Paediatric respiratory disorders

UPPER RESPIRATORY TRACT INFECTIONS

Croup  Cause: parainfluenza virus <3 y/o more common in autumn
 Features: stridor, barking cough, fever
 Investigations: clinical diagnosis, CXR (steeple sign)
 Mx: oral dexamethasone, if severe neb adrenaline and high flow O2
 Failure to improve- ?bacterial tracheitis (intubation/Abx)

Acute epiglottitis  Cause: H. influenza type B

 Features: no cough, sore throat, voice changes, dysphagia, hoarseness, drooling of
saliva
 Management: electively intubate before obstruction occurs and cover with cefotaxime

Laryngomalacia  Cause: congenital anomaly of larynx and laryngeal collapse in inspiration

 Features: inspiratory stridor noticeable in certain positions
 Mx: none; improves by 2 y/o, associated with GORD

Laryngeal paralysis  Cause: ? vagal stretching at delivery

 Features: hoarse, breathy cry if unilateral and inspiratory stridor if bilateral (Rx
intubation, tracheotomy)

Diphtheria  Cause: toxin of Corynebacterium diphteria

 Features: tonsillitis with pseudomembrane, dysphagia, polyneuritis
 Diagnosis: Swab culture for PCR
 Mx: diphtheria anti-toxin and erythromycin

LOWER RESPIRATORY TRACT INFECTIONS

Acute  Cause: RSV, commonly in the winter
Bronchiolitis  Features: coryza precedes cough, wheeze, inspiratory crackles
 Admit if: poor feeding, >50 breaths/min, patient exhaustion
 Diagnosis: clinical
 Mx: O2 <92%), don’t use steroids/bronchodilators
 Consider prevention with palivizumab to those with chest disease, prematurity

Pneumonia  Cause: pneumococcus, mycoplasma, haemophilus

 Features: pyrexia, poor feeding, grunting
 Older children may have typical lobar signs
 Admit if: SpO2 <90, <6 months, resp distress
 Investigations: CXR and sputum cultures
 Mx: amoxicillin

TB  Features: anorexia, low fever, failure to thrive

 Suspect if: overseas contacts HIV+ , odd
 Diagnosis: tuberculin test, ziehl-neelson stain of sputum
 Mx: get expert help, RIPE (rifampicin, isoniazid, pyrazinamide, ethambutol)

Whooping Cough  Features: bouts of cough ending with vomiting, cyanosis, worse at nights
 Investigations: PCR
 Mx: Azithromycin

Cystic Fibrosis  Features: meconium ileus, recurrent pneumonia, bronchiectasis

 Diagnosis: sweat test, CXR, neonatal screening through IRT (immunoreactive trypsin)
 Suspect if: overseas contacts HIV+ , odd
  Mx: physiotherapy, Rx acute infection at higher doses , lung transplant, gene therapy

Asthma  Features: wheeze, dyspnoea, cough

 Severe asthma: cannot complete a sentence, peak flow 1/3 of predicted, silent chest,
fatigue
 Mx: avoid trigger, inhaler technique