Journal conference

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Journal conference

• Reporter ?????
• Supervisor ?????
• 92-11-19

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Paper review

• Brook et al.Unexplained fever in young children
  how to manage severe bacterial infection BMJ,
  327(7423).November 8,20031094-1097)
• Baranwal et al.Empyema thoracis A10 year
  comparative review of hospitalised children from
  south AsiaArc of Dis in Chid .88(11) , Nov 2003
  pp.1009-1014

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• Fever in children less than 36 months of
  age-questions and strategies for management in
  the emergency department. The J of Eme Med
  ,25(2), 2003pp149-157
• Shah et al.Risk of Bacteremia in Young Children
  with Pneumonia treated as outpatients.Arc Ped and
  Adol Med.154(4)April 2003p.389-392

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Bacteremia
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(No Transcript)
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Low risk criteria

• For children younger than 3 months with fever and
  no focus of infection
• Clinical criteria
• Laboratory criteria

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Clinical criteria

• Born at term (Gestational age gt 37 weeks) with
  uncomplicated nursery stay
• Previously healthy infants
• No toxic manifestations
• No focal bacterial infection (except otitis media)

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Laboratory criteria

• WBC 5000-150000 /mm3 , lt1500 band or band /
  neutorphil ratio lt 0.2
• Normal U/A(negative Gram stain , leucocyte
  esterase and nitrite , WBC lt5 /HPF)
• lt 8 WBC , negative Gram stain in CSF
• No infiltrate on CXR

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Parenteral antibiotics with fever and no focus of
infection

• lt3 month
• Ampicillin 100-200 mg/kg/day q6h Gentamicin 7.5
  mg/kg/day q8h
• Ceftriaxine 50 mg /kg/day in single dose
• Cefotaxime 150 mg/kg/day q8h

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• gt 3 months
• Ceftriaxone 50 mg/kg/day in a single dose
• Cefuroxime 150-200 mg/kg/day q6-8 h

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Referral and admission criteria

• Febrile infants 7 days of age or less
• High risk febrile infants 28 90 days of age
• Toxic looking febrile children up to 36 months of
  age

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Bacteraemia and meningitis

• lt 1 months old
• GBS , E. coli , Listeria monocytogens
• Step. Pneumoniae , H. influenzae
• Stap aureus , N. meningitides
• Salmonella spp.

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• 1- 3 months
• Strep. Pneumonia
• N. meningitides
• Salmonella spp.
• H. influenzae
• Listeria monocytogenes

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• Over 3 months
• Strep. Pneumoniae
• H. influenzae
• N. meningitides
• Salmonella spp.

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Bacteremia

• The incidence of post-H. influenza and
  pneumococcal vaccine is probably less than 2
• Children less than 3 months of age,in low-risk
  infants the prevalence of occult bacteremia is
  0.2-1

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Bacteremia

• Children aged 2-24 months with pneumonia who are
  treated as outpatients are at low risk of
  bacteremia
• H. influenzae and Streptococcus pneumonia were
  the most common bacterial pathogens

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Empyema
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Medical treatment

• Anti-Staph and Anti-Strep were used empirically .
  Aminoglycosides used to synergistic effect in
  first 5-7 days
• Usually parental 7-14 days for symptomatic
  relief and oral antibiotics for continued further
  2 4 weeks

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Pleural space drainage

• Continuous closed tube drainage leads to clinical
  and radiological improvement within 24 hours
• Tube removed once drainage becomes minimal (lt
  10-15 ml/day) ,irrespective of roentgenogtaphic
  resolution

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Surgery

• Only for persistent pleural sepsis
• Tube drainage for more than 10 days , surgery is
  indicated for debridement of the pleural space

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Empyema

• Staphylococcus spp. is the most isolation ,
  especially lower than 5 years old
• S. Pneumonia was found from older children , and
  Gram negative rods were more older children

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Cough
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Cause

• Infection
• Inflammation/Allergy
• Mechanical or chemical irritation
• Neoplasm
• Congenital anomalies
• Miscellaneous

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Infection

• Upper respiratory infection
• Sinusitis , Tonsillitis , Laryngitis , Croup
• Tracheitis , Bronchiolitis , Acute bronchitis
• Pneumonia , Pleuritis
• Bronchiectasis

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Inflammation /Allergy

• Allergic rhinitis
• Laryngeal edema
• Reactive airway disease
• Chronic bronchitis
• Cystic fibrosis

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Mechanical or chemical irritation

• chemical fumes
• Inhaled particulates
• Foreign body aspiration
• Neck/chest contusions
• Smoking

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Neoplasm

• Pharyngeal or nasal polyp
• Papilloma
• Lymphoma
• Mediastinal tumors

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Congenital abnormaly

• Cleft palate
• Laryngotracheomalacia
• Laryngeal or tracheal webs
• Tracheoesophageal fistula
• Vascular ring
• Pulmonary sequestration

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Miscellaneous

• GE reflux
• CHF
• Swallowing dysfunction
• Granulomatous disease
• Psychogenic cough
• Foreign body in otic canal

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Life threaten

• Reactive airway disease
• Croup
• Bronchiolitis
• Forign body
• Pneumonia
• Laryngeal edema
• Pertusis
• Toxic inhalation
• CHF