Pre-school wheeze – emergency guideline children’s health queensland georgia state university sports

Though it is thought that MTW reflects chronic allergic airway inflammation there is little evidence to support this. Georgia southwestern state university logo pre-school wheeze should be described in terms of the temporal patterns (EVW and MTW), frequency, severity, age of onset and relevant associated clinical parameters such as atopy and eczema. 6 note that children may change between categories over time and in that event pharmacological treatment should also change. 2 asthma

Several clinical predictive indices for future risk of asthma have been developed based on combinations of the presence of atopic manifestations, indirect evidence of airway inflammation such as peripheral blood eosinophil count, and severity of pre-school wheeze. 2 the clinical utility of such predictive indices is limited due to a poor ability to correctly identify those who will develop asthma (positive predictive value (PPV) ranging from 44 to 54%).

However, the absence of known risk factors can be useful to reassure parents of a lower risk of future asthma. Assessment

Steroids are not recommended for pre-school aged children who present for the first time or infrequently with a mild to moderate wheeze however, the literature is constantly evolving. Some studies suggest that steroids do not reduce symptom severity or the need for hospital treatment in pre-school children with mild to moderate wheeze. 8 A large randomised, double-blind, placebo-controlled trial found no significant difference in the duration of hospitalisation in children with mild to moderate wheezing associated with viral infection in those given oral steroids compared to placebo. 13 however, a recent australian study concluded that prednisone reduced the length of stay in children with mild-moderate viral associated wheeze. 14

Studies have shown that an alternative steroid, dexamethasone, with benefits of a longer half-life, may also be a suitable treatment for children with wheeze. Georgia state university mailing address in a recent paediatric study, dexamethasone was found to have a similar efficacy as prednisone when comparing respiratory scores, with a single dose of 0.3mg/kg dexamethasone having the same efficacy as a course of prednisone to prednisone 0.1mg/kg for 3 days. 16 however, dexamethasone suspension is not readily available in the community or non-tertiary hospitals.

There is no evidence to clearly define an optimal oxygen saturation (spo 2) target for young children with respiratory illnesses and therefore threshold for supplemental oxygen administration. Consensus opinion supports a target of spo 2 ≥94%. Lower saturations may be tolerated depending upon institutional practice. A study in children with bronchiolitis aged 90% was as safe and clinically effective as 94%. 25 this study may influence future consensus opinion in other respiratory tract illnesses in children. A current randomised controlled trial studying high flow oxygen therapy for children with acute hypoxemic respiratory failure uses a cut off of ≤92% for the commencement of oxygen supplementation. 26

Low flow oxygen should not be given to children for work of breathing in isolation, and the practice of “fly-by” oxygen (ie. Leaving a mask adjacent the patient’s face) is discouraged. Georgia college and state university ranking transient (< 5 mins) desaturations below the local limit during sleep with rapid self-correction does not mandate increasing or commencing supplemental oxygen. Nurse-initiated commencement of supplemental oxygen is suitable however, a review by a medical officer should be requested at the time for cause of deterioration and, where applicable (per institutional recommendations), should be prescribed on an oxygen order form. 8