Respiratory - Chest Infections and CF Flashcards
What is bronchiolitis?
most common serious respiratory infection in infancy infants are admitted to hospital each year during the annual winter epidemics mostly between 1-9 months old RSCV is pathogen in 90%
What is the natural history of bronchiolitis?
Coryzal symptoms precede a dry cough and increasing breathlessness
Feeding difficulty associated with increasing dyspnoea is often the reason for hospital admission
Recurrent apnoea is a serious complication
Most infants recover in 2 weeks - however half will have recurrent episodes of cough and wheeze
What are the clinical features of bronchiolitis?
dry wheezy cough tachypnoea and tackycardia subcostal and intercostal recession hyperinflation of the chest fine end expiratory crackles high pitched wheezes - expiratory > inspiratory
How is acute bronchiolitis treated?
Supportive treatment
Humidified oxygen us either delivered via nasal cannula or using a head box
Infant is monitored for apnoea
Fluids may be given by NG tube or intravenously
Assisted ventilation in the form of non invasive respiratory support - CPAP or mechanical ventilation may be required in a small number of children
How should you advise parents to care for a child with bvrochiolitis?
Keep child upright - makes breathing easier
Drink plenty of fluids
Keep air moist
Smoke free environment
Relieving a fever - paracetamol/ibuprofen
Saline nasal drops
Which babies are at risk of severe bronchiolitis?
Premature babies who develop bronchopulmonary dysplasia
Babies with underlying lung disease (CF)
Babies with congenital heart disease
What are the common causative organisms of pneumonia in newborns?
Newborn - organisms from the mothers genital tract are common –> group B strep, gram negative enterococci and bacilli
What are the common causative organisms of pneumonia in infants and young children?
Infants and young children - RSV (most COMMON), Also - Strep. pneumoniae or H.influenza. Bordetella pertussis and Chlamydia trachomatis
What are the common causative organisms of pneumonia in children over 5 years?
Mycoplasma pneumoniae, Streptococcus pneumonia and Chlamydia pneumonia are the main causes
What other organism should be considered when thinking about pneumonia in children of all ages?
Mycobacterium tuberculosis
What are the presenting symptoms of pneumonia?
MOST COMMON: fever cough rapid breathing usually preceding URTI OTHER: lethargy poor feeding "unwell" child localised chest/abdo/neck pain is a feature of pleural irritation and is a sign of a bacterial infection
What is seen on examination in pneumonia?
Nasal flaring
Tachypnoea
Chest indrawing
Respiratory rate increase is an important sign of pneumonia
End inspiratory course crackles of affected area
Consolidation signs - dull percussion, decreased breath sounds and absent bronchial breathing
Low oxygen sats
What investigations are used in pneumonia?
Chest X-ray Nasopharyngeal aspirate to differentiate between bacterial and viral pneumonia
How are children with pneumonia treated?
most can be managed at home but hospital admission is required in some cases (o2 sats <92%, recurrent apnoea, grunting and inability to maintain fluids/feeds intake) IV fluids to correct dehydration Oxygen for hypoxia Analgesia for pain Physio has no proven role Antibiotics
Which antibiotics should be given in pneumonia in children of different ages?
Newborns: Broad spectrum IV Abx
Older infants: oral amoxicillin with broad spectrum reserved for unresponsive pneumonia
Children over 5 years: amoxicillin or oral macrolide (erythromycin) Oral treatment is used for mild/moderate pneumonia
When is a pleural collection suggested in pneumonia?
persistent fever despite 48 hours of antibiotics
How should you advise patients to care for a child with a chest infection?
encourage child to drink milk
paracetamol and ibuprofen
nasal drops,
upright position for nose steam inhalation?
What is pertussis?
Whooping cough
Highly contagious respiratory infection caused by Bordetella pertussis
How does pertussis present?
paroxysmal cough followed by inspiratory whoop and vomitting; in infants, apnoea rather than whoop, which is potentially dangerous
How does immunisation effect the presentation on pertussis?
reduces the risk and severity of disease but does not guarantee protection reimmunization by mothers during pregnancy reduces the risk of pertussis
What are the clinical features of tuberculosis in children?
Primary infection can lead to symptomatic presentation (active TB) or asymptomatic presentationactive TB symptoms are often non specific, such as prolonged fever, malaise, anorexia, weight loss, focal signs of infection (lymph node swelling)
How is TB treated in children?
Triple or quadruple therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) is recommended initial combination
This is then decreased to rifampicin and isoniazid alone after 2 months
Treatment is 6 months in uncomplicated TB
Older children should be given pyridoxine to prevent peripheral neuropathy associated with isoniazid therapy
Asymptomatic children who test positive should be given 3 months of rifampicin and isoniazid and isoniazid for 3 months alone
What is cystic fibrosis?
most common life limiting autosomal recessive condition life expectancy is 30-40 years it is caused by a defective protein called the CF transmembrane conductance regulator (CFTR)
What are the clinical features of cystic fibrosis?
newborns: diagnosed through newborn screening, meconium ileus
Infancy: prolonged neonatal jaundice, growth faltering, recurrent chest infections, malabsorption, steatorrhoea
Young child: bronchiectasis, rectal prolapse, nasal polyp, sinusitis
Older Children and adolescent: allergic bronchopulmonary aspergillosis, DM, Cirrhosis, portal HTN, distal intestinal obstruction, pneumothorax or recurrent hamoptysis, sterility in males
How is CF managed?
- MDT management
- Respiratory symptoms should be monitored through symptoms in younger children and spirometry in older children - Physiotherapy should be at least twice a day
- Continuous prophylactic antibiotics oral antibiotics (flucloxacillin) with additional oral rescue antibiotics
IV therapy to limit lung damage if persisting symptoms - Chronic pseudomonas infection is associated with more chronic decline which is slowed through daily nebulized antiseudomonal antibiotics
- Nebulized DNase or hyaline saline may be helpful at increasing sputum clearance- Azithromycin can be used to decrease respiratory exacerbations do to immunomodulatory effect
- More severe CF requires regular IV antibiotics and central venous catheter may need to be inserted
- Bilateral sequential lung trasnplantation is only therapeutic option for end stage CF disease
How is physio uses to treat CF?
Children should have physiotherapy for at least twice a day to clear airway secretions In younger patients parent are taught to perform airway clearance a home using chest percussion and postural drainage Older patients perform controlled deep breathing exercises and use a variety of physio devices
What are the indications for hospital admission in bronchiolitis?
apnoea episodes intake <50% normal in preceeding 24 hours cyanosis severe resp distress (grunting, nasal flaring) congenital heart disease significant hypotonia (trisomy 21) survivor of extreme prematurity social factors
