Peds 6 - Pulm

Laryngotracheobronchitis (subglottic croup).

What is the most common cause of acute upper respiratory obstruction in children?

Fall and winter.

During which seasons is pediatric croup more common?

6 months to 5 years.

What age range is most commonly affected by croup?

6 months to 2 years.

At what age does croup incidence peak?

Parainfluenza types 1, 2, and 3.

Which viruses account for 65-75% of croup cases?

Influenza A, RSV, and adenovirus.

What other viruses can cause croup besides parainfluenza?

Upper respiratory infection symptoms.

What prodrome typically precedes croup?

Barking or seal-like.

How is the characteristic cough of croup described?

At night.

At what time is the cough of croup usually worse?

Crying.

What behavior aggravates croup symptoms?

Inspiratory stridor.

What type of stridor is characteristic of croup?

Absent or low-grade fever, sometimes higher in younger patients.

What fever pattern is typical of croup?

Nasal flaring, intercostal and suprasternal retractions, and possibly cyanosis.

What signs indicate more severe croup?

AP neck radiograph.

What radiographic view may demonstrate the steeple sign in croup?

Subglottic narrowing.

What does the steeple sign represent in croup?

Normal epiglottitis.

What epiglottic appearance accompanies the steeple sign in croup?

Keep child calm, hydration, vaporizer.

What supportive measures are listed for croup?

Cool outside air to reduce subglottic swelling.

What environmental measure is recommended during an acute croup episode in the lecture?

Dexamethasone, prednisone, racemic epinephrine

What medications treat croup?

1-2 mg/kg/day.

What prednisone dose is listed for croup?

10-30 minutes.

How quickly does racemic epinephrine begin working for croup?

Potential rebound symptoms.

Why must a child be observed after racemic epinephrine treatment for croup?

If well after 3 hours with a steroid on board.

When does the lecture say discharge may be considered after racemic epinephrine for croup?

About 2 days.

How long does it usually take for croup symptoms to improve substantially?

About 1 week.

When does croup usually resolve completely?

Respiratory failure.

What uncommon severe complication may occur with croup?

Bacterial tracheitis.

What bacterial complication can develop following croup?

Middle ear (AOM), terminal bronchioles, or lung parenchyma.

Where else can an infection causing croup spread?

2-7 years; peak at 3.5 years.

Which age range is most typical for pediatric epiglottitis in the lecture?

Males.

Which sex is more frequently affected by pediatric epiglottitis?

Haemophilus influenzae type b (Hib).

What organism is listed as the predominant cause of epiglottitis?

S. pneumoniae, S. pyogenes groups A and C, Neisseria, and Staphylococcus.

What less common bacterial causes of epiglottitis are listed?

Sudden high fever, usually over 102°F.

How does the fever in epiglottitis typically begin?

Dysphagia and drooling.

What swallowing-related findings suggest epiglottitis?

Muffled voice or aphonia.

What voice finding is characteristic of epiglottitis?

Softer or quieter stridor.

How does the stridor of epiglottitis compare with croup?

More toxic appearing.

How does a child with epiglottitis generally appear compared with one with croup?

Leaning forward, neck extended, mouth open and drooling (sniffing dog position).

What posture can a child with epiglottitis assume?

Thumbprint sign.

What sign may appear on lateral neck radiography in epiglottitis?

It may delay urgent treatment.

Why is lateral neck radiography generally discouraged in suspected epiglottitis?

Cherry-red, swollen epiglottis.

What is the definitive visual finding in epiglottitis?

Controlled setting, usually OR, with intubation or tracheostomy capability.

In what setting should the epiglottis be directly examined in suspected epiglottitis?

May trigger laryngospasm and complete airway obstruction.

Why should the pharynx not be manipulated with a tongue blade in suspected epiglottitis?

Intubation.

What immediate airway intervention is needed for most children with epiglottitis?

ceftriaxoneIV/parental

What medication is listed for epiglottitis?

Blood and epiglottic cultures.

What cultures are listed for epiglottitis?

24-48 hours after documented decrease in epiglottic swelling.

When may a child with epiglottitis be extubated according to the lecture?

Days 4-10 after sensitivities are available.

When are oral antibiotics used in epiglottitis according to the lecture?

2-3 days.

What is the typical illness duration with appropriate epiglottitis treatment?

Almost zero.

What mortality is described for intubated epiglottitis patients?

Pneumonia, cervical adenitis, and septic arthritis.

What distant infectious complications are listed for epiglottitis?

December through March.

During what months is bronchiolitis most common?

Male infants aged 3-6 months.

What age and sex group is most affected by bronchiolitis?

Passive smoke and day care attendance.

What exposures increase bronchiolitis risk?

Infant airways are smaller and more reactive.

Why can RSV cause worse lower airway disease in infants than in older children?

More than 50%.

What proportion of bronchiolitis is attributed to RSV?

Nasal wash testing.

How can RSV be identified according to the lecture?

90%.

What proportion of children acquire RSV by age 2 according to the lecture?

40%.

What proportion of RSV-infected children develop lower respiratory infection according to the lecture?

Parainfluenza, influenza, adenovirus; bacterial cause questioned.

Which pathogens besides RSV are listed as possible bronchiolitis causes?

Inflammation, edema, epithelial necrosis, increased mucus, bronchospasm.

What small-airway pathologic changes occur in bronchiolitis?

History and physical examination.

How should bronchiolitis usually be diagnosed according to the AAP statement in the lecture?

No.

Are routine laboratory studies or imaging recommended for bronchiolitis?

1-2 days of fever, rhinorrhea, and cough.

What initial symptoms typically precede wheezing in bronchiolitis?

Wheezing, respiratory distress, and difficulty feeding.

What symptoms follow the initial URI phase of bronchiolitis?

30-60 breaths/minute.

What respiratory rate is described in bronchiolitis?

Above 50-60 breaths/minute.

At what resting respiratory rate should admission be considered for bronchiolitis?

Nasal flaring, intercostal and subcostal retractions.

What work-of-breathing findings are listed in bronchiolitis?

Fine crackles, audible wheezing, and prolonged expiration.

What auscultatory findings are characteristic of bronchiolitis?

Cyanosis.

What other serious respiratory sign can accompany bronchiolitis?

Hyperinflation, mild interstitial infiltrates, peribronchial cuffing.

What chest radiograph findings may be seen in bronchiolitis?

1-3%.

What proportion of infants with bronchiolitis require hospitalization according to the lecture?

Moderate/severe distress, reduced intake or possible dehydration.

What respiratory and hydration findings support hospitalization for bronchiolitis?

Below 92%.

What oxygen saturation threshold is listed as a bronchiolitis admission indication?

Inadequate care at home or history of apnea.

What social or historical factors support admission for bronchiolitis?

Below 90%.

At what oxygen saturation does the lecture recommend oxygen for bronchiolitis?

Impending respiratory failure.

When is intubation indicated in bronchiolitis?

Hydration.

What is a key supportive treatment for bronchiolitis?

Not recommended routinely; a trial may be continued if helpful.

What does the AAP say about routine bronchodilators for bronchiolitis in the lecture?

Not recommended; studies show no improvement in length of stay or clinical outcomes.

What does the AAP say about routine steroids for bronchiolitis in the lecture?

Children with underlying cardiopulmonary disease.

Which bronchiolitis patients might benefit from ribavirin according to the lecture?

Slightly upright positioning, monitor fluid intake, vaporizer.

What home care is suggested for bronchiolitis?

First 48-72 hours.

When are acute bronchiolitis problems most prominent?

Cough.

What symptom of bronchiolitis may persist after the acute phase?

Yes.

Are RSV reinfections common?

Increased episodes of wheezing.

What long-term respiratory issue may follow bronchiolitis?

IgE antibodies in the nasopharynx; relationship unclear.

What immunologic finding is mentioned as a possible explanation for recurrent wheezing after bronchiolitis?

Respiratory failure, apnea, secondary bacterial infections.

What complications of bronchiolitis are listed?

Less than 1%.

What bronchiolitis mortality is given for otherwise healthy children?

3-4%.

What bronchiolitis mortality is given for children with cardiopulmonary disease?

Hand decontamination.

What is the most important prevention measure for bronchiolitis in the lecture?

Breastfeeding and avoiding passive smoke.

What other nonpharmacologic measures help prevent bronchiolitis?

RSV prevention with palivizumab monoclonal antibody.

What is Synagis used for in the lecture?

15 mg/kg intramuscularly once monthly.

What palivizumab dose and route are listed for RSV prevention?

Begin November or December, continue monthly through March or April.

During what months does the lecture schedule palivizumab administration?

Nirsevimab (Beyfortus).

What newer monoclonal antibody for RSV prevention is named?

Maternal vaccination.

What pregnancy-related strategy for RSV prevention is mentioned?

About 200,000.

How many U.S. pertussis cases annually were reported before vaccination in the 1940s?

80% decrease.

What decline in pertussis cases followed vaccination according to the lecture?

1980s.

Since which decade have pertussis cases increased again according to the lecture?