August 2015: ENT feature this month – acute mastoiditis, PVL producing staph from the dermatology team, Henoch Schonlein purpura – long term management and follow up and Part 1 of the NICE guideline summary on bronchiolitis. Just in time for the RSV season….
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January 2015 newsletter is being published late with apologies. The newsletter is circulated prior to publication to be checked by my 8 paediatric consultant colleagues and any guest authors. I neglected to attach the newsletter to my initial email, a fact pointed out to me on the 31st January….. Now checked and ready to go.
Andrew Lock has put together a really helpful guide to viral exanthems with trustworthy links to proper images, Vicky Agunloye is back this month with an invaluable guide to the healthcare professional’s assessment of a crying baby (and his/her mother). Tom Waterfield has looked at the usefulness of saline nebs in bronchiolitis, there are some more “do not do” recommendations from NICE and a link to Suffolk’s guideline on managing anaphylaxis and its follow up from primary care. Do leave comments below:
Have a look at the November 2010 Paediatric Pearls PDF digest for information on bronchiolitis, heart murmurs and burns. The featured NICE guideline this month was Nocturnal Enuresis which, even with the best will in the world, has very little to do with Accident and Emergency! Those of you who are interested in the topic could look at this month’s GP version.
November’s Paediatric Pearls is now published and is available for download here. It sees the start of our 6 week check series, kicking off with information on heart murmurs. There is also a bit on bronchiolitis as the season is upon us now and a feature on the NICE guideline on nocturnal enuresis which was published at the end of October 2010.
With thanks to Amutha for this article….
As winter approaches, most of us are very well aware that the bronchiolitis season is in full swing. Bronchiolitis is a lower respiratory tract infection – in the under 1s predominantly – that can cause fever, dry cough, nasal discharge and bilateral fine inspiratory creps ± wheeze. Most cases of bronchiolitis occur from November to March, when the viruses that can cause bronchiolitis are more common. It is also possible to get bronchiolitis more than once during the same winter season (1).
Treatment is largely supportive and many infants are managed at home if they are feeding adequately and do not have significant respiratory difficulty. Patients at high risk are ex-premature babies, those with congenital cardiac or respiratory diseases, immunodeficiency and babies < 3months of age (2). When seeing a child, we should focus our history and examination on risk factors, signs of dehydration and respiratory distress. This podcast provides an example of respiratory distress:
3% of children will present with severe illness and require admission (2). Map of Medicine (http://healthguides.mapofmedicine.com/choices/map/bronchiolitis1.html) defines “severe” as those with:
- poor feeding – less than half normal intake
- history of apnoea
- respiratory rate above 70breaths/minute
- presence of nasal flare and/or grunting
- severe chest wall recession
- marked use of accessory muscles
- marked intercostal and subcostal recession
- oxygen saturation (SaO2) 94% or less
There have been no therapies that have been consistently effective enough to change the current supportive management of bronchiolitis. The majority of trials show that bronchodilators do not provide benefit and their routine use is not recommended (3).
2. Scottish Intercollegiate Guidelines Network (SIGN). Bronchiolitis in children. A national clinical guideline. Edinburgh: SIGN; 2006. http://www.sign.ac.uk/pdf/sign91.pdf
3. Petruzella FD, Gorelick MH. Current therapies in bronchiolitis. Pediatr Emerg Care 2010 Apr;26(4):302-7