Respiratory smooth muscle more mature after 5 months

Respiratory smooth muscle more mature after 5 months old
o Younger the pt, less mature, worse off they are if they get respiratory
infection, esp if premature or post-premature baby
Bronchiolitis
 Inflammation , mucus filling of smallest airways
 Caused by bacteria or virus, most often by respiratory syncytial virus ( RSV )
 Highly contagious
 Increases mucus production
 Cough – to clear airways
 Fever
 Irritability, loss of appetite – dehydration!!
 Wheezing, coarse lung sounds -mucus & wet airways
Bronchiolitis: Respiratory Syncytial Virus
 Season is October-March
 Generally, the younger the child, the more severe the case
 Severity can range from mild cold-like symptoms to ICU, respiratory failure,
ventilator
 Chronic conditions = worse – asthma, heart conditions
 Protection: breast feeding
 Symptoms can linger up to a month
 Hospitalization can last weeks
 Virus can live on surfaces for over 6 hours
 Infectivity: don’t always get infected when you intro to your body
o RSV = 79% infectivity
 Isolation: Contact / Droplet
Bronchiolitis: Respiratory Syncytial Virus

 RSV is particularly dangerous for:
 Age < 24 months
 History of chronic lung disease
 Congenital heart disease
 Premature birth
 Synagis is an RSV immunoglobulin (antibodes) for those at high risk
 Given monthly – to at risk infants to help protect from RSV – not vaccine,
body doesn’t form defense (not acquired)
 Very expensive ($1500)
o Premie getting sick, ICU chance is higher & COST is higher…
Bronchiolitis: Diagnosis
 Nasopharyngeal culture
o Respiratory viral panel
 Chest x-ray
o Hyperinflation
o Atelectasis
Bronchiolitis/RSV Treatment
 antibiotics, if indicated (usually viral)
 Frequent saline (loosen secretions, protect mucosa), suction
 Oxygen, if indicated NC or intubation is needed
 IVFs/tube feeding, if indicated
 Respiratory support – vent, face mask, blow by
 Antipyretics – Tylenol, motrin for comfort
 Bronchodilators – albuterol – open airways
o Nebulizer or Metered Dose Inhaler
 Decongestants? Cough syrups?
o Only for ages > 6 yr
o Honey for cough suppressant only for >1yr
 Prevention
Which of the following interventions would be inappropriate for a baby with
bronchiolitis caused by RSV?
A. Frequent saline and suction
B. Nutrition via NG
C. Large, bolus feeds – vomit – smaller more frequent feedings!
D. Oxygen administration
Pneumonia
 Many times, pneumonia with bronchiolitis
 Inflammation or infection of the bronchioles and alveolar spaces of the
lungs
 Can be viral or bacterial or due to aspiration – feeding tubes pt
 Cause fever, cough, abdominal and chest tightness/pain, coarse lung sounds
Pneumonia: Diagnosis
 Based on history and physical
 CXR may show areas of consolidation

Pneumonia: Treatment
 Oxygen
 Humidification
 Hydration
 Antibiotics
 Antipyretics
 Prevention
 Bronchodilators
 Pulmonary Toileting –
hygiene, cough & deep
breathe, incentive
spirometer (suck like big
milk shake)
 BUBBLES!