jUNlE 1978 F I S I O T E R A P I E RESPIRATORIESE AANDOENING IN KINDERS J. C A R L T H O M , M .B ., C h.B . M .M e d .* o e s p ira to rie s e a a n d o e n in g in jo n g k in d e r s en b a b a s 0 r d ie a lg e m e e n m e e r a k u u t as in vo lw a sse n es. ' / r°skeie f a k to r e is h i e r v o o r v e ra n tw o o rd e lik . A n a - iese fisio lo g ie se e n im m u n o lo g ie se v e rsk ille , a s o o k t0̂ a e \v i'n g sfa k to re b e in v lo e d e n b e p a a l d ie p a tr o o n v a n ° feksie e n d ie b e h a n d e lin g s m e to d e s in d ie v e rs k ille n d e ouderdom sgroepe. a N A T O M IE S E e n f i s i o l o g i e s e v e r s k i l l e n i e to n g v a n d ie b a b a is ’n m o n d o rg a a n e n v u l d ie u-ie m o n d a a n g e s ie n d ie b a s is v a n d ie to n g n o g n ie fuedaal h e t in d ie f a rin k s n ie. D ie b a sis v a n d ie to n g vas a a n d ie e p ig lo ttis e n la rin k s w a t g e v o lg lik reg o n d e r k a n t d ie n a s o fa rin k s gelee is. F ig 1 (v e rg e ly k tig. 2 volw assenes). D ie m e e ste b a b a s v in d d it f e itlik o n m o o n tlik om deur d ie m o n d a se m te h a a l. E n ig ie ts w a t d ie n e u s- gange v e rsp e r, sal a s e m h a lin g b e m o e ilik s o d a t m a a g - v o e dingsbuise v e rk ie s lik d e u r d ie m o n d in g e p la a s w o rd tydens p e rio d e s v a n re s p ir a to r ie s e in k o rtin g . D ie b o rsk a s v a n d ie b a b a is ro n d e n v e r a n d e r in vorm ty d en s g ro e i e n m e t o u d e rd o m . (F ig. 3). A sem h a lin g is g ro te n d e e ls d ia fra g m a tie s e n d ie b u ik m oet v ry lik k a n b ew eeg. S tyw e v e rb a n d e o m d ie m a a g m oet te n a lle k o s te v e rm y w o rd . F ig . 2. D I E V O L W A S S E N E . D ie p o s te r io r d e rd e v a n d ie to n g v o rm d ie a n te r io r w a n d v a n d ie n a s o fa rin k s . D ie to n g is n ie m e e r n e t ’n m o n d - o r g a a n n ie. D ie la rin k s h e t a fg e d a a l e n d ie e p ig lo ttis r a a k n ie m e e r a a n d ie sa g te v e rh e m e lte n ie. * D e p a rte m e n t P e d ia trie , T y g e rb e rg -h o s p ita a l en die U n iv e rs ite it v a n S te lle n b o sc h F ig . 3. D I E B O R S K A S V O R M . D ie p a s g e b o re n e se b o rs k a s is ro n d in te e n ste llin g m e t d ie o u e r k in d en v o lw a sse n e w a t m e e r o v a a lv o rm ig is. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 10 P H Y S I O T H E R A P Y JUNE 1978 D ie ste rn u m is k o rt, d ie b e n ig e b o rsk a s is sag en v e rv o rm m a k lik . T y d e n s sie k te to e s ta n d e w a t long- v e r v o rm b a a r h e id in k o rt, is a s e m h a lin g m in d e r effek- tie f o m d a t d ie b e n ig e b o rs k a s n e ig o m in te trek . D ie tra g e a v a n d ie b a b a is slegs 4 cm la n k (v ergelyk 12 cm in v o lw a sse n es) m et ’n d e u rsn e e v a n 3,6 m m (v e rg e ly k 18 m m in volw assenes). K le in e r d e u rs n e e in tu b a s ie b u is e is n o d ig , e n d ie len g te v a n d ie b u is e m o e t n o u k e u r ig g e k o n tro le e r w o rd . D ie re g tc h o o fb ro n g u s is w y e r as d ie lin k e r een en so te se in ’n re g u it ly n m e t d ie tra g e a (Fig. 4). I n t u b a s ie ­ b u ise d rin g d ie re g te r h o o fb ro n g u s du s b a ie m a k lik b in n e in d ie n n ie o p d ie le n g te v a n d ie tiuis g e le t w o rd n ie . D ie h e le lin k e rlo n g k a n a ld u s gi k o r ts lu it w ord. G e a s p ire e r d e v re e m d e v o o rw e rp e w o rd d a n o o k ge- w o o n lik in d ie re g te r h o o fb ro n g u s g evind. F ig . 4. D I E T R A G E A E N H O O F B R O N G I . D ie re g te r h o o fb ro n g u s is so te se in ’n re g u itly n m et d ie tra g e a en o o k w y e r as d ie lin k e r h o o fb ro n g u s . P n e u m o n ie v a n d ie re g te r b o k w a b k o m d ik w e ls v o o r in b a b a s n a a s p ir a s ie v a n v o e d in g as h u lle le e n d rin k , w eens d ie p o s is ie v a n d ie k o r t w ye b o k w a b b ro n g u s . L o n g a lv e o li v e rm e e rd e r v a n ’n g e sk a tte 30 m iljo e n b y g e b o o rte to t 70 m iljo e n o p d r ie m a a n d e o u d e rd o m to t 300 m iljo e n o p v o lw a sse lee fty d . D ie p o o r tjie s v a n K o h n is n o g n ie o n tw ik k e l in d ie b a b a en jo n g k in d n ie s o d a t k o lla te ra le s irk u la s ie tu sse n d ie a lv e o li b a ie b e p e rk is. A te le k ta s e v in d d u s b a ie m e e r g e re d e lik p la a s in h ie r d ie o u d e rd o m s g ro e p . O p p e rv la k te s p a n n in g a k tie w e s to f ^ (su rfa c ta n t) is n o o d s a a k lik v i r lo n g s ta b ilite it en v e rg e m a k lik d ie w e rk v a n a s e m h a lin g . D i t is a fk o m s tig v a n d ie osm o filie se g ra n u le s v a n d ie T ip e 2 selle v a n a lv e o le re m e m b ra a n . G e b r e k a a n “ s u r f a c ta n t” gee a a n le id in g to t a lv e o le re k o lla p s — a te le k ta s e . T e k o r t a a n “s u r f a c ta n t” is e e n v a n d ie b e la n g rik s te f a k to r e as o o r s a a k v a n d ie h ia l- e e n m e m b ra a n s ie k te . I n n o rm a le v o lw a sse n es sal o n g e v e e r 4% v e n eu se b lo e d d ir e k o o rv lo e i n a d ie a r te r ie le s irk u la s ie d e u r a fta k k in g s o p b r o n g ia le v la k . I n p a s g e b o re n e s is h ie rd ie sy fe r h e e lw a t h o e r e n w o rd g estel o p 1 1 - 2 0 % . H ie r- v o o r is d ie f o r a m e n o v a le en d ie d u c tu s a r te rio s u s g ro te n d e e ls v e ra n tw o o rd e lik . A n o k s ie v e r g ro o t d ie af- ta k k in g en d it w o rd b e re k e n d a t to t 90% v a n d ie to ta le b lo e d v lo e i h e r s ir k u le e r s o n d e r d a t g a sw isselin g p la a s- v in d in e rg e ge v alle v a n r e s p ir a to r ie s e n o o d v a n p a s ­ g e b o re n e s s o o s h ia le e n m e m b ra a n s ie k te . A s e m h a lin g is v in n ig in b a b a s e n d ie g e ty v o lu m e k le in ; g e v o lg lik is d ie d o o ie sp a sie v a n g ro o t b e la n g ty d e n s k u n s m a tig e a se m h a lin g en ty d e n s e rn s tig e r e s p ir a ­ to rie se in k o rtin g , A p p a r a a t v i r g e b r u ik in h ie r d ie o u d e rd o m s g ro e p m o e t d a n o o k a a n g e p a s w o r d o m te v o ld o e n a a n d ie sp e sia le b e h o e fte s v a n h ie r d ie o u d e r ­ d o m sg ro e p . H e m o g lo b ie n F v a n p a s g e b o re n e s v e ro o rs a a k > v e rsk u iw in g n a lin k s v a n d ie s u u rs to f-d iss o sia s ie k u rw 0 v an h e m o g lo b ie n . H ie r d e u r w o rd d ie o p n a m e v a n suUrE s to f d e u r h e m o g lo b ie n a s o o k d ie b e sk ik b a a rste llin d a a r v a n a a n w eefsel bei'nvloed. V ir ’n gegew e arteriele^ v e n e u s e v e rsk il in s u u rs to fte n s ie , sal tw e e to t driem aal m e e r s u u r s to f afg eg e e w o r d d e u r v o lw a sse H b A d e u r fe ta le H b F . s IM M U N I T E I T W e e rs ta n d tee n in fe k s ie is a f h a n k lik v a n verskeie f a k to r e w a a rv a n im m u n o g lo b u lie n e en k o m p le m e n t be- la n g rik is. T y d e n s d ie e e rste p a a r m a a n d e v a n lew e w o rd die b a b a ty delik b e sk e rm d e u r im m u n o g lo b u lie n e ontvane v a n d ie m o e d e r. A a n g e s ie n slegs k le in e r m o le k u le s oor d ie p la s e n ta k a n bew eeg, o n tv a n g d ie b a b a slegs IgG w a t h o m b e sk e rm in g b ie d tee n G r a m positiew e o rg a n is m e s, m a a r m in o f g e en b e s k e rm in g teen G ram n e g a tie w e o rg a n is m e s n ie. D ie p a s g e b o re b a b a w o r d g e b o re m e t m in im m u n o ’ g lo b u lie n e v a n sy eie, a a n g e sie n p r o d u k s ie gew oonlik ee rs n a g e b o o rte g e s tim u le e r w o rd d e u r a a n ra k in g m et m ik ro -o rg a n is m e s . K o m p le m e n t is g e b re k k ig in se k e re p a sg e b o re n e s en gee a a n le id in g to t in fe k s ie s so o s d ie G r o e p B strepto- k o k k a le in fe k s ie s w a t n o u b e sk o u w o rd as d ie b e lang­ rik s te in fe k s ie v a n p a s g e b o re b a b a s . O M G E W I N G S - E N A N D E R F A K T O R E B a b a s w o rd so v e r m o o n tlik b e s k e rm teen infeksie. W a a r d ie b e s k e rm in g o n tb re e k , k a n d it e rn s tig e gevolge h e v ir d ie b a b a , soos in d ie g e v al w a n n e e r d ie m oeder tu b e rk u lo s e o n d e r lede h et. W a n v o e d in g t r e f v e ra l d ie k in d n a d e lig en verlaag sy w e e rs ta n d tee n in fek sie . V iru s in fe k s ie is d ie a lg e m e e n ste o o r s a a k v a n re sp ira ­ to rie s e a a n d o e n in g s in jo n g k in d e rs . I n p a sg e b o re n e s is G r a m n e g a tie w e b a k te r ie v e ra n tw o o r d e lik v ir m eeste in fe k s ie s, terw yl d ie sta filo k o k a lty d in g e d a g te gehou m o e t w o r d in g e v al v a n lo n g in fe k s ie s in k in d e rs o nder tw ee j a a r o u d e rd o m . D ie re a k s ie te e n in fe k s ie v e rsk il o o k v a n d i 6 in die vo lw a sse n e. P n e u m o k o k k a le lo n g -in fe k sie s v e ro o rs a a k b ro n g o p n e u m o n ie en n ie lo b e re p n e u m o n ie nie. L ong^ tu b e rk u lo s e in jo n g k in d e rs w o r d g e k e n m e rk d e u r v eij g ro te h ilu s k lie re , en g e n esin g d e u r v e rk a lk in g in te e n v ste llin g m e t fib ro se so o s g e v in d in v o lw a sse n es. M iliere v e rs p re id in g en tu b e rk u lo s e m e n in g itis k o m o o k m eer a lg e m e e n v o o r in jo n g k in d e rs . ’n G r o o t a a n ta l a n d e r f a k to r e d r a b y to t re sp ira to rie se in fe k s ie s in k in d e rs e n b e p a a l o o k d ie a a r d d aarvan. T o e s ta n d e b u ite d ie lo n g , so o s a a n g e b o re h a rtto e s ta n d e m e t ’n lin k s n a regs a f ta k k in g , D o w n se sindroom , k re tin is m e , a g a m m a g lo b u lin e m ie , m u k o v is sid o se , sikliese n e u tr o p e n ie , c h ro n ie se g ra n u lo m a te u s e sie k te is g ro ten ­ d e els b e p e r k to t d ie k in d en is v e ra n tw o o rd e lik vir h e rh a a ld e lo n g in fe k sie s. D I E S IE K T E T O E S T A N D E S ie k te s v a n d ie re s p ir a to r ie s e siste em k a n verdeel w o rd in o b s tru k tie w e e n re s trik tie w e siektes. O b s tru k s ie v in d m a k lik p la a s in d ie k le in lugwec v a n k in d e rs w a a r d ie s e lfd e m a te v a n e d e e m b a ie groter o b s tr u k s ie v e r o o rs a a k as in v o lw a sse n es. S iek teto estan d e so o s b ro n g io litis is d u s b e p e r k t o t d ie v ro e e kinder- ja r e e n k o m se ld e v o o r in v o lw a sse n es w a n n e e r die lu g w e e g r o te r is. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p i e a lg e m e e n ste o b s tru k tie w e sie k te s i n jo n g k in d e rs b r o n g i o l i t i s , k in k h o e s , m u k o v is sid o se , a sm a en J ^ in g o tra g e o -b ro n g itis . O b s tr u k s ie k a n v e r o o rs a a k w o rd d e u r e d ee m , ta a i e k r e s i e s , se llu le re d e b ris , sp a sm e , v e rg ro te k lie re of v r e e m d e v o o rw e rp e . V o l l e d i g e o b s tru k s ie lei to t a te le k ta s e w e en s a b so rp - ;e van lug d is ta a l to t d ie o b s tru k s ie . D a a r e n te e n sal d ie j j ep a k sie v a n g e d e e lte lik e o b s tru k s ie lu g v e rs trik k in g v e r o o r s a a k . O b s t r u k s i e v a n lugw ee b e n a d e e l ga sw isselin g en v er- hoog d ie w e rk v a n a se m h a lin g . B e h a n d e lin g is d a a ro p eIn ik o m d ie o b s tru k s ie o p te hef. H i e r v o o r is spoed- e i s e n d e n o o d b e h a n d e lin g som s n o d ig , so o s bv. in tu b a sie s o f t r a g e o s t o m i e . R e strik tiew e re s p ir a to r ie s e sie k te s w o rd v e ro o rs a a k deur erge b o rs k a s d e fo rm ite ite , n e u ro m u s k u le re v er- l a m m i n g v a n a s e m h a lin g s p ie re a s o o k a a n ta s tin g van longweefsel as g e v o lg v a n p n e u m o n ie , fib ro se , long- v e r n i e t i g i n g en r u im te -o p n e m e n d e letsels. ln k o r tin g v a n lo n g fu n k s ie w o rd b e p a a l d e u r d ie ‘graad v a n .a a n ta stin g . b e h a n d e l i n g Spesifieke e n n ie -sp e sifie k e b e h a n d e lin g sm e to d e s be- oog d ie v o lle d ig e h e rste l v a n d ie a n a to m ie s e en fisio ­ logiese o rg a a n fu n k s ie s v a n d ie re s p ir a to r ie s e sisteem . A n tib io tik a w o rd to e g e d ie n w a a r a a n g e d u i, gew oon- lik b re e s p e k tru m a n ti b io ti k a w a t b e id e G r a m p o si- tiewe en G r a m n e g a tie w e o rg a n is m e s d e k in pas- geborenes, e n g e w o o n lik p e n is illie n o f k lo k s a s illie n in die o u d e rd o m s g ro e p n a d ie p a s g e b o re ty d p e rk v ir s ta filo - kokkale in fek sie s. V o ld o e n e o k s ig e n a s ie is le w e n s b e la n g rik . S u u rs to f moet to e g e d ie n w o rd in ’n k o n s e n tra s ie w a t d ie su u r- sto fsp a n n in g v a n d ie p a s ie n t se a r te r ie le b lo e d ( P a 0 2) na d ie n o rm a le w a a rd e s v a n 1 2 - 1 4 K p a sal la a t terugkeer. Slegs b y h ie r d ie s u u rs to fs p a n n in g sal h e m o - g lobien g e n o e g s a a m s u u r s to f k a n d r a e n v o o rs ie n a a n die o rg a a n w e e fse l. S u u r s to f te r a p ie is n ie s o n d e r g e v a a r n ie. W a n n e e r su u rsto f in ’n k o n s e n tra s ie to e g e d ie n w o r d w a t d ie P a 0 2 la a t styg to t m e e r as 14 K p a , is d ie k o n s e n tra s ie su u rs to f o n n o d ig h o o g en k a n so ’n to e d ie n in g g e v aa r- lik w ees v i r d ie p a s ie n t. D i t is o n n o d ig h o o g o m d a t h e m o g lo b ie n a lre e d s v o lle d ig v e rs a d ig is b y ’n P a 0 2 V a n 14 K p a . D i t k a n g e v a a rlik w ees in d ie p a s g e b o re y ly d p erk o m d a t to ta le o f g e d e e lte lik e b lin d h e id m ag volg in d ie n d ie P a 0 2 v a n d ie p a s ie n t h o 6 r as 15 K p a is v ir la n g e r as ’n p a a r u re . T o e d ie n in g v a n ’n h o e k o n s e n tra s ie s u u r s to f v e r- hoog d ie g e v a a r v a n lo n g fib ro se, en s u u r s to f m o e t n o o it in ’n h o e r k o n s e n tra s ie to e g e d ie n w o rd as w a t n o d ig is om d ie p a s ie n t se P a 0 2 te n o rm a lis e e r nie. V o ld o e n d e g a sw isse lin g is le w e n s b e la n g rik v i r die pasient. I n d ie n n o d ig , m o e t ’n o o p lugw eg v e rs e k e r w ord d e u r d ie in p la s in g v a n ’n e n d o tra g e a le b u is o f tra g e o sto m ie b u is . V re e m d e v o o rw e rp e m o e t v e rw y d e r w ord. B ro n g o s p a s m e k a n to t ’n m e e rd e re o f m in d e r m ate o p g e h e f w o rd d e u r d ie g e b r u ik v a n b ro n g o d ila - tore. A s e m h a lin g s h u lp is a a n g e d u i in d ie p a s ie n t w a t in a k u te r e s p ir a to r ie s e v e rs a k in g g a a n . In d ie pas- g e b o ren e w o r d a a n h o u d e n d e p o s itie w e d r u k a se m h a lin g to eg e p as o m s a m e v a llin g v a n d ie a lv e o lie , w e en s g e b re k a a n o p p e rv la k te s p a n n in g a k tie w e s to f (s u rfa c ta n t) o p te hef. A lso w o r d d ie w e rk v a n a s e m h a lin g v e r m in d e r e n gasw isseling b e v o rd e r. I n te r m itte r e n d e p o s itie w e d ru k a se m h a lin g m e t o f s o n d e r e in d - e k p ir a to r ie s e p o sitie w e d ru k (P .E .E .P .) is a a n g e d u i in d ie n d ie p a s ie n t se P C 0 2> 1 1 K p a in p a sg e b o re n e s en > 8 in g r o te r k in d e rs is. jUNlE 1978 11 G a sw is se lin g k a n o o k v e rb e te r w o rd d e u r d ie b e sk ik - b a r e lo n g fu n k s ie te n v o ile te m o b ilis e e r, d e u r a te le k ta s e te v o o rk o m e n d e u r e k o n o m ie se a se m h a lin g te b e v o rd e r. D it is o p h ie r d ie g e b ie d w a a r d ie fis io te ra p e u te ’n w a a rd e v o lle b y d ra e k a n lew er. D ie p o s is io n e rin g v a n d ie p a s ie n t, b o rs k a s b e k lo p p in g , v ib ra s ie -b e h a n d e lin g , a s o o k d ie s tim u la s ie v a n d ie hoes- refleks b e v o rd e r b ro n g ia le d re in a s ie . T o e p a s s in g v a n k o r r e k te a se m h a lin g s m e to d e s v e rlig d ie p a s ie n t se py n e n b e v o r d e r g a sw isseling. F i s io te r a p e u tie s e m e to d e s w o r d b e in v lo e d d e u r a n a ­ to m ie se v e rs k ille in d ie v e rs k ille n d e o u d e rd o m s g ro e p e . So bv. sal d ie te g n ie k v a n su ig in g d e u r ’n e n d o tra g e a le - b u is o f tra g e o s to m ie b u is in b a b a s e n jo n g k in d e rs v e rsk il v a n su ig te g n ie k e in v o lw a sse p e rso n e . I n d ie g e v al v a n b a b a s e n k le in k in d e rs v u l d ie s u ig k a te te r g e w o o n lik d ie h e le lu m e n v a n d ie b u is w a a r d e u r g esuig w o rd , in te e n ste llin g m e t v olw assenes. D i t is d u s b e la n g rik d a t ’n s u ig k a te te r ’n o p e n in g o p d ie p u n t sal h e en n ie slegs s y -o p e n in g e n ie. D ie b a b a e n k le in k in d k a n n ie a se m h a a l ty d en s su ig p ro s e d u re s n ie. S u ig in g m o e t v in n ig g e sk ied en to e g e p a s w o rd slegs ty d e n s te ru g tre k k in g v a n d ie s u ig ­ k a te te r. D ie h e le p ro s e d u re m o e t, n ie la n g e r as v y f se k o n d e s d u u r n ie. V c rs ig tig e su ig in g e n la e n e g a tie w e su ig k ra g sal t r o u m a b e p e rk en g e v o lg lik o o k e d e e m w a t d ie k le in d e u rs n e e lu g w e e k a n la a t toesw el en se k o n d e re lo n g k o lla p s v e ro o rs a a k . D ie o p tim a le h a n te rin g v a n d ie p a s ie n t is n o o d sa a k - lik v e ra l in d ie b a b a en k le in k in d . F is i o t e r a p ie m o e t e ffe k tie f to e g e p a s w o rd m a a r n o o it so d ra s tie s d a t d ie p a s ie n t b e n o u d e n a n g stig o f a n o k sie s w o rd n ie . ’n P e rio d e v a n a n o k s ie ty d e n s b e h a n d e lin g k a n p e r m a n e n te b re in s k a d e v e ro o rs a a k . D i t is dus n o o d s a a k lik d a t d ie f is io te ra p e u t g o e d v e r tr o u d sal w ees m e t p ro s e d u re s in d ie k le in p a s ie n tjie s . S p a n w e rk d e u r m e d ie se en p a ra m e d ie s e p e rs o n e e l is n o d ig v i r d ie v o lle d ig e re h a b ilita s ie v a n d ie p a sie n t. Slegs d e u r d ie to e p a ss in g v a n a lle b e s k ik b a r e k e n n is in sa k e d ie b a ie f a k to r e w a t d ie b e h a n d e lin g a ffe k te e r in d ie v e rs k ille n d e o u d e rd o m s g ro e p e , k a n r e s p ira to rie s e a a n d o e n in g s in k in d e rs su k sesv o l b e h a n d e l w o rd . V erw ysings 1. A v e ry , M . E . e n F le tc h e r, B. D . (1974): T h e lu n g a n d its d iso rd e rs in th e n e w b o rn in fa n t. 3rd E d . W . B S a u n d e rs a n d C o, P h ila d e lp h ia . 2. C re lin , E . S. (1973): F u n c tio n a l A n a to m y o f the N e w b o rn . Y a le U n iv e rsity P re ss. 3. D a v is, J. e n D o b b in g , J. (1974): S cien tific F o u n d a ­ tio n s in P e d ia tric s . W illia m H e in e m a n n M e d ica l B o o k s L td ., L o n d o n . 4. D u n n , D . e n L ew is, A . T . (1973): S o m e I m p o r ta n t A s p e c ts o f N e o n a ta l N u rs in g re la te d to P u lm o n a ry D ise a se a n d F a m ily In v o lv e m e n t. P e d ia tric C lin. N . A m e r., 20, 2: 481. 5. G a ird n e r, D . en H ill, D . (1971): R e c e n t A d v a n ce s in P a e d ia tric s . 4 th E d . C h u rc h ill a n d S o n s, L o n d o n . 6 . Jo n e s, R . S. en O w e n -T h o m a s, J. B. (1971): C a re of th e C ritic a lly 111 C hild. E d w a rd A r n o ld P u b lish e rs L td ., L o n d o n . 7. K la u s, M . H . e n F a n a r o ff , A . A . (1973): C a re o f th e H ig h R is k N e o n a te . W . B. S a u n d e rs a n d C o., P h i la d e lp h ia . 8 . K e n d ig , E . L. (1972): P u lm o n a ry D iso rd e rs. V o l. 1. W . B. S a u n d e rs a n d C o, P h ila d e lp h ia 9. P e d ia tric R e se a rc h (1977): 11, 3: P a r t 2, pp. 210-223. W o rk s h o p on B ro n c h io litis. F I S I O T E R A P I E R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )