scholarly journals Dehydration in Children with Respiratory Tract Infections in a Pediatric Emergency Department of a Tertiary Hospital

2020 ◽  
pp. 1-6
Author(s):  
Rebeca Sosa ◽  
◽  
Luis Alonso Mata-Perez ◽  
Manuel E Soto-Quiros ◽  
Manuel E Soto-Martinez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Respiratory Infections ◽  
Pediatric Population ◽  
Fluid Management ◽  
Tertiary Hospital ◽  
Pediatric Emergency ◽  
Common Finding ◽  
P Value ◽  
Tract Infections

Backgrounds: Dehydration is a common finding the Emergency Department(ED). The main cause of dehydration in the pediatric population is acute gastroenteritis, but it can be present with other illness such as respiratory infections. The aim of this study was to determine the prevalence of dehydration in patients presenting with lower respiratory tract infection (LRTI). Methods: Prospective observational study of patients with LRTI admitted in the ED in a period of three-months. Patients with LRTI were included and assessed with the Clinical Dehydration Scale (CDS) to determine clinical dehydration. Patients were weighted on admission and 24-hours after admission to determine weight change after fluid management. Results: 88 patients with LRTI were included. A total of 23(26.1%) patients presented a degree of dehydration according to the CDS scale. Comparing weight changed on admission and 24-hours later 55.6% had an increased weight. When comparing the grade of dehydration with the CDS scale vs increased weight changed at 24-hours after fluid management, it was statically significant for patients 6 months-1 year(23% vs 64%;p value 0.01), 1-2 years(25% vs 50%;p value 0.05) and >2 years(16% vs 50%;p value 0.03). The most common clinical finding was mild dehydration in 22 patients and moderate/severe in only 1 patient. Conclusions: This is one of the few studies of dehydration in illness not related to gastroenteritis. The key finding of this study was that LRTI in some of the patients were associated with certain degree of dehydration. Not all patients with dehydration were detected using clinical findings and this difference was found using weight changed

scholarly journals Did admissions caused by respiratory infections and asthma decrease during the COVID-19 pandemic?

2021 ◽  
Author(s):  
Zeynep Onay ◽  
Deniz Mavi ◽  
Yetkin Ayhan ◽  
Sinem Can Oksay ◽  
Gulay Bas ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Outpatient Clinic ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Pediatric Population ◽  
Pediatric Intensive Care ◽  
Acute Bronchiolitis ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: COVID-19 outbreak lead to nationwide lockdown on the March 16th, 2020 in Turkey. We aimed to quantitively determine the change in frequency of upper and lower respiratory tract infections and asthma in pediatric population associated with COVID-19. Methods: The electronic medical record data of pediatric population admitted to the emergency department (ED), outpatient and inpatient clinics and pediatric intensive care unit (PICU) were analyzed with the diagnosis of Influenza, upper and lower respiratory tract infections (URTI, LRTI) acute bronchiolitis and asthma. The data of the first year of the pandemic was compared with the previous year. Results: In total 112496 admissions were made between April 1, 2019 and March 31, 2021 in our hospital. A decline was observed in ED admissions (-73%) and outpatient clinic (-70%) visits, hospitalizations (-41.5%) and PICU admissions (-42%). The admissions with the diagnosis of Influenza and URTI had a decline from 4.26% to 0.37% (p=0.0001), and from 81.54% to 75.62% (p=0.0001), respectively. An increase was observed in the LRTI, acute bronchiolitis and asthma (from 8.22% to 10.01% (p=0.0001), from 2.76% to 3.07% (p=0.027) and from 5.96% to 14% (p=0.0001), respectively). Conclusions: A dramatic decrease was observed in the number of admissions to ED and inpatient clinics and outpatient clinic visits and PICU admissions, and, when the rates of admissions were compared, the general rate of admissions to ED showed a decrease while inpatient, outpatient clinics and PICU admissions demonstrated an increase during the pandemic.

scholarly journals Pediatric emergency department; resource exhaustion and burden of work in a resource-constrained region.

2021 ◽  
Vol 62 (4) ◽  
pp. 110-116
Author(s):  
Hasanein Habeeb Ghali ◽  
Mustafa A. Al-Shafiei ◽  
Hayder M. Al-Musawi
Keyword(s):  
Emergency Department ◽  
Complete Blood Count ◽  
Hospital Setting ◽  
Pediatric Emergency ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chronic Respiratory Diseases ◽  
Resource Exhaustion ◽  
Tract Infections

