Chronic Lung Disease: Its Not Just For The Elderly

When you hear the words Chronic Lung Disease, most people think older people walking around with nasal canulas dragging oxygen tanks with them. Very few people would ever imagine a baby with Chronic Lung Disease. So you could imagine how heart broken I was when Liam was diagnosed with CLD. Come to find out Chronic Lung Disease is just another way of saying long term respitory problems. And although its used mostly for premature babies and elderly, others can get it too.It is also known as bronchopulmonary dysplasia (BPD).

What causes chronic lung disease?

CLD results from lung injury to newborns who must use a mechanical ventilator and extra oxygen for breathing. The lungs of premature babies are fragile and are easily damaged. With injury, the tissues inside the lungs become inflamed and can break down causing scarring. This scarring can result in difficulty breathing and increased oxygen needs. Some of the causes of lung injury include the following:

• prematurity - the lungs, especially the air sacs, are not fully developed
• low amounts of surfactant (a substance in the lungs that helps keep the tiny air sacs open)
• oxygen use (high concentrations of oxygen can damage the cells of the lungs)
• mechanical ventilation - the pressure of air from breathing machines, suctioning of the airways, use of an endotracheal tube (ET tube - a tube placed in the trachea and connected to a breathing machine)

Who is affected by chronic lung disease?

Chronic lung disease can develop in premature babies who have had mechanical ventilation (breathing machine). Risk factors for developing CLD include:

• birth at less than 30 weeks gestation
• birth weight less than 1,000 (less than 2 pounds) to 1,500 grams (3 pounds 5 ounces)
• hyaline membrane disease - lung disease of prematurity due to lack of surfactant that does not show the usual improvement by the third or fourth day.
• pulmonary interstitial emphysema (PIE) - a problem in which air leaks out of the airways into the spaces between the small air sacs of the lungs.
• patent ductus arteriosus (PDA) - a connection between the blood vessels of the heart and lungs that does not close as it should after birth.
• premature Caucasian, male babies are at greater risk for developing BPD
• maternal womb infection (chorioamnionitis)
• a family history of asthma
• breathing problems at birth
• develop an infection during or shortly after birth

What are the symptoms of chronic lung disease?

The following are the most common symptoms of CLD. However, each baby may experience different symptoms of the condition. Symptoms may include:

• respiratory distress (rapid breathing, flaring of the nostrils, grunting, chest retractions)
• continued need for mechanical ventilation or oxygen after a premature baby reaches 36 weeks gestation

Symptoms of CLD may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is chronic lung disease diagnosed?

Because CLD is a chronic disease and appears gradually, physicians must look at several factors. It is often diagnosed when a premature baby with respiratory problems continues to need additional oxygen after reaching 28 days old. Chest x-rays compared with previous x-rays may show changes in the appearance of the lungs. The x-ray of lungs with CLD often have a bubbly, sponge-like appearance. X-rays are diagnostic tests which use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Blood tests (test used to determine if enough oxygen is in the blood) and an echocardiography (test that use sound waves to create images of the heart to rule out defects) are also used to confirm causes of bronchopulmonary dysplasia.

Treatment of chronic lung disease:

Specific treatment for CLD will be determined by your baby's physician based on:

• your baby's gestational age, overall health, and medical history
• extent of the disease
• your baby's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment of CLD may include:

• extra oxygen (to make up for the decreased breathing ability of the damaged lungs) and a pulse oximetry to measure how much oxygen is in the blood
• mechanical ventilation with gradual weaning as the baby's lungs grow and can do more of the work of breathing
• surfactant replacement
• medications such as:
  • bronchodilators (to help open the airways)
  • steroids (to help reduce inflammation)
  • diuretics (to help reduce excess fluid in the lungs)
  • antibiotics (to fight an infection)
• intravenous fluids and nutrition (to help the baby and the lungs grow). It is important to monitor the fluid intake, because excess fluids can build up in the lungs and worsen the infant's breathing ability.
• radiant warmers or incubators to keep the infant warm and decrease the risks of developing an infection
• nutrition (to help the baby and the lungs grow)
• immunization against lung infection by respiratory syncytial virus (RSV) and influenza

CLD can be a long-term condition. Some babies with CLD require mechanical ventilators for several months. Some babies will continue to require oxygen when they go home from the hospital, but most can be weaned from oxygen by the end of their first year. Babies with CLD may be at increased risk for respiratory infection and may have to be re-hospitalized

(Information here was taken from http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/respire/cld.html and is for educational purposes. Always seek medical attention and advice when it comes to your health)

RSV: Symptoms and prevention

RSV:
 Respiratory syncytial virus (RSV) is a very common virus that leads to mild, Respiratory syncytial virus (RSV)cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially to those in certain high-risk groups.

Children or babies with Congenital Diaphragmatic Hernia, Chronic Lung Disease and Severe Asthma are at high risk for RSV.

RSV is the most common germ that causes lung and airway infections in infants and young children.

Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.
The infection can occur in people of all ages. The virus spreads through tiny droplets that go into the air when a sick person blows their nose, coughs, or sneezes.
You can catch RSV if:

• A person with RSV sneezes, coughs, or blows their nose near you
• You touch, kiss, or shake hands with someone who is infected by the virus
• You touch your nose, eyes, or mouth after you have touched something contamined by the virus, such as a toy or doorknob.

RSV often spreads very rapidly in crowded households and day care centers. The virus can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues.
The following increase the risk for RSV:

• Attending day care
• Being near tobacco smoke
• Having school-aged brothers or sisters
• Living in crowded conditions

Symptoms vary and differ with age. They usually appear 4 - 6 days after coming in contact with the virus.
Older children usually have only mild, cold-like symptoms, such as cough, stuffy nose, or low-grade fever.
Infants under age 1 may have more severe symptoms and often have the most trouble breathing

In general, RSV symptoms include:

• Bluish skin color due to a lack of oxygen (cyanosis)
• Breathing difficulty or labored breathing
• Cough
• Croupy cough (often described as a "seal bark" cough)
• Fever
• Nasal flaring
• Rapid breathing (tachypnea)
• Shortness of breath
• Stuffy nose
• Wheezing

Many hospitals and clinics can rapidly test for RSV using a sample of fluid taken from the nose with a cotton swab. They can also suction the nose to get mucus from deaper in.

Antibiotics do not treat RSV.
Mild infections go away without treatment.
Infants and children with a severe RSV infection may be admitted to the hospital .
Treatment will include:

• Oxygen
• Moist (humidified) air
• Fluids through a vein (by IV)

A breathing machine (ventilator) may be needed.

Rarely, RSV infection can cause death in infants. However, this is unlikely if the child is seen by a health care provider in the early stages of the disease .
More severe RSV disease may occur in the following infants:

• Premature infants
• Infants with chronic lung disease
• Infants whose immune system does not work well
• Infants with certain forms of heart disease

In young children, RSV can cause:

• Bronchiolitis
• Croup
• Ear infections
• Lung failure
• Pneumonia

Children who have had RSV bronchiolitis may be more likely to develop asthma.

Call your health care provider if breathing difficulties or other symptoms of this disorder appear. Any breathing difficulties in an infant are an emergency. Seek medical attention right away.

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make certain that other people, especially caregivers, take steps to avoid giving RSV to your baby.
The following simple steps can help protect your baby from getting sick:

• Insist that others wash their hands with warm water and soap before touching your baby.
• Have others avoid contact with the baby if they have a cold or fever. If necessary, have them wear a mask.
• Be aware that kissing the baby can spread RSV infection.
• Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.
• Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.

Parents of high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported in the local news and newspapers to provide parents with an opportunity to avoid exposure.
The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your doctor if your child should receive this medicine.

Synagis HELPS prevent RSV but its not 100%.
Washing your hands
Using hand sanatizer
Wiping down your countertops and other surfaces with Lysol wipes
Using Lysol Nuetra air to kill air born germs
Keeping your child out of stores during RSV, cold and flu season
Keeping sick visitors away
Wearing a mask when sick
All these things helps increase the chance of preventing RSV for your family.

I hear alot of people with stuffy noses or coughs say "Oh its just allergies". 95% of the time it turns out NOT to be just allergies, in my experience anyway. Don't take their word for it. Refuse their company or make them wear a mask and wash their hands. If your baby gets sick, theyre the ones suffering not you. Even if your child gets a cough and runny nose, remember RSV starts out the same way. You can take your child to your pediatrician to be checked. Its better to be safe than sorry. We wish you all the luck and pray you avoid a RSV breakout in your home.