& Pediatric Respiratory Care
NORTHEASTERN UNIVERSITY BOUVE
COLLEGE OF PHARMACY AND HEALTH
INTRODUCTION TO PERINATAL/PEDIATRIC RESPIRATORY CARE
Day #: | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | final |
Course Description- Lecture
course begins with the American Academy
of Pediatrics Newborn Resuscitation Program
(the practical for which is completed in lab). Then the program
falls back to an overview of human cardiopulmonary development from the
time of conception through the childhood years. Normal and abnormal
manifestations of pregnancy, labor and the process of delivery are then
discussed with an emphasis on those factors which compromise the
cardio-respiratory health of the neonate. Respiratory care of the acutely
ill neonate and the acutely and chronically ill infant and pediatric
patient is a major focus on the course with much exploration into methods
of assessment and trends in current practice. Some associated
non-cardiopulmonary disorders of prematurity are considered, and there
will be some examination and discussion of the common congenital cardiac
anomalies. Care for common pediatric diseases shall be reviewed. This
course closely parallels and complements the laboratory course.
R.A. Jackson RRT CPFT NPS Phone: 617.680.0152
Lauren Perlman RRT
Lecture Class Meeting Time
October 9 - Colombus
November 23 - Thanksgiving
Finals December 14
Perinatal & Pediatric Respiratory Care
3rd. Ed., Albany, NY
Delmar, 2001 ISBN 0766813738
of Neonatal Resuscitation 5th ed., American Heart Assn.
list of objectives for each study topic will be distributed, usually at
the beginning of each class meeting. Class discussions and examinations
will focus on these objectives. It is the student's responsibility to meet
all objectives, utilizing arterial presented in class, handouts, and
assigned reading and video programs.
examinations are scheduled. The first will be at Newborn Resuscitation.
The second is at mid quarter. A final examination will evaluate the
remainder of the study topics. This examination will be given during the
final exam week according to the published schedule.
percent of the course grade will be based on attendance and participation
at class meetings.
final grade for the course will be according to the following
Written Exam 10%
Term Examination 35%
Lecture Study Topics, Objectives & Reading Assignments
Lecture 1 (
Thurs. Sept. 7, '06)
Introduction to the Course
Heart Assn. American
Academy for Pediatrics Newborn
Resuscitation Manual (4th Edition)
Embryologic & Fetal Development
the embryology and the approximate time of development of the morula,
blastocyst,blastoderm, and trophoblast.
the three germ layers and the body structures that evolve from each
the four periods of embryonic lung growth and describe the major
milestones of each period
the three Reid's rules regarding lung growth. Describe the general lung
development that takes place after birth.
the functions of the amnionic fluid and define the following:
Visible Embryo http://www.visembryo.com/baby/hp.html
Basic Embryology Review http://www.med.upenn.edu/meded/public/berp/
Michael J Embryo http://msrcol.org/nu/embryo.html
� 14 mm embryo lung branching
� REID's RULES for FETAL DEVELOPMENT
� generations of airway branching
� Cardiac Embryogenesis
Lecture 2 (
Thurs. Sept. 14, '06)
fetal lung fluid, describe the following:
hazards of lung fluid retention
the embryonic development of the heart including:
of the cardiac chambers
of major vessels and cardiac chambers
regard to fetal circulation, describe and explain:
cause of pressure differences between the right and left heart.
flow of blood from the placenta, trough the body, and back to the
shunt that is encountered with the approximate amount of blood that
passes each shunt.
an approximate history, determine whether a pregnancy is high risk.
the effects of maternal age on pregnancy risk.
the features of toxemia of pregnancy.
the conditions related to uteroplacental insufficiency.
the possible results of uteroplacental insufficiency.
the possible effects fo maternal infection with rubella, toxoplasmosis,
herpes,cytomegalovisis, and syphilis on the fetus.
and describe maternal anatomic abnormalities which may increase fetal
how ultrasonography is used to assess fetal status.
the possible effects of maternal diabetes on fetal development in general
and on lung maturation in particular.
Teratogenensis . Describe the effects of the abuse of such teratogens as
tobacco, marijuana, cocaine and alcohol.
amniocentesis and describe the role of each of the following
of meconium staining
examination of cells
- Review maternal history antenatal & prepartum
- Stress testing
- Lung maturity premature and/or premature rupture of
membranes, anesthesia, medications, presence of meconium
Reading Assignment: Whitaker, pp. 3-10; 15-25 EMBRYO
pp. 225 Maternal Drug Abuse ...........................................................................
