From the Guidelines
Infants with lower airway obstructions typically respond by exhibiting increased respiratory effort, including nasal flaring, grunting, and retractions of the chest wall, as they attempt to compensate for decreased airflow 1.
Key Characteristics of Infants with Lower Airway Obstructions
- They may develop tachypnea (rapid breathing) as they attempt to compensate for decreased airflow.
- Unlike adults, infants are obligate nasal breathers and have smaller airways, making them more vulnerable to respiratory distress from even minor obstructions.
- When obstruction worsens, infants may become irritable, lethargic, or have feeding difficulties.
- They often assume positions that maximize airway patency.
- Cyanosis (bluish discoloration) may appear in severe cases, indicating inadequate oxygenation.
- Wheezing or stridor might be present depending on the location and nature of the obstruction.
Importance of Early Recognition and Intervention
- Infants have limited respiratory reserves and can decompensate rapidly, progressing from respiratory distress to respiratory failure more quickly than adults.
- This rapid progression occurs because infants have underdeveloped respiratory muscles and higher metabolic demands relative to their size, making early recognition and intervention crucial in managing lower airway obstructions 1.
Management Considerations
- Bronchodilators have been shown to improve pulmonary function in infants with chronic lung disease of infancy and childhood (CLDI) by reducing bronchospasm and improving lung compliance 1.
- Oxygen therapy is also crucial in managing infants with CLDI, as it helps to improve oxygen saturation and reduce the risk of pulmonary hypertension and other complications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Infant Response to Lower Airway Obstructions
- Infants with lower airway obstructions may present with respiratory distress, altered breathing patterns, and forced breathing efforts 2.
- The pathophysiology of airway obstruction in infants is distinct due to anatomic differences, and clinical presentation and consequences vary by age 3.
- Lower airway obstruction in infants can be caused by various factors, including congenital or acquired conditions, and may require immediate medical attention 2, 3.
- Treatment of lower airway obstruction in infants may involve restoration of airway patency, supporting breathing with high-flow oxygen and assisted ventilation, and restoration of circulation 2.
- Specific management of lower airway obstruction in infants may require endotracheal intubation, mechanical ventilation, and other supportive therapies 2, 4.
Assessment and Management
- Rapid assessment of infants with suspected lower airway obstruction is crucial to ascertain adequacy of airway patency, breathing, and circulation 2.
- A stepwise approach to managing the neonatal airway, including assessment, preparation, induction, and premedication, is essential for safe and effective airway management 5.
- Clinicians should be familiar with the skills and techniques available for managing normal neonatal airways, as well as strategies for airway management in patients with difficult anatomy 5.
Prehospital Experience
- Prehospital data on airway obstruction in children under 5 years old show that liquid obstructions are most common in the youngest children, while solid food and nonfood solid obstructions are more prevalent in older children 6.
- Parents' actions, such as bulb suction, finger sweeps, and back blows, may be used to relieve airway obstruction, but paramedics may need to use advanced life support skills in some cases 6.