Showing posts with label respiratory difficulties. Show all posts
Showing posts with label respiratory difficulties. Show all posts

Wednesday, January 15, 2014

Human Rhinovirus Infection in Children: Something to Sneeze At!

Photo by D. Sharon Pruitt via Flickr
We certainly think of human rhinovirus (HRV) as a common cause of upper respiratory infections in children—but
is it really something to worry about relative to other viruses that can
present with moderate to severe symptoms, such as respiratory
syncytial virus (RSV)?

In a study we are releasing this week, Costa et al. (doi: 10.1542/peds.2013-2216) examined 434 children with respiratory symptoms and classified them by severity. They then tested for HRV and 8 other respiratory viruses
to determine HRV’s prevalence and whether it operates alone or with other viruses as a co-infection—especially if symptoms are moderate to severe.

The co-morbidities associated with HRV disease severity are well-worth reading about, so wash your hands, grab a tissue, and learn more about what HRV is and is-snot.

Friday, October 4, 2013

Eighteen Years of Data on Pediatric Interstitial Lung Disease: What Can We Learn?

Interstitial lung diseases are not the most common pulmonary problem we see in our pediatric patients with respiratory difficulties—but they can and do occur. Just how they present and what we should do about them once suspected form the nidus for a fascinating retrospective review of 93 cases seen at Vanderbilt Children’s Hospital between 1994 and 2011 that Soares et al. (doi: 10.1542/peds.2013-1780) share with us in an article we are releasing this week. The authors, knowing the natural history of these cases, suggest that a lung biopsy is not necessarily required for diagnosis, making this problem one that may be initially diagnosed and subsequently followed (likely  with guidance from a pediatric pulmonary specialist) by a child’s primary care pediatrician. If you need to brush up on your knowledge of pediatric interstitial lung diseases and how they present, you’ll find this article inspiring.

Thursday, September 19, 2013

Thinking of Trying Oral Dexamethasone for Bronchiolitis? Have We Got a Study For You!

Bronchiolitis studies are frequent nowadays as multiple investigators search for the elusive treatment that will result in improved outcomes. A number of studies have looked at the risks and benefits of intravenous and inhaled steroids in treating this disorder, but not necessarily the role of oral dexamethasone—at least until Al-Ansari et al. (doi: 10.1542/peds.2012-3746) performed a randomized controlled study looking at the efficacy and safety of dexamethasone versus placebo in 200 hospitalized patients with asthma-risk based on family history of asthma or having eczema as an infant. All patients also received inhaled salbutamol.  Length of stay was the primary outcome indicator, but the risk of side effects was also evaluated. The results are good ones to read about and perhaps implement in your own young patients with bronchiolitis and asthma-risk. See for yourself what I mean by following the link to this article to learn more.

Monday, September 2, 2013

Pulmonary Embolus in Children: They Do Occur, But Who’s at Risk?

While pulmonary embolus (PE) sits prominently on the adult differential diagnosis of acute respiratory distress, we probably don’t think of it as often as we might in our younger patients. It is perhaps for that reason that Agha et al. (doi: 10.1542/peds.2013-0126) opted to review patients in their emergency department who were diagnosed with a pulmonary embolus from 2003 to 2011.  While only 105 PEs were identified from over one million patient visits, this is still a number we can learn from—and learn we do in this article in terms of demographic risk factors as well as whether these patients would have been identified using adult exclusionary criteria or missed in their diagnosis. The authors indicate that even children with PEs are not just little adults and instead require their own specific clinical decision rules if we are going to have a high pretest probability of diagnosing and not missing a pulmonary embolus in our pediatric patients. You’ll breathe easier if you read this study to learn more.