Paediatric Respiratory Disorders

17 October 2018 18:21

CROUP NICE CKS

Larngotracheobronchitis- Common childhood Respiratory Disease- AGE 6 MONTHS TO 3 YEARS,

Boys slightly more common than girls

PATH
Symptoms are a result of upper airway obstruction due to generalised inflammation of the airways
 Typically caused by PARAINFLUENZA VIRUS TYPE 1 TO 3

PX
 Characterised by sudden onset of a Seal-Like barking Cough ( worse at night )
 Stridor
 Sternal In drawing
 Child may show signs of respiratory distress such as
○ Persistant agitation
○ Lethargy
○ Pallor or cyanosis

DX
Give Racemic Epinephrine - they should have an improvement in their overall condition

TX and Management
 Take care not to frighten the child ( agitaqtion can worsen the symptoms)
 Catergorise the severity of symptoms
1. Mild: ( Seal- like barking cough no stridor)------Prescribe a single dose of oral dexamethasone
(0.15 mg/kg) to be taken immediately------ send home

2. Moderate (seal-like barking cough with stridor and sternal recession at rest; no agitation or
lethargy) ------Racemic Epinephrine, Steroids , Oxygen supplementation

3. Severe -(Seal-like barking cough with stridor and sternal/intercostal recession associated with
agitation or lethargy ) Admit
4. Impending Respiratory Failure - increased upper airway obstruction NOT GOOD - RR >70bm ---
respiratory distress

Bronchiolitis NICE CKS

Predominantly affects Infants of less than 12 months of age

 Viral infection - Respiratory Syncytial Virus of the epithelial lining of the lower bronchial tree
 Infected epithelial cells slough off into the small airways and alveolar spaces
 Mucus + the infected cells ---> obstruct the airways
These changes result in impaired gas exchange leading to hypoxia and breathlessness

 typically lasting for 3–7 days. Bronchiolitis is likely to be more severe in infants:
 With chronic lung disease (including bronchopulmonary dysplasia),
 Haemodynamically significant congenital heart disease, neuromuscular disorders, or
immunodeficiency.
 Born prematurely (particularly before 32 gestational weeks).

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  Born prematurely (particularly before 32 gestational weeks).
The cough associated with bronchiolitis resolves within three weeks in 90% of infants.
It is uncommon for bronchiolitis to cause death.

DX
Diagnosis - experienced coryzal prodome lasting 1- 3 days ---followed by persistent cough
Auscultations--Wheeze crackles (present throughout lung fields)
Fever, poor feeding,
Increased RR

TX and Management

Immediately refer children with bronchiolitis for emergency hospital care (usually by 999
ambulance) if there are any of the following:
 Apnoea (observed or reported).
 Child looks seriously unwell.
 Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate
of over 70 breaths/minute.
 Central cyanosis.
 Persistent oxygen saturation of less than 92% when breathing air.
Consider referral for children with any of the following:
• Respiratory rate of over 60 breaths/minute.
• Difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume).
• Clinical dehydration (indicated by reduced skin turgor and/or a capillary refill time of more than
three seconds, and/or dry mucous membranes, and/or reduced urine output).
• Factors that should lower the threshold for hospital admission include:
 Chronic lung disease (including bronchopulmonary dysplasia).
 Haemodynamically significant congenital heart disease.
 Neuromuscular disorders.
 Immunodeficiency.
 Age under three months.
• The infant having been born prematurely, particularly before 32 gestational weeks.
• Factors that might affect a carer's ability to look after a child with bronchiolitis, such as adverse
social circumstances, or concerns about the skill and confidence of the carer in looking after a child
with bronchiolitis at home, or the carer being able to spot red flag symptoms.

• While awaiting admission to hospital:

Give controlled supplementary oxygen to all children whose oxygen saturation is persistently less
than 92%.

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