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with BPD (required >21% oxygen for at least 28 days after birth), (iii) have
hemodynamically significant heart disease. It may also be considered in the first
year of life for infants with pulmonary abnormality or neuromuscular disease that
impairs the ability to clear secretions from the upper airways. Children from 1 to
2 years of age should only receive palivizumab if they required oxygen at least 28
days after birth and continue to require medical interventions for their BPD.
Annual influenza vaccination should also be considered for children with BPD.
Clinical Indications for Discharge or Admission
Indications for admission generally include respiratory distress, tachypnea,
increasing hypoxia or hypercarbia, poor feeding, apnea, or new radiographic
infiltrates. Parental fatigue and stress are also important factors to consider in the
decision to hospitalize.

CYSTIC FIBROSIS
CLINICAL PEARLS AND PITFALLS
Patients with cystic fibrosis (CF) may have worsening of underlying
disease due to several causes including: bacterial colonization and
exacerbation, acute viral illness, acute bacterial infection,
pneumothorax, hemoptysis, or allergic bronchopulmonary aspergillosis
(ABPA).
Communication with the patient’s primary CF team should occur in a
timely manner.
CXRs should be obtained in patients with increased respiratory
symptoms and compared to prior studies.
Isolation precautions should be initiated as soon as possible.

Current Evidence
CF is an autosomal recessive genetic disease, predominantly seen in Caucasians.
The basic genetic defect is a mutation on the long arm of chromosome 7,
resulting in an abnormal cystic fibrosis transmembrane conductance regulator
(CFTR) protein with wide phenotypic variability. These CFTR defects affect

function of cells lining the respiratory tract, pancreatic exocrine system, sweat
glands, and intrahepatic biliary epithelium. In the respiratory and GI tracts, this
leads to dehydrated secretions that are difficult to mobilize. The manifestation in
the respiratory tract is chronic inflammation and chronic infection. In the sweat