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Pediatric Infectious Obstructive Airway Diseases

Pediatric Infectious Obstructive Airway Diseases. Fred Hill, MA, RRT. Obstructive Airways Diseases of Children. Epiglottitis Croup Bronchiolitis. Epiglottitis: Etiology and Incidence. Acute inflammation and edema of supraglottic structures

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Pediatric Infectious Obstructive Airway Diseases

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  1. Pediatric Infectious Obstructive Airway Diseases Fred Hill, MA, RRT

  2. Obstructive Airways Diseases of Children • Epiglottitis • Croup • Bronchiolitis

  3. Epiglottitis: Etiology and Incidence • Acute inflammation and edema of supraglottic structures • Causative agent - most often Haemophilus influenzae type B • Typically affects children ages 2 to 6 years

  4. Epiglottitis: Clinical Presentation • Acute onset: Upper airway obstruction and fever • Lethargic or agitated • Child sits upright • May be drooling • Toxic appearance • Temperature > 38 C

  5. Epiglottitis: Diagnosis • Lateral neck X-ray: “thumb sign”

  6. Epiglottitis: Treatment • Intubation • Antibiotics: ampicillin and chloramphenicol

  7. Croup: Etiology and Incidence • More correctly: Laryngotracheobronchitis • Inflammation and edema of subglottic structures • Viral in origin: Parainfluenzae types I & II, RSV, others. Occasionally, Mycoplasma pneumoniae • Children: 6 months to 3 years

  8. Croup: Clinical Presentation & History • Common cold precedes LTB by 1-3 days • Low grade fever • Barking cough (worse at night) • Stridor, hoarseness • Retractions, tachypnea • Recovery period: 2 to 6 days

  9. Croup: Diagnosis • Lateral or AP X-ray of the neck: “steeple sign”

  10. Bronchiolitis: Etiology and Incidence • Lower airways: inflammation, edema, secretions • Transmission: contact with infected secretions • Prevalent in fall and winter • Viral: RSV and parainfluenzae viruses, others • Children <2 years

  11. Bronchiolitis: Clinical Presentation & History • Preceded by common cold, upper RTI • Congested cough • Wheezing, perhaps wet crackles • Tachypnea • Hyperinflation • Low grade fever

  12. Bronchiolitis: Diagnosis • Chest X-ray: • Hyperinflation • Peribronchial thickening • Patchy consolidation • Sternal bowing

  13. Bronchiolitis: Treatment • Most often mild form, doesn’t require hospitalization, primarily supportive • Hospitalization • Supplemental O2 for hypoxemia • Sp O2 <92%, Pa O2 <70 mm Hg • Mechanical ventilation • Ribavirin (Virazole): now controversial

  14. Comparison

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