This document discusses various pulmonary disorders that can affect children, including infections like croup, epiglottitis, and pneumonia. It describes respiratory distress syndrome in newborns, caused by lack of surfactant, and bronchopulmonary dysplasia, a chronic lung disease in preterm infants. Cystic fibrosis and its manifestations involving thick mucus in the lungs are also outlined. Sudden infant death syndrome is introduced as a condition of unknown cause that peaks at 3-4 months of age.

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Alterations of Pulmonary
Function in Children
Chapter 27

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Pulmonary Disorders
 Disorders of upper airways
 Acute upper airway obstructions
• Infections, foreign body aspiration, angioedema, and
trauma
 Chronic upper airway obstructions
• Congenital malformations, cartilaginous weakness,
vocal cord paralysis, and subglottic stenosis

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Pulmonary Disorders
 Breathing sounds
 A snoring noise is common for nasopharyngeal
obstructions
 Stridor
• Harsh, vibratory sound caused by turbulent flow
through a partially obstructed airway
• Inspiratory stridor is common with extrathoracic
airway obstructions
• Expiratory stridor is common with intrathoracic
airway obstructions

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Breathing Sounds

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Pulmonary Disorders
 Breathing sounds
 A weak or hoarse voice suggests possible
laryngeal problems
 A cough is an indicator of an irritative symptom

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Upper Airway Infections
 Acute laryngotracheobronchitis (croup)
 Acute epiglottitis
 Aspiration of foreign bodies
 Obstructive sleep apnea

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Croup
 Acute laryngotracheobronchitis
 Common in children from 6 months to 5
years
 Commonly caused by a virus
(parainfluenza, influenza A or RSV)
 Causes subglottic edema

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Croup
 Usually occurs after an episode of
rhinorrhea, sore throat, and fever
 Causes seal-like barking cough
 Self-limiting condition
 Severe cases are treated with nebulized
epinephrine

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Spasmodic Croup
 Similar hoarseness, cough, and stridor to
croup
 Usually in older children
 Demonstrates sudden onset, usually at
night, and with no previous viral illness
 Resolves quickly

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Upper Airway Obstruction with
Croup

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Acute Epiglottitis
 Severe, rapidly progressive, life-
threatening infection of the epiglottis and
surrounding area
 Usually caused by Haemophilus
influenzae type B
 Decreased incidence due to HIB vaccination

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Acute Epiglottitis
 Manifestations
 High fever, sore throat, inspiratory stridor, and
severe respiratory distress
 Treatment
 Emergency airway and antibiotics

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Aspiration of Foreign Bodies
 Foreign body aspiration in children occurs
frequently between the ages of 1 and 3
 Manifestations
 Coughing, choking, gagging, and wheezing
 Symptoms depend on foreign body size
 Aspirated foreign bodies can be removed
by bronchoscopy

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Obstructive Sleep Apnea
Syndrome (OSAS)
 Partial or complete upper airway
obstruction during sleep
 Obstructive sleep apnea disrupts normal
ventilation and sleep patterns
 The most common cause for childhood
obstructive sleep apnea is adenotonsillar
hypertrophy
 Treatment tonsillectomy and
adenoidectomy, or CPAP

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Respiratory Distress Syndrome
(RDS) of the Newborn
 Also known as hyaline membrane disease
(HMD)
 Poor lung structure and lack of adequate
surfactant
 Primarily a disease of preterm infants
 Causes widespread atelectasis, respiratory
distress, and pulmonary hypertension

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Respiratory Distress Syndrome
(RDS) of the Newborn
 Pulmonary hypertension causes continued
shunting of blood away from the lungs
(ductus arteriosus)
 Symptoms
 Tachypnea, expiratory grunting, nasal flaring,
dusky skin

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Respiratory Distress Syndrome
(RDS) of the Newborn
 Treatment
 Prevention of preterm birth
 Mechanical ventilation, surfactant
administration, glucocorticoid administration to
women in preterm labor

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RDS in the Newborn

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Bronchopulmonary Dysplasia
 Chronic disease; result of acute respiratory
disease in the neonatal period
 Caused by premature birth, immature
lungs, infections, genetics, poor formation
of alveoli, etc.

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Bronchopulmonary Dysplasia
 Manifestations
 Hypoxemia, hypercapnia, elevated work of
breathing, bronchospasm, mucus plugging,
pulmonary hypertension
 Bronchopulmonary dysplasia is not as
common because of the availability of
exogenous surfactant and antenatal
glucocorticoids

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Bronchopulmonary Dysplasia

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Respiratory Infections
 Bronchiolitis
 Pneumonia
 Bacterial pneumonia
 Viral pneumonia
 Atypical pneumonia
 Aspiration pneumonitis

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Respiratory Infections
 Bronchiolitis obliterans
 Asthma
 Acute respiratory distress syndrome
(ARDS)

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Asthma

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Cystic Fibrosis
 Autosomal recessive multisystem disease
 Exocrine or mucus-producing glands
secrete abnormally thick mucus because
of defective epithelial ion transport
 In the lungs, thick secretions obstruct the
bronchioles and predispose the lungs to
chronic infections

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Cystic Fibrosis
 Chronic inflammation leads to hyperplasia
of goblet cells, bronchiectasis, pneumonia,
hypoxia, fibrosis, etc.

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Cystic Fibrosis

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Sudden Infant Death Syndrome
(SIDS)
 Disease of unknown cause
 Incidence
 Lower during first month of life, increases in the
second month, and peaks at 3 to 4 months
 More common in male infants

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Sudden Infant Death Syndrome
(SIDS)
 Seasonal variation
 Possible relationship to respiratory infections
 Wide range of risk factors