Background: emergency care is well known as the care delivered in a hospital setting to any patient with unexpected, sudden, threatening reversible condition. In countries where health care is not optimum, this type of care represents the weakest element of the health system. Aims of the study: to figure out the main causes behind the admission in Pediatric Emergency Department (PED) of Children Welfare Teaching Hospital (CWTH) and the urgency of visits. Patients and methods: a cross sectional study retrospective analysis that was carried out in the PED of CWTH in Medical City, Baghdad. Five hundred visits for patients below the age of 14 years between August and November 2017 were enrolled in this study and their data were analyzed. Perceived urgency of the current visit was assessed and analyzed. Results: the mean age for the patients was 3 years. Males represent 239 patients (47.8%). Of the whole group, 110 patients with a range of hours (22.0%). The most common complaint recorded was fever in 175 patients (21.0%). The most common comorbidities recorded were chronic respiratory diseases in 10 patients. Complete blood count was ordered for 460 patients (92.0%). Strikingly, blood culture was recorded in 5 patients only (1.0%). Reviewing the patients’ files has shown that 381 patients (76.2%) were prescribed antibiotics during stay in PED. The diagnosis of the patients visiting the PED was documented in 252 (50.4%) patients’ files only. Lower respiratory tract infections were the most frequently recorded diagnosis in 41 patients (8.2%). 266 patients (53.2%) were shown to be urgent visits, while 234 of them (46.8%) were non-urgent visits. Most of the patients who have comorbidities were labeled as urgent patients (89.4%), with a significant statistical difference (P value 0.001). Most of the patients who presented with a duration of complaint of within hours (89.1%) were stratified as urgent cases. Noteworthy, the majority of the patients who did not receive antibiotic therapy were stratified to be urgent (74.7%), the p value was 0.0001. Considering the disposition of the patients, majority of the patient who were discharged home (61.2%) were stratified as non-urgent, while (38.8%) were urgent. Conclusions: The study identifies the critical pitfalls of improper documentation of the data in the PED. It also delineates the resource exhaustion from the non-urgent visits. This may call for the need of structured training of physicians in the PED to improve efficiency, and reduce the cost and expenses of each patients through reducing the investigations and this will improve the standards of service. Triage system should be implemented in CWTH PED.

Antibiotic Prescribing for Patients with Upper Respiratory Tract Infections by Emergency Physicians in a Singapore Tertiary Hospital

2005 ◽  
Vol 12 (2) ◽  
pp. 70-76 ◽  
Author(s):  
WY Lee
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Tertiary Hospital ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Emergency Physicians ◽  
Upper Respiratory ◽  
Tract Infections

Objective Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital. Methods Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing. Results Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea. Conclusion A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.

scholarly journals The Role of the Respiratory Microbiome and Viral Presence in Lower Respiratory Tract Infection Severity in the First Five Years of Life

2021 ◽  
Vol 9 (7) ◽  
pp. 1446
Author(s):  
Ivo Hoefnagels ◽  
Josephine van de Maat ◽  
Jeroen J.A. van Kampen ◽  
Annemarie van Rossum ◽  
Charlie Obihara ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Disease Severity ◽  
Lower Respiratory Tract ◽  
Influenza A ◽  
Pediatric Population ◽  
16S Rrna Gene Sequencing ◽  
Rrna Gene ◽  
Detection Rates ◽  
Tract Infections ◽  
Respiratory Microbiome

Lower respiratory tract infections (LRTIs) in children are common and, although often mild, a major cause of mortality and hospitalization. Recently, the respiratory microbiome has been associated with both susceptibility and severity of LRTI. In this current study, we combined respiratory microbiome, viral, and clinical data to find associations with the severity of LRTI. Nasopharyngeal aspirates of children aged one month to five years included in the STRAP study (Study to Reduce Antibiotic prescription in childhood Pneumonia), who presented at the emergency department (ED) with fever and cough or dyspnea, were sequenced with nanopore 16S-rRNA gene sequencing and subsequently analyzed with hierarchical clustering to identify respiratory microbiome profiles. Samples were also tested using a panel of 15 respiratory viruses and Mycoplasma pneumoniae, which were analyzed in two groups, according to their reported virulence. The primary outcome was hospitalization, as measure of disease severity. Nasopharyngeal samples were isolated from a total of 167 children. After quality filtering, microbiome results were available for 54 children and virology panels for 158 children. Six distinct genus-dominant microbiome profiles were identified, with Haemophilus-, Moraxella-, and Streptococcus-dominant profiles being the most prevalent. However, these profiles were not found to be significantly associated with hospitalization. At least one virus was detected in 139 (88%) children, of whom 32.4% had co-infections with multiple viruses. Viral co-infections were common for adenovirus, bocavirus, and enterovirus, and uncommon for human metapneumovirus (hMPV) and influenza A virus. The detection of enteroviruses was negatively associated with hospitalization. Virulence groups were not significantly associated with hospitalization. Our data underlines high detection rates and co-infection of viruses in children with respiratory symptoms and confirms the predominant presence of Haemophilus-, Streptococcus-, and Moraxella-dominant profiles in a symptomatic pediatric population at the ED. However, we could not assess significant associations between microbiome profiles and disease severity measures.

scholarly journals Viral etiology and epidemiology of pediatric patients hospitalized for acute respiratory tract infections in Macao: a retrospective study from 2014 to 2017

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheng Lei ◽  
Lisong Yang ◽  
Cheong Tat Lou ◽  
Fan Yang ◽  
Kin Ian SiTou ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Pediatric Patients ◽  
Respiratory Infections ◽  
Upper Respiratory Tract ◽  
Viral Etiology ◽  
Upper Respiratory ◽  
Syncytial Virus ◽  
Tract Infections

