Newborn and Early Childhood

Respiratory DisordersRT 265

Chapter 33

Childhood Definitions Neonate

Birth to 1 month (first 28 days)

Infant 1 month to 1 year (some texts use until 3rd

year)

Pediatric 1 year to 12 years (some texts use until 21st

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