Pediatric emergency medicine trisk 2784 2784

FIGURE 99.2 Bronchopulmonary dysplasia. This 2-month-old child was treated with
mechanical ventilation during the first days of life for hyaline membrane disease. The chest
film shows generalized overaeration and coarse nodularity with multiple cyst-like areas
throughout both lung fields.

Pulse oximetry is important to assess for hypoxemia. ETCO2 measurement
through noninvasive means or PCO2 measurement with arterial, venous, or
capillary blood gas analysis is indicated when signs and symptoms predict
hypercapnia or when cyanosis, respiratory distress, or deterioration from baseline
cannot be easily reversed. A CXR may provide additional information; however,
given baseline abnormalities, these often need to be compared with prior films.
Bronchodilators, ICSs, and diuretics may also be helpful. Most children with
BPD have had trials of β-agonist therapy. Although the use of MDIs for βagonists is effective in older infants with asthma, the evidence for their use in
young infants with BPD is less well defined. Although most acute episodes are
from viral infection, antibiotic therapy should be considered when the risk of
bacterial infection appears higher.
Prevention of BPD exacerbations is challenging. Although routine viral
illnesses may not be avoidable, RSV and influenza are the leading preventable
causes of rehospitalization in patients with BPD. Monoclonal antibody against
RSV (palivizumab, Synagis) is used to help prevent or lessen disease secondary
to RSV. Such immunoprophylaxis is recommended for children less than 1 year
of age who: (i) were born prior to 29 weeks’ gestation, (ii) were born <32 weeks