PAEDIATRICS
Retinopathy of Prematurity
Shaken Baby Syndrome ↳ Free radical
↳ retinal haemorrhage damage from 1 0 ,
levels
↳ Abnormal
↳ subdural haematoma + Uncontrolled development of blood vessels
↳ T risk in prematures I birth that has
↳ encephalopathy ↑ Levels
with
weight
of FiOz
, LARYNGOMALACIA
Most common congenital laryngeal abnormality
• Flaccidity of supraglottic structures leads to floppy and soft larynx which collapses during inspiration
• Leads to intermittent upper airway obstruction
• Presents within the first few weeks of life (typically at 4-6 weeks) with noisy respiration and inspiratory stridor
• Vocal cord palsy - abnormal cry, birth trauma, iatrogenic, Arnold chiari malformation
Types
• Type 1: tightening of the aryepiglottic folds
• Type 2: redundant tissue in supraglottic region
• Type 3: associated with other disorders - neuromuscular weakness, GORD
Features
• Inspiratory stridor = high-pitched and crowing, intermittent, occurring in the supine position
• Symptoms increase in severity during first 8 months
• Respiratory distress, failure to thrive and cyanosis are rare
Investigations
• Oxygen saturation should be monitored and blood gases taken if there is desaturation
• Laryngoscopy and bronchoscopy indicated if severe features or diagnostic difficulty
Management
• Most cases usually resolve spontaneously by 18-24 months
• Symptomatic relief by hyperextending neck during episodes of stridor
• Surgical intervention required with severe respiratory distress
, CROUP
Form of upper respiratory tract infection seen in infants and toddlers
• Peak incidence at 6 months - 3 years
• Causes = parainfluenza (most common), RSV, influenza, rhinovirus
Features
• Cough - barking, seal-like, worse at night
• Stridor - caused due to laryngeal oedema and secretions
• Coryzal symptoms
• Increased work of breathing e.g. retraction
NICE suggest admitting any child with
• Moderate or severe croup
• < 3 months of age
• Known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome)
• Uncertainty about diagnosis
Investigations >
• Majority diagnosed clinically
• CXR posterior-anterior view - subglottic narrowing ('steeple sign’)
Management
• Single dose of PO dexamethasone (0.15mg/kg)
- Dose can be repeated after 12 hrs if needed
• Prednisolone is an alternative if dexamethasone is not available
• Emergency treatment = high-flow oxygen, nebulised adrenaline
-
Nebulised adrenaline provides quick relief +
improves symptoms before steroids
, BRONCHIOLITIS
Acute bronchiolar inflammation
• Peak incidence at 3 months - 6 months
• Causes = RSV (most common), mycoplasma, adenovirus
• More serious if bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
Features
• Coryzal symptoms day 1-3
• Dry cough, increasing breathlessness
• Wheezing, fine inspiratory crackles (not always present)
• Feeding difficulties associated with increasing dyspnoea
Investigations
• Majority diagnosed clinically
• Immunofluorescence of nasopharyngeal secretions may show RSV
NICE recommend immediate referral if any:
• apnoea (observed or reported)
• child looks seriously unwell
• severe respiratory distress
• central cyanosi
• persistent sats < 92% when breathing air
NICE recommend that clinicians 'consider' referring to hospital if any:
• a respiratory rate of over 60 breaths/minute
• difficulty with breastfeeding or inadequate oral fluid intake
• clinical dehydration
> RSV
prophylaxis with PALIVIZUMAB to minimise
infection risk in premature babies with congenital heart defects
Management
• Largely supportive admit infants with apnoea episodesfor
>
-
monitoringclose
• Humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
• NG feeding may be needed if children cannot take enough fluid/feed by mouth
• Suction is sometimes used for excessive upper airway secretions
Retinopathy of Prematurity
Shaken Baby Syndrome ↳ Free radical
↳ retinal haemorrhage damage from 1 0 ,
levels
↳ Abnormal
↳ subdural haematoma + Uncontrolled development of blood vessels
↳ T risk in prematures I birth that has
↳ encephalopathy ↑ Levels
with
weight
of FiOz
, LARYNGOMALACIA
Most common congenital laryngeal abnormality
• Flaccidity of supraglottic structures leads to floppy and soft larynx which collapses during inspiration
• Leads to intermittent upper airway obstruction
• Presents within the first few weeks of life (typically at 4-6 weeks) with noisy respiration and inspiratory stridor
• Vocal cord palsy - abnormal cry, birth trauma, iatrogenic, Arnold chiari malformation
Types
• Type 1: tightening of the aryepiglottic folds
• Type 2: redundant tissue in supraglottic region
• Type 3: associated with other disorders - neuromuscular weakness, GORD
Features
• Inspiratory stridor = high-pitched and crowing, intermittent, occurring in the supine position
• Symptoms increase in severity during first 8 months
• Respiratory distress, failure to thrive and cyanosis are rare
Investigations
• Oxygen saturation should be monitored and blood gases taken if there is desaturation
• Laryngoscopy and bronchoscopy indicated if severe features or diagnostic difficulty
Management
• Most cases usually resolve spontaneously by 18-24 months
• Symptomatic relief by hyperextending neck during episodes of stridor
• Surgical intervention required with severe respiratory distress
, CROUP
Form of upper respiratory tract infection seen in infants and toddlers
• Peak incidence at 6 months - 3 years
• Causes = parainfluenza (most common), RSV, influenza, rhinovirus
Features
• Cough - barking, seal-like, worse at night
• Stridor - caused due to laryngeal oedema and secretions
• Coryzal symptoms
• Increased work of breathing e.g. retraction
NICE suggest admitting any child with
• Moderate or severe croup
• < 3 months of age
• Known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome)
• Uncertainty about diagnosis
Investigations >
• Majority diagnosed clinically
• CXR posterior-anterior view - subglottic narrowing ('steeple sign’)
Management
• Single dose of PO dexamethasone (0.15mg/kg)
- Dose can be repeated after 12 hrs if needed
• Prednisolone is an alternative if dexamethasone is not available
• Emergency treatment = high-flow oxygen, nebulised adrenaline
-
Nebulised adrenaline provides quick relief +
improves symptoms before steroids
, BRONCHIOLITIS
Acute bronchiolar inflammation
• Peak incidence at 3 months - 6 months
• Causes = RSV (most common), mycoplasma, adenovirus
• More serious if bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
Features
• Coryzal symptoms day 1-3
• Dry cough, increasing breathlessness
• Wheezing, fine inspiratory crackles (not always present)
• Feeding difficulties associated with increasing dyspnoea
Investigations
• Majority diagnosed clinically
• Immunofluorescence of nasopharyngeal secretions may show RSV
NICE recommend immediate referral if any:
• apnoea (observed or reported)
• child looks seriously unwell
• severe respiratory distress
• central cyanosi
• persistent sats < 92% when breathing air
NICE recommend that clinicians 'consider' referring to hospital if any:
• a respiratory rate of over 60 breaths/minute
• difficulty with breastfeeding or inadequate oral fluid intake
• clinical dehydration
> RSV
prophylaxis with PALIVIZUMAB to minimise
infection risk in premature babies with congenital heart defects
Management
• Largely supportive admit infants with apnoea episodesfor
>
-
monitoringclose
• Humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
• NG feeding may be needed if children cannot take enough fluid/feed by mouth
• Suction is sometimes used for excessive upper airway secretions
