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Paediatric Respiratory Infections

From Mediwikis

Respiratory infections are the most common infections of childhood, and the most common cause of death across the world. 50% of acute paediatric presentations to GPs arise from respiratory infections, and account for 25% of admissions to hospital.

Overview

  • Viruses are the main pathogens causing childhood respiratory infections, responsible for approx 80-90%. The main ones are: **Respiratory Syncitial Virus (RSV)
    • Rhinovirus
    • Influenza
    • Parainfluenza
    • Metapneumovirus
    • Adenovirus
  • Bacteria also cause respiratory infections. The main ones are:
    • Streptococcus pneumonia
    • Haemophilus influenza
    • Bordatella pertussis
    • Mycoplasma pneumonia

Dual bacterial and viral infections can occur.

Risk Factors

Factors increasing risk of respiratory infection in children:

  • Parental smoking
  • Poor nutrition
  • Low socio-economic status
  • Males> Females
  • Underlying lung disease
  • Congenital heart disease
  • Immunodeficiency

Crib sheets (Print off and use!)

Infections

Coryza (Common cold)

This presents with clear, or purulent nasal discharge.

Pathogens

  • Rhinoviruses
  • Coronaviruses
  • RSV

Management

Self limiting- offer reassurance, paracetomol / ibuprofen if needed.

Croup (acute laryngotracheobronchitis)

Croup is an URTI which commonly affects children aged 6 months to 6 years.There is inflammation of mucosa which can occur at any point from the nose to lower airways, along with increased secretions, affecting the airway. In severe cases, oedema of the subglottis can lead to obstruction of the trachea.

Presentation

  • 6 months to 6 years old
  • Commonest in autumn

Croup presents initially with coryzal symptoms and fever over a period of days then progression to:

  • Stridor
  • Wheeze
  • Barking Cough
  • Hoarse voice

Often worse at night

Examination

It is important to differentiate from acute epiglottitis (which is characterised by slight or no cough, acute onset, drooling saliva with mouth open, fever)

Caused by:

In 95% of cases: Parainfluenza infection of all the upper airways.

In mild cases croup is:
  • Self limiting
  • Managed conservatively through observation and good hydration
  • May be treated with humidified air, nebulised budesonide and oral dexamethasone to reduce symptom severity
In severe cases:
  • There are signs of an increased work of breathing, restlessness and cyanosis
  • May require treatment with nebulised adrenaline along with oxygen and in some cases intubation and ventilation may be required

Bronchiolitis

Bronchiolitis is a LRTI which is the most common serious respiratory infection affecting babies and infants under 1 year old, usually those aged 3 to 6 months. Outbreaks typically occur during the winter months. There is increased mucus production, with inflammation and obstruction of bronchioles.

Bronchiolitis presents with:

  • Dry, persistent cough
  • Wheeze
  • Fever
  • Breathlessness

Examination

Hyperinflation of chest, subcostal and intercostal recession, tachypnoea, tachycardia, downward displacement of liver, high pitched wheeze, prolonged expiration, fine end inspiratory crackles, pallor, cyanosis

Caused by: In 80% of cases- Respiratory Syncitial Virus (RSV).

In mild cases Bronchiolitis:

  • Is self limiting
  • Is managed conservatively through observation and good hydration
  • May be treated with paracetamol or ibuprofen to reduce temperature

In severe cases:

  • Poor feeding is main reason for hospital admission; also signs of lethargy, severe recession and cyanosis
  • It is managed with supportive measures including oxygen, bronchodilators and in severe respiratory distress mechanical ventilation may be required.


Pneumonia

Pneumonia is a LRTI that commonly affects babies and infants under 1 year old, usually those aged 3 to 6 months. It causes consolidation in lower respiratory tract.

Pneumonia presents with:

  • Productive cough
  • Fever
  • Wheeze
  • Chest or Abdominal pain
  • Lethargy

O/E: Intercostal recession, use of accessories, tachypnoea, cyanosis, percussion dullness, reduced air entry, bronchial breathing, increased vocal fremitus, crackles

Caused by:

  • Viral (accounts for 14-35% of CAP): RSV, influenza, parainfluenza, adenovirus, coxsackie virus
  • Bacterial - Streptococcus pneumonia (most common in under 5’s), Haemophilus influenza type B, Staphylococcus, Mycoplasma pneumonia (most common in over 5’s), and Group B beta haemolytic streptococcus (in newborns)
  • In those with underlying respiratory disease- Psedomonas aeruginosa and Staphylococcus aureus

Predisposing factors:

  • Abnormality of bronchi
  • Foreign body inhalation
  • Immunosuppression
  • Recurrent aspiration
  • Cystic Fibrosis

Management:

  • Amoxacillin is first line treatment
  • May also require anti-pyretics, fluids, oxygen
  • In severe cases, co-amoxiclav, cefotaxime, cefuroxime