Paediatric respiratory reviews
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Paediatr Respir Rev · Mar 2014
ReviewChorioamnionitis is essential in the evolution of bronchopulmonary dysplasia--the case in favour.
Bronchopulmonary dysplasia (BPD) is a major sequel of extremely premature birth. Multiple ante- and postnatal factors act in concert to injure the immature lung in the pathogenesis of the disease. Among them, chorioamnionitis--according to current evidence--plays a pivotal role. ⋯ Antenatal inflammation with signs of a systemic fetal response reduces the response to exogenous surfactant in infants with respiratory distress syndrome, leading to a longer need for mechanical ventilation. Moreover, chorioamnionitis increases the risk of early onset sepsis. Both mechanical ventilation and sepsis are, however, major postnatal risk factors for BPD.
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As a student I recall being told that half of what we would learn in medical school would be proven to be wrong. The challenges were to identify the incorrect half and, often more challenging, be willing to give up our entrenched ideas. Myths have been defined as traditional concepts or practice with no basis in fact. ⋯ Many of these are myths that have long been vanquished and even forgotten, while others are controversial. In the future, many things taken as either fact or "clinical experience" today will be proven wrong. Let us examine these myths with an open mind and willingness to change our beliefs when justified.
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Asthma is usually treated with inhaled corticosteroids (ICS) and bronchodilators generated from pressurized metered dose inhalers (pMDI), dry powder inhalers (DPI), or nebulizers. The target areas for ICS and beta 2-agonists in the treatment of asthma are explained. ⋯ Myths regarding inhalation treatments lead to less than optimal use of these delivery systems. We discuss the origin of many of these myths and provide the background and evidence for rejecting them.
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Chronic cough has been variably defined as a cough lasting longer than 3, 4 or 8 weeks. Many post viral or pertussis like illnesses are associated with prolonged coughing that resolves over time. Management involves first trying to make a diagnosis and identify the presence of any underlying condition. ⋯ Only a small proportion of children with an isolated non-specific dry cough have asthma and care is needed not to over diagnose asthma. Children with chronic wet cough may have protracted bacterial bronchitis (PBB) that responds to a full course of antibiotics. Children with PBB failing to respond to treatment or with specific pointers should be investigated for specific causes of suppurative lung disease.
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Paediatr Respir Rev · Jun 2013
ReviewManagement of acute severe upper airway obstruction in children.
There are many causes of acute severe upper airway obstruction (UAO) in children. The timing of symptom onset and the presence of fever will help to distinguish infectious from non-infectious conditions. Signs and symptoms from congenital malformations often present at birth but may also develop over time. ⋯ A child with partial airway obstruction may initially have an adequate airway. However, this situation can deteriorate rapidly. Therefore, providing supportive care and mobilizing resources for definitive airway management may be the most appropriate interventions.