Pediatrics Subject Collection: Respiratory Tract

Care of the Child Assisted by Technology [ARTICLES]

Glader, L. J. — 2009-11-01

Objectives Objectives Introduction Who Are Technology-dependent... Specific Technologies Psychosocial Issues General Management Principles Prognosis Websites for Families References After completing this article, readers should be able to: Describe children who are dependent on technology. List common indications for and complications of gastrostomy tubes. Define invasive and noninvasive mechanical ventilation. Recognize the psychosocial effects of having a child dependent on technology. Introduction Objectives Introduction Who Are Techn ...

Visual Diagnosis: Sepsis, Respiratory Distress, and a Persistent Right Lung Opacification in a Newborn [ARTICLES]

Sabnis, H. — 2009-11-01

Presentation Presentation Diagnosis: Right Diaphragmatic... Summary Suggested Reading A 20-year-old primigravida woman delivers a term female infant weighing 3,112 g via caesarean section under spinal anesthesia. The mother's antenatal test results are unremarkable, including a negative group B beta-hemolytic Streptococcus (GBS) screen at 33 to 34 weeks' gestation. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Physical examination results are normal. Four hours after delivery, the infant develops tachypnea, grunting, and "blue" lower extremities. Supplemental oxygen is provided, blood and urine cultures are performed, and empiric treatment with intravenous ampicillin and cefotaxime is initiated. A chest radiograph reveals a normal cardia ...

Secondhand Tobacco Smoke Exposure Among Children and Adolescents: United States, 2003-2006 [ARTICLES]

Marano, C. — 2009-11-01

OBJECTIVE: The implementation of policies that prohibit tobacco smoking in public places has resulted in a significant reduction in secondhand smoke (SHS) exposure in the US population; however, such policies do not extend to private homes, where children continue to be exposed. Our objective was to assess SHS exposure among US children and adolescents by using serum cotinine measures to compare those who were exposed to SHS in the home and those without home exposure. METHODS: We analyzed serum cotinine data from the 2003-2006 National Health and Nutrition Examination Survey for 5518 children (3-11 years) and nonsmoking adolescents (12-19 years). We calculated geometric mean serum cotinine levels by sociodemographic and household characteristics according to self-reported home SHS exposure. Multiple regression analysis was conducted to evaluate independent predictors of serum cotinine levels. RESULTS: Geometric mean serum cotinine levels were 1.05 ng/mL among those with home SHS exposure and 0.05 ng/mL among those without home exposure. Among children who were exposed to SHS at home, serum cotinine levels were inversely associated with age and were similar for non-Hispanic black and non-Hispanic white children. Conversely, among children without SHS exposure at home, serum cotinine levels were higher among non-Hispanic black compared with non-Hispanic white children, and there was no relationship with age. Mexican American children had the lowest level of SHS exposure. CONCLUSIONS: Serum cotinine levels were an order of magnitude higher among children with reported SHS exposure at home compared with those with no exposure in the home.

Secondhand Smoke and Respiratory Symptoms Among Adolescent Current Smokers [ARTICLES]

Lai, H.-K. — 2009-11-01

OBJECTIVE: No study has ever reported the association between persistent respiratory symptoms and exposure to secondhand smoke (SHS) in adolescent smokers. The impact of SHS exposure on child health could be largely underestimated by not taking into account such effects. We investigated the association between exposure to SHS and respiratory symptoms among adolescent current smokers. METHODS: A total of 32506 students aged 11 to 20 years from 85 randomly selected secondary schools in Hong Kong completed a self-administered questionnaire that included persistent respiratory symptoms (for 3 consecutive months in the past 12 months), number of days of SHS exposure per week at home and outside home, smoking status, amount of active smoking, and other basic demographic characteristics and socioeconomic status. RESULTS: Adolescent current smokers who were exposed to SHS at home 1 to 4 and 5 to 7 days/wk were 50% (95% confidence interval [CI]: 3%-121%) and 77% (95% CI: 5%-199%) more likely, respectively, to report respiratory symptoms compared with those who were unexposed (P = .01 for trend). The corresponding figures for exposure outside home were 41% (95% CI: 3%-94%) and 85% (95% CI: 31%-161%; P = .004 for trend). Such associations were also observed among never-smokers, but they were weaker than those among current smokers (P < .01 for interaction). CONCLUSIONS: This is the first evidence that SHS exposure is associated with increased risks for persistent respiratory symptoms among adolescent current smokers. Health promotion programs should aim at SHS reduction as well as smoking cessation among adolescent smokers.

Practical Management of Asthma [ARTICLES]

Wood, P. R. — 2009-10-01

Objectives Objectives Introduction Initial Assessment Medical Management The Physician-family Partnership... Periodic Monitoring Management of Acute... References Additional Resources After completing this article, readers should be able to: Identify the major environmental factors and comorbid conditions that affect asthma. Describe the role of a written asthma action plan in the management of asthma. Know how to assess asthma control and adjust therapy appropriately. Discuss the evaluation and management of the child who has an acute exacerbation of asthma. ...

Bronchiolitis [ARTICLES]

Wagner, T. — 2009-10-01

Objectives Objectives Introduction Epidemiology Diagnosis Management Prevention Prognosis References Suggested Reading After completing this article, readers should be able to: Recognize the clinical presentation of bronchiolitis. Be aware of the recommendations made in the current American Academy of Pediatrics clinical practice guideline for diagnosis and management of bronchiolitis. Describe the role of laboratory testing in the diagnosis of bronchiolitis. Delineate the efficacy of current therapeutic interventions in the treatment of bronchiolitis. Discuss the evaluation fo ...

Management of Micrognathia [ARTICLES]

Thimmappa, B. — 2009-10-01

Micrognathia and the associated retroposition of the tongue into the oropharynx (glossoptosis) can obstruct the upper airway, producing obstructive apnea. The primary management of respiratory compromise in patients who have micrognathia is controversial. Numerous modalities have been used, including prone positioning, nasopharyngeal airways, tongue-lip adhesion, mandibular distraction, and tracheostomy. The goal of any intervention is to relieve airway obstruction, with secondary goals reported in the literature including avoidance or early removal of tracheostomy, improvement in feeding, and accelerated growth. This review examines nonsurgical and surgical therapeutic options and their outcomes. The diagnostic and treatment algorithm employed at the senior author's institution is presented.

Neonatal Vocal Cord Paralysis [ARTICLES]

Benjamin, J. R. — 2009-10-01

Neonatal vocal cord paralysis (VCP) remains an important cause of acute and chronic respiratory compromise in infants. Despite a normal cry, infants who have bilateral VCP may present with marked respiratory distress, and emergency tracheostomy is a lifesaving procedure in the most severe cases. Unilateral VCP usually causes more pronounced abnormalities of the infant's voice, but respiratory symptoms are typically mild. VCP most commonly results from iatrogenic causes due to injury to the left recurrent laryngeal nerve during cardiac surgery. VCP also can result from congenital or neurologic disorders. Vocal cord dysfunction usually improves over time but may take years to resolve. Infants who have VCP are at risk for aspiration, prolonged duration of mechanical ventilation, reactive airway disease, and persistent feeding problems. Serial examination of vocal cord function at regular intervals using flexible fiberoptic endoscopy or direct laryngoscopy is essential to monitor airway patency and document improvement or resolution of paralysis over time. Affected infants also must be followed closely to determine the need for future medical or surgical intervention.

Risk Factors for Lower Respiratory Tract Infection Death Among Infants in the United States, 1999-2004 [ARTICLES]

Singleton, R. J. — 2009-10-01

OBJECTIVE: To describe maternal and birth-related risk factors associated with lower respiratory tract infection (LRTI) deaths among infants. METHODS: Records for infants with LRTI as a cause of death were examined by using the linked birth/infant death database for 1999-2004. Singleton infants dying with LRTI and a random sample of surviving singleton infants were compared for selected characteristics. RESULTS: A total of 5420 LRTI-associated infant deaths were documented in the United States during 1999-2004, for an LRTI-associated infant mortality rate of 22.3 per 100000 live births. Rates varied according to race; the rate for American Indian/Alaska Native (AI/AN) infants was highest (53.2), followed by black (44.1), white (18.7), and Asian/Pacific Islander infants (12.3). Singleton infants with low birth weight (<2500 g) were at increased risk of dying with LRTI after controlling for other characteristics, especially black infants. Both AI/AN and black infants born with a birth weight of [≥]2500 g were more likely to have died with LRTI than other infants of the same birth weight. Other risk factors associated with LRTI infant death included male gender, the third or more live birth, an Apgar score of <8, unmarried mother, mother with <12 years of education, mother <25 years of age, and mother using tobacco during pregnancy. CONCLUSIONS: Low birth weight was associated with markedly increased risk for LRTI-associated death among all of the racial groups. Among infants with a birth weight of [≥]2500 g, AI/AN and black infants were at higher risk of LRTI-associated death, even after controlling for maternal and birth-related factors. Additional studies and strategies should focus on the prevention of maternal and birth-related risk factors for postneonatal LRTI and on identifying additional risk factors that contribute to elevated mortality among AI/AN and black infants.

Asthma Epidemiology, Pathophysiology, and Initial Evaluation [ARTICLES]

Hill, V. L. — 2009-09-01

Objectives Objectives Introduction Epidemiology Clinical Aspects References After completing this article, readers should be able to: Describe the underlying pathophysiology of asthma. Discuss the role of atopy in the development of asthma. Identify risk factors for death from asthma. List conditions to be considered in the differential diagnosis of wheezing in children. Introduction Objectives Introduction Epidemiology Clinical Aspects References Asthma is a disease of airway inflammation characterized by hyperresponsiveness and airflow obstruction that lead to symptoms ...