Newborn and Early Childhood Respiratory Disorders RT 265 Chapter 33

Childhood Definitions  Neonate  Birth to 1 month (first 28 days)  Infant  1 month to 1 year (some texts use until 3 rd year)  Pediatric  1 year to 12 years (some texts use until 21 st year)

Development of the Respiratory System

Lung Growth

Transition at Birth  Clear lung fluid  High transpulmonary pressures to open lungs  Breathing must be stimulated  Pulmonary vasodilation, decreased PVR  Constriction of the ductus arteriosus  Closure of umbilical blood supply closes ductus venousus  Increased SVR  Closure of the foramen ovale

Pathophysiological Differences  Flexible compliant thorax  Low lung compliance  High negative intrapleural pressures during inspiration

Clinical Manifestations of Distress  Retractions  Flaring nostrils  Expiratory grunting  Apnea of prematurity  Persistent pulmonary hypertension of the newborn

Arterial Blood Gases  Acute alveolar hypoventilation with hypoxemia  Acute ventilatory failure with hypoxemia  Low oxygen levels due to ……  Pulmonary shunting and venous admixture  PPHN  Infant fatigue

Apgar Score  Scores:  0-3 – severe distress  4-6 – moderate distress  7-10 – absence of difficulty in adjusting to extrauterine life  The 5 minute score should be higher than the 1 minute score

Pediatric Patients  Not “little adults”  Differences in physiology affect drug dosing  Requires equipment and techniques tailored to size, weight, and age

Newborn and Pediatric Assessment  Systematic collection of clinical data  Assessment of the data  Formulation of an appropriate treatment plan  Utilizing:  Objective data  Assessments  Treatment plans  Apgar Score