Pediatric emergency medicine trisk 2783 2783

Initial Assessment/H&P
Signs and symptoms of BPD exacerbations vary based on severity of the
underlying disease; therefore, recognizing interim worsening of disease requires
an understanding of baseline examination findings and pulmonary function.
Children with BPD are often tachypneic at baseline, with some degree of
retractions that worsen with even mild respiratory or febrile illnesses. Findings on
auscultation including crackles, wheezes, or decreased breath sounds may be
present at baseline and worsened with exacerbations or acute illness. Infants with
BPD may have a history of failure to thrive, often resulting from concomitant
nutritional issues, or from increased energy expenditure secondary to chronic
increased work of breathing. CXRs ( Fig. 99.2 ) often demonstrate varying
amounts of hyperinflation; several patterns occur, including cystic areas with
signs of fibrosis, which are often confused with congenital lobar emphysema or
severe CF. Comparison with prior CXRs is important to distinguish old changes
from new infiltrates.
Management
Management of children with BPD and intercurrent respiratory illnesses is
primarily limited to supportive care. If the exacerbation is mild, outpatient
therapy may be indicated with frequent follow-up every 1 to 2 days. However, for
infants with moderate to severe BPD at baseline, even mild deterioration may
herald early respiratory failure. Ensuring hydration by oral or IV routes, and,
when necessary, providing supplemental oxygen or assisted ventilation for
hypoxemia or hypercarbia with respiratory acidosis are the mainstays of therapy.