Abstract Background Acute respiratory infections (ARIs) are among the leading causes of hospitalization in children. Understanding the local dominant viral etiologies is important to inform infection control practices and clinical management. This study aimed to investigate the viral etiology and epidemiology of respiratory infections among pediatric inpatients in Macao. Methods A retrospective study using electronic health records between 2014 and 2017 at Kiang Wu Hospital was performed. Nasopharyngeal swab specimens were obtained from hospitalized children aged 13 years or younger with respiratory tract diseases. xMAP multiplex assays were employed to detect respiratory agents including 10 respiratory viruses. Data were analyzed to describe the frequency and seasonality. Results Of the 4880 children enrolled in the study, 3767 (77.1%) were positive for at least one of the 13 viral pathogens tested, of which 2707 (55.5%) being male and 2635 (70.0%) under 2 years old. Among the positive results, there were 3091 (82.0%) single infections and 676 (18.0%) multiple infections. The predominant viruses included human rhinovirus/enterovirus (HRV/EV 27.4%), adenovirus (ADV, 15.8%), respiratory syncytial virus B (RSVB, 7.8%) and respiratory syncytial virus A (RSVA, 7.8%). The detection of viral infection was the most prevalent in autumn (960/1176, 81.6%), followed by spring (1095/1406, 77.9%), winter (768/992, 77.4%), and summer (944/1306, 72.3%), with HRV/EV and ADV being most commonly detected throughout the 4 years of study period. The detection rate of viral infection was highest among ARI patients presented with croup (123/141, 87.2%), followed by lower respiratory tract infection (1924/2356, 81.7%) and upper respiratory tract infection (1720/2383, 72.2%). FluA, FluB and ADV were positive factors for upper respiratory tract infections. On the other hand, infection with RSVA, RSVB, PIV3, PIV4, HMPV, and EV/RHV were positively associated with lower respiratory tract infections; and PIV1, PIV2, and PIV3 were positively associated with croup. Conclusions This is the first study in Macao to determine the viral etiology and epidemiology of pediatric patients hospitalized for ARIs. The study findings can contribute to the awareness of pathogen, appropriate preventative measure, accurate diagnosis, and proper clinical management of respiratory viral infections among children in Macao.

scholarly journals The local antibody response to R.S. virus infection in the respiratory tract

1974 ◽  
Vol 72 (1) ◽  
pp. 111-120 ◽  
Author(s):  
R. Scott ◽  
P. S. Gardner
Keyword(s):  
Virus Infection ◽  
Respiratory Tract ◽  
Acute Phase ◽  
Respiratory Infections ◽  
Geometric Mean ◽  
High Titre ◽  
Virus Infections ◽  
Mean Values ◽  
Neutralizing Activity ◽  
Tract Infections

SUMMARYNasopharyngeal secretions were taken during the acute phase of illness from 66 infants and children admitted to hospital with lower respiratory tract infections. Second secretions were taken, after an interval of 7 days, from 33 of these patients. A significant increase in neutralizing activity to R.S. virus was demonstrated in the nasopharyngeal secretions of patients in response to severe R.S. virus infection. Seventeen out of 25 patients (68%) with R.S. virus infections developed a rise in secretory neutralizing titre, compared with only 1 out of 8 patients (13%) with respiratory infections not involving R.S. virus.A high titre of secretory neutralizing activity was found more often in the acute phase of illness in patients with R.S. virus infections, especially bronchiolitis, than in patients with respiratory infections not involving R.S. virus. Fifteen out of 34 patients (44%) with R.S. virus bronchiolitis were found to possess a neutralizing titre of 1/4 or more in their first secretions, compared with 4 out of 12 patients (33%) with R.S. virus infections other than bronchiolitis and 3 out of 20 patients (15%) with respiratory infections not involving R.S. virus.A quantitative analysis of the immunoglobulins present in the secretions indicated that IgA was the only immunoglobulin consistently present at a detectable concentration. The geometric mean values of IgA, IgM and IgG in the secretions examined were found to be 22·3, 4·3 and 5·3 mg./lOO ml. respectively.The neutralizing activity against R.S. virus, present in the secretions, was shown to be due to specific IgA antibody. This was accomplished by removing the neutralizing activitv in two secretions bv absorotion with anti-IaA serum.

Urinary Tract Infections in Febrile Infants Younger Than 8 Weeks of Age

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 363-367 ◽  
Author(s):  
Ellen F. Crain ◽  
Jeffrey C. Gershel
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Pediatric Emergency ◽  
Urine Specimen ◽  
High Power Field ◽  
Tract Infections

In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature ≥100.6°F (38.1° C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapublic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.

Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 163-165 ◽  
Author(s):  
Scott F. Dowell ◽  
S. Michael Marcy ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
Benjamin Schwartz
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Agents ◽  
Respiratory Infections ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Upper Respiratory Tract ◽  
Oral Agents ◽  
Upper Respiratory ◽  
Tract Infections

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account for the majority of outpatient antimicrobial use in the United States. Data from the National Center for Health Statistