Breath Holding attacks, GBS, Head lice, MMR and Otitis Media Flashcards
What are breath holding attacks?
A devleopmental condition in which the child experiences a biref episode of apneoa.
What is the background of breath holding attacks?
2% children 6m-5y. 75% between 5-18m.
Pallid attack: abnormal sensitivity to carotid sinus or ocular compression – causing temporary asystole or marked bradycardia
Cyanotic attack: Unclear – centrally mediated reduced respiratory effort, altered lung mechanics that timulate pulmonary reflexes, resulting in aopnea.
What do you want from history and exam for breath holding attacks?
History
Pallid: Fear/Pain > Stop breathing > LOC . Pale and hypotonic > ?seizure
Cyanotic: Anger/frustration > cries and holds breath > Cyanosis LOC > Tonic clonic jerks and arching of back à Bradycardia
Attacks last less than one minute.
Examination
Neuro exam to exclude underlying disease.
What investigations do you do for breath holding attacks?
Not usually required. EEG if worried about siezures, if during attack shows generalised flattening (=cerebral hypoxia). Interictal EEG normal.
ECG: if arrhythmia is suspected.
What is the management of breath holding attacks?
Parental education – no reinforcement of behavior pattern. Lie child flat during attack to increase cerebral eprfusion. Atropine sulphate can be considered if refractory pallid attack.
What is the complications and prognosis of breath holding attacks?
Danger of injury if falling over.
Usually stops at 5-6y.
What is a GBS infection?
Bacterial infecton caused by strep agalactiae causing neonatal sepsis.
What is the background of a GBS infection?
3/1k live births. Maternal colonisation 30%.
Common infection in adults. Colonises GI, GU, throat. Most common cause of NN sepsis, vertical (in utero) or intrapartum transmission. Early>late infection.
· Early: first day-week. Vertical transmission. Sepsis, pneumonia, meningitis.
· Late: between 1-3months. Vertical transmission with delayed infection or horixonta in hospital or community. Meningitis 85%.
Related to prematurity, prolonged rupture of membranes, maternal GBS +, chorio-amnionitis, previous GBS in sibling.
What do you want from history and exam for a GBS infection?
Sepsis:
· Pyrexia, temperature instability, hypothermia
· Shock, irritability, seizures, drowsy, neutrophilia, inflammatory markers.
· Vomiting, abdo distension, jaundice, poor feeding.
· Aopnea, bradycardia.
Meningitis: As for sepsis with tense fontanelle and head retraction ophistotonos.
Pneumonia: Respiratory distress: recession, tracheal tub, grunting, flaring etc.
What investigations do you do for a GBS infection?
Radiology: CXR
Bloods: FBC and WCC, Glucose, inflammatory markers, CULTURES.
Urine and CSF culture, blood too.
What is the management of a GBS infection?
Preventive: Identify at risk, colonised mothers, and intrapartum IV penicillin G.
Treatment: admit to NNU with IV access, IVI fluid, blood and cultures. BSAbx started before culture available – IV penicillin and gentamicin.
Future: vaccination?
What is the complications and prognosis of a GBS infection?
Hearing and vision loss, neurodevelopment impairment
Morbidity 5% and mortality with meningitis 50%.
What are head lice?
Infestation of the head with lice.
What is the background of head lice?
Peak age 3-11 y, high lifetime incidence, underreported due to stigma
Padinculosis humanis capitis: six legged flat body no wings.
Spread by head to head contact or with sheets. Eggs can live up to 1m.
What do you want from history and exam for head lice?
History
Pruritus and hx of contact
Examination
Urticarial macules and excoriations, can see live lice and eggs o/e scalp.
What investigations do you do for head lice?
Wood’s light exam reveals fluorescent lice in head.
What is the management of head lice?
Non medical management: wet combing and dimeticone 4% (Covers lice and disrupts their water balance).
Medical: peniculicides such as mathation and phenotinon, kill lice. OTC. Apply and remove lice with comb.
Environmental eradication, wash sheets, hairbands etc. Treat contacts if chance of infection.
What is the complications and prognosis of head lice?
Infection of bites and excoriations. Good prognosis.
What is an MMR infection?
Infection with MM or R RNA viruses
What is the background of an MMR infection?
Each has a 4/100k incidence.
Measles: Contact, droplet, 7-14d incubation, 4d infection
Mumps: Contact, droplet, 14-21d incubation, 7d infection
Rubella: Contact, placental, 14-21d incubation, 14d infection
Association w/ malnutrition, immuncompromise, lack of immunisations,
What do you want from history and exam for a measles (Morbilivirus) infection?
Prodrome: 4d: Fever, conjunctivitis, koplik spots, coryza
Symptoms: Rash behind ear
Examination: Maculopapular and then blotchy, spreads to whole body
What investigations do you do for an MMR infection?
Clinical dx with serology.
What is the management of an MMR infection?
Antipyretic, encourage oral intake, notify CDC. Prevent with immunisation.
What is the complications and prognosis of an MMR infection?
Measles: otitis media, encephalitis. Moderate high mortality rate.
Mumps: Viral meningitis, encephalitis, orchitis. Self resolving usually.
Rubella: arthropathy, encephalopathy, thrombocytopenia, cardiomyopathy, congenital Rubella stnydome. Self limiting in adults but worse in infants.
What is otitis media?
AOM: inflammation of the middle ear chamber
CSOM: glue ear, middle ear effusion without perforation for >3m.
What is the background of otitis media?
AOM: viral mostly (rhinovirus and RSV) bacteria in 35%, Strep pneumonia and Hib. Parental smoking, contacts, nursery increase risk.
CSOM: Obstruction of eustachian tube due to adneoidal hypertrophy, allergic rhinitis or craniofacial abnoramlities. Most likely in children <2yo with recurrent AOM.
Epidemiology
80% have had AOM by 3y. CSOM in 70% of 3yos.
What do you want from history and exam for otitis media?
AOM: ear pain and pulling after URTI symtpoms. May have hearing loss and vomiting/diahrrea/poor feeding.
AOM: red eardrum, inflamed, narrowed tube. May have effusion. Loss or normal light reflex and may have perforation.
CSOM: reduced hearing, inattention.
CSOM: tympanic membrane retraced and large effusion in front. May have speech and hearing issues. CHECK FOR MASTOIDITIS mastoid tenderness.
What investigations do you do for otitis media?
Simple AOM: fever and obs, swabs may be taken from ear for MCS.
Recurrent AOM/CSOM: may warrant screening for immune deficiency
CSOM: audiology tests
What is the management of otitis media?
AOM acute: analgesia, antibiotics if suspect bacterial cause. No aminoglycosides (ototoxic).
AOM prophylaxis: pneumococcal vaccinaton in children with recurrences.
CSOM: no benefit for antihistamines, little benefit with steroids. If severe and persisting consider adenoidectomy or gromlets
What is the complications of otitis media?
AOM: perforation of middle ear and ifnection. Avoid swimming.
CSOM: hearing loss and therefore delay in speech and language. Choleastoma exclude. Mastoiditis rare but serious complication. (à meningitis/brain abscess).
What do you want from history and exam for a mumps (paramyxo) infection?
Prodrome: Fever, muscle pain, headache, malaise
Symptoms: Swelling of parotids
Examination: Parotid swelling
What do you want from history and exam for a Rubella (rubivirus) infection?
Prodrome: Fever, malaise lymphadenopathy
Symptoms: Rash
Examination: Small, pink maculopapular, face initially then down to thights.