The High Risk Pregnancy: Assessment of Fetal Growth
Labor, Delivery, and Physiologic Changes After Birth
-Stages of Normal Labor and Delivery
-Abnormal Labor and Delivery
-Adaptation to Extrauterine Life
and describe the different methods of measuring fetal heart rates and
describe the cause and characteristics of the following:
how fetal scalp pH is used to assess fetal asphyxia
and describe the five methods used to estimate the date of delivery.
and contrast the contraction stress test with the non-stress test.
Describe how each is performed and the advantages and disadvantages.
the use fetal movements as methods of assessing fetal well being.
the six tests used in the biophysical profile.
the implications of meconium stained amnionic fluid in assessing fetal
the basic process of cervical dilatation and effacement. Identify the most
station and how it is expressed. Describe the sequence of events that lead
to the descent and delivery of the fetus.
tocolysis and describe the various methods used to achieve tocolysis .
dystocia and describe the three etiological factors that cause it.
each of the following types of presentation
or footling breech.
of the umbilical cord and occult cord compression.
and describe the three types of placenta previa.
the three categories of abruptio placentae and discuss treatment.
the issues and risks associated with premature rupture of membranes (PROM)
the indications for Cesarean birth
the problems of multiple gestation in high risk pregnancies.
what occurs in discordant and parabiotic twinning.
the factors that are responsible for the first breath
the importance of overcoming surface forces in adapting to extrauterine
and describe factors that cause the change from fetal to the adult
Assignment: Whitaker pp30-46 111-130 L&D webpage
Delivery and Assessment of th Newborn
- oligo &
- Mike J Labor & Delivery
- Rgestational age, birth weight, physical findings, APGA
scores, breathing pattern
Lecture 3 (
Thurs. Sept. 21, '06)
Surfactant Deficiency & Severe Prematurity
surface tension and describe the following:
it is developed
to alveolar mechanics.
Discuss the role of surfactant in
Identify the major componants of pulmonary surfactant and explain their
the risk factors associated with the development of respiratory distress
and describe the abnormalities typically associated with RDS
the pathopyhysiology of RDS. Explain why alveolar hyaline membranes are
formed.Describe the vicious cycle which contributes to the deteriorationg
clinical condition of the infant with RDS.
the clinical features of RDS and describe the usual clinical course.
a case description of a patient with typical but severe care of RDS,
identify key steps in the proper treatment and management.
the disorders which frequently accompany RDS or are complications of
the essential features foan effective exogenous surfactant
the many types of exogenous surfactant.
hysteresis and describe and justify the shape of a normal hysteresis
curve. Explain how a decreased pulmonary surfactant would affect the
the normal values for functional residual capacity (FRC), pulmonary
compliance, airway resistance, tidal volume, minute ventilation,
deadspace, and alveolar ventliation of the term newborn. Explain how these
values change with age.
what is meant by time constants and the consequences of decreased
the effecte of decresaed compliance and increased airway resistance on
tidal volume and respiratory rate in the newborn.
the differences between the adult and the newborn infant with regard to
ventilation/perfusion ratio, diffusing capacity, and hemoglobin type.
the consequences of increased fetal risk and identify the extrapulmonary
complications of prematurity in the neonate. Discuss IUGR and distinguish
between the two types.
Whitaker pp 10-15 Surface forces and the role of surfactant pp 294-299
458-469 Respiratory Distress Syndrome
Disease at Virtual Hospital
Reading Assignment: Whitaker pp10-15, 53-71
Transient Tachypnea & Pneumonia
Tachypnea of the Newborn
the etiology of transient tachypnea of the newborn (TTN) and identify the
types of neonates and the perinatal situations which give rise to this
the typical presentation and progression of TTN.
how TTN is diagnosed. Describe the typical chest x-ray findings.
a typical TTN case, discuss how the patient should be managed.
between early onset and late onset neonatal pneumonia. Compare the two
types' response to treatment. Explain the ways in which transmission of
pathogens can occur in the neonate.
the most common causative organism for neonatal pneumonia. Identify the
complications that occur with this pneumonia. Identify other
transplacental and perinatally acquired organisms.
causative organisms for late onset pneumonia. Discuss the ways in which
pathogenbs are transmitted.
the clinical presentation,the most frequently encountered clinical
issues,the typical x- ray findings, and the general management of the
neonate with pneumonia.
the conditions which predispose a neonate to the meconium aspiration
syndroome (MAS). Describe the meconium material.
the do's and don'ts for the delivery room management of the meconium
key areas in the management of the MAS infant. Contrast the various
clinical scenarios that could occur with MAS. Explain the limitations of
conventional interventions and why they sometimes fail.
Disease at Virtual Hospital
Reading Assignment: Whitaker. pp 322 (TTN),
386-387 (pneumonia), 312-316, 474-506 Mechanical Ventilation, 557-560, 602-605
Home Ventilation, 135-140 Pulmonary Function Testing (meconium aspiration)
Lecture 4 ( Thurs. Sept.
Complications of Prematurity
retinopathy of prematuriy (ROP) and explain in general terms the nature of
this disease. Identify the risk factors for developing ROP.
the process by which ROP develops. Describe the five stages of ROP.
Identify the ways in which the disease is treated.
between intracranial and intraventricular hemorrhage in terms of the
gestational ages they affect and the area of the brain in which they are
the physiological reasons by which intracranial and intraventricular
hemorrhages develop. List the contributory factors of intraventricular
the clinical signs that may be present in the neonate who is developing
and intraventricular hemorrhage (IVH).
how long-lasting complications from IVH are managed. Explain how the
condition known as posthemorrhagic hydrocephalus (PHH) develops and how it
the infant who is at risk for necrotizing enterocolitis (NEC). Explain how
NEC is diagnosed and how the infant on "NEC watch" is managed.
the pathophysioloy of NEC and the treatment.
Reading Assignment: Whitaker, pp. 170-171, 214-216 (NEC),
Additional Issues in Prematurity
the types of air leak syndromes that occur frequently in the neonate.
Explain the pathophysiology of each of the types.
the types fo pulmonary interstitial emphysema (PIE). Explain how PIE
develops and how it can be prevented or minimized. Describe the
ways in which pneumothorax can develop. Discuss the difference between
spontaneous pneumothorax and tension pneumothorax.
how pneumothorax can be diagnosed. Decribe the signs and symptoms. Explain
how the transilluminator is used to diagnose pneumothorax.
the emergency and non-emergency treatment of pneumothorax.
pneumomediastinum from pneumothorax and discuss the treatment.
-Congenital Anomalies Involving the Airway
-Infectious Disease Involving the Airway
neonatal jaundice and discuss its prevalence in the newborn population.
Explain in basic terms why neonatal jaundice is
problematic,differentiating between physiologic and non- physiologic
the source of bilirubin and explain in basic terms how unconjugated
bilirubin becomes conjugated. Explain what can happen to allow
persistently high serum levels of unconjugated bilirubin
the common issues that occur in the neonate that can lead to
Discuss the dangers and complications of jaundice. Explain what is meant
by kernicterus. Outline the basic treatments.
Assignments: Whitaker, pp. 316-319 (PIE), 210-214 (Jaundice)
Lecture 5 (
Thurs. Oct. 5, '06)
the type of child who has obstructive sleep apnea. Discuss some of the
major treatments for this problem.
sudden infant death sydrome (SIDS) and identify the age group affected.
Explain how a diagnosis is made.
why SIDS is sometimes called a development disorder. Identify the major
risk factors for the syndrome. Explain how the risks for SIDS can be
minimized. Discuss the position theory.
what is meant by an ALTE and how a patient affected by SIDS can become an
intensive care admission.
the types of congenital tracheoesophageal fistulas.
what is meant by esophageal atresia. Describe the signs seen in the
newborn that may lead to a suspicion TEF.
how the infant with TEF should be positioned.
the signs of choanal atresia and explain how the affected infant should be
managed before surgical repair. Explain what is meant by apnea fo
prematurity. List the three types of apnea.
the mechanism to which the cause of apnea of prematurity is attributed.
when most episodes fo apnea occur. Identify the common disorders which are
reported to precipitate apnea of prematurity.
Explain how the infant who is prone to apnea spells is cared for and monitored.
State the target theophylline level range.
Whittaker pp. 323-326 (Apnea)
6 (Thurs. Oct. 12, 06)
Lecture 7 (Thurs.
Oct. 19, '06 )
Airway Anomalies in the Infant and Child
stridor . Given the type of stridor, identify where in the airway an
obstruction is likely to be located.
the types of supraglottic airway abnormalities.
those types of obstructions that interfere with obligate nasal breathing.
Explain how an infant with bilateral nasal obstruction might behave.
choanal atresia and explain why this conditions affects obligate nasal
breathing. Explain how the condition is clinically diagnosed.
CHARGE syndrome by explaining the acronym. Explain the airway issues
in this syndrome.
how crainiofacial dysmorphology may produce airway obstruction and other
difficulties. List the three most common types of crainiofacial
the characteristics of Pierre Robin, Treacher Collins, and Apert's
the main feature of Beckwith Wiedemann syndrome and explain how airway
obstruction occurs in this syndrome.
how and why Down's syndrome is associated with upper airway obstruction.
how hemangiomas and neuroblastomas can be associated with airway
laryngotracheomalacia and identify its cause. Describe its usual
presentation and usual course.
and describe those disorders which obstruct the airway at supraglottic,
glottic, and subglottic areas. Where appropriate, discuss the causes of
these disorders, the signs and symptoms, the clinical manifestations, and
tracheoespophageal fistula and espohageal atresia. Describe the two
most common presentations of these anomalies. Discuss the signs and symptoms,
diagnosis, and respiratory implications of this disorder. Identify
theanacronyms VATER and VACTERL, and explain their association to
tracheoespophageal fistula and espohageal atresia.
the major congenital anomalies which produce airway obstruction.
how stridor is produced. Explain how the character of stridor differs with
partial obstructions at different locations in the airways.
the child with laryngomalacia describe the structural abnormalities and
discuss the prognosis and management.
the child affected by vocal cord paralysis, explain under what conditions
airway obstruction is likely. Discuss the potential causes of vocal cord
paralysis and the treatment and prognosis.
the causes and describe the basic abnormalities found in subglottic
stenosis, tracheal stenosis, and tracheomalacia. Discuss the management of
patients affected by these problems.
the airway structures that are affected by epiglottitis. Explain how this
Airway (list of sites)
Disease at Virtual Hospital
Whittaker pp. 345-348 (TE fistula), 607
Croup Epiglottitis Bronchiolitis
is diagnosed. Explain how an airway emergency can arise from this problem.
Discuss the cause, presentation, and treatment of epiglottitis .
between croup and epiglottitis. Identify the three types of croup.
discussing the three types of croup,m identify the presumed causes of
theis disease. Discuss the patient history for each type and explain how a
diagnosis is made. Discuss the treatment.
397 (SIDS), 345-348 (choanal atresia)
croup epiglottitis page
Lecture 8 ( Thurs.
Nov. 2, '06)-
Surgical Disorders in the Newborn and Child
For each of the following pulmonary lesions, explain exactly what they are
and discuss the potential causes, potential complications, and treatment
adenomatoid malformation (CAM)
diaphragmatic hernia (CDH)
congenital diapharagmetic hernia and define the paradigm. Explain how an
to what degree ventilation is compromised in CDH.
the diagnosis and delivery room management of CDH. Describe the
ventilation strategies used in treating CDH.
additional treatment measures for CDH in addition to or beyond mechanical
between the definitions of gastroschisis and omphalocele . Discuss how
both of these problems are thought to develop.
the complicating issues that are present in infants with either
gastroschisis or omphalocele. Explain what is involved insurgical repair
and athe short and long term pulmonary issues. Explain how the infant
should be managed on the ventilatory before and after surical repair.
Disease at Virtual Hospital
Reading Assignment: Whitaker,
neurolmuscular diseases into the neuronopathies, neuropathies,
myopathies, and myasthenic syndromes. Explain what is meant by the term
hypotonia. Explain the difference in how a child with a neuromuscular
disease would present as compared to one with a primary brain disease.
what constitutes Wernig-Hoffman disease, discuss the two types, and
discuss the treatment and prognosis. Discuss the problem of spinal
deformities that occur in many neuromuscular diseases.
the two types of neuropathies. List and describe the pathology of the
three types of demyelinating neuropathies. Discuss the management of
affected patients and the progression of each type.
the types of myasthenic syndromes, explaining the mechanism by which
muscular weakness or paralysis occurs. Outline the treatments for these
the commonly encountered myopathies. identify the most common, describe
its usual progression, and outline the treatment goals. Discuss options
for assisted ventilatory support.
Reye's syndrome, describe the usual progression, and identify the key
elements of treatment.
429 (CLE), 384-386
Lecture 9 ( Thurs
Nov. 9, '06)
what occurs physiologically in cystic fibrosis (CF). Define meconium ileus
syndrome and relate this to CF. Describe the progression of CF and explain
how it affects non- respiratory systems.
the infectious organisms that affect CF patients and explain why infection
is problematic in advancing the disease.
the treatment elements for cystic fibrosis. Review the basis for every
type of treatment. Discuss some of the newer approaches to respiratory
care, and point out the experimental interventions.
Lecture 10 (
Thurs Nov. 16, '06)
Nitric Oxide PPHN High Frequency Ventilation
- � Whittaker 348-350
Cardiac Anomalies 1: Defects that Increase &
Decrease Pulmonary Blood Flow
� Identify the major cardiac anomalies that
alter pulmonary/systemic hemodynamics. For each of the anomalies describe the
basic defect in anatomy and its effect on hemodynamics .
Discuss signs and symptoms of infants affected by these disorders.
Lecture 11 (Thurs.
Nov. 30, '06)
Cardiac Anomalies 2: Defects that Increase &
Decrease Pulmonary Blood Flow
the major cardiac anomalies that alter pulmonary/systemic hemodynamics. For
each of the anomalies describe the basic defect in anatomy and its effect on
Discuss signs and symptoms of infants affected by these disorders.
Lecture 12 (Thurs.
Dec. 7, '06)
Lecture 13 (Thurs.
Dec. 14 , '06 )
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