Chapter 11:	The Infant
Page 11 0f 11

Miscellaneous Neonate/Pediatric Care Issues

There are a variety of other pulmonary-related problems affecting the neonatal/pediatric populations, and requiring the attention of respiratory care professionals, including:

Aspiration Syndromes: Since infants are seemingly obsessed with putting objects of all sorts into their little mouths, they are at high-risk of having their narrow airways accidentally obstructed. Aspiration of gastric contents is commonly the result of reflux in neonates, and the pathologic result of aspiration is airtrapping and tissue damage secondary to hydrocarbon aspiration. The trapping of air behind the object placed in the infant's mouth causes hyperexpansion of the lung, reduced ventilation, and possible pneumothoraces. The aspiration of hydrocarbons can cause toxic damage to the epithelial lining of the lung.

Treatment of an aspirated foreign object primarily involves actions aimed at removing the object. Chest physiotherapy often helps dislodge the object, while more severe cases may require the use of a bronchoscope to retrieve it.

Smoke Inhalation: Household fires give off many acids and aldehydes in their smoke, and inhalation of these noxious fumes can cause serious toxicities in the blood and tissues. Neonates, whose pulmonary systems are delicate even under normal conditions, are at high-risk for serious injury. Treatment of patients for smoke inhalation and carbon monoxide poisoning involves the immediate application of 100% oxygen, preferably under pressure.

The victims of smoke inhalation are also at risk for development of RDS, making it necessary for the caregivers to closely monitor their status. Antibiotics are given to combat lung infections, nebulized bronchodilators are helpful in maintaining the patency of the airways, and mechanical ventilation is required for comatose patients in order to establish an airway and administer oxygen.

Sudden Infant Death Syndrome (SIDS): While SIDS accounts for the highest number of deaths among infants under a year old, little is known regarding its etiology. The common event in all SIDS deaths is a quiet cessation of breathing during sleep. In fact, the diagnosis of SIDS is not made until an autopsy has been performed. In 1992, the American Academy of Pediatrics recommended that infants not be placed in the prone position to sleep because of association with SIDS.

While no exact relationship between the prone position and SIDS has been established, the reduction in the number of infants sleeping prone has recently been cited as a factor in the decline in SIDS-related deaths. Other factors that have been identified as elevating the risk for SIDS among infants include:

• the use of natural fiber mattresses
• swaddling
• recent illness
• the use of heating in the bedroom
• low birth weight
• prematurity
• a five minute Apgar score under 7
• low maternal age and education level
• multiple births
• maternal smoking ·
• male gender
• black race

Even with a knowledge of the various risk factors, it remains impossible to identify those infants who will die of SIDS, and the incidence remains at about 2 out of every 1,000 births.

Cystic Fibrosis (Mucoviscidosis)

CF is a chronic pulmonary disease that is characterized tenacious mucus production which causes obstruction, leading to hyperinflation, an increased chest diameter (barrel-like chest), atelectasis, and infection.

A majority of patients with CF are diagnosed in childhood, but a few are not diagnosed until their mid to late teens. The most reliable diagnostic indicator of CF is the determination of abnormally high sweat chloride levels. Other symptoms associated with CF include: a chronic paroxysmal cough, cyanosis, digital clubbing, atelectasis, hemoptysis, hypoxemia, hypercapnia, and pneumothorax.

Until a cure is found for CF, treatment is primarily aimed at improving long-term survival and improving the quality of life. Protocols call for treating the pulmonary, dietary and psychological aspects of the disease. Therapies available for effectively treating CF patients include administration of mists, aerosols, positive-pressure, physiotherapy, antibiotics, and oxygen.