up to 4 weeks of severe coughing
o Can lead to pneumonias
o Up to 2 months old – most at risk

o ***Mucus MUCH thicker than RSV, upper airway narrowing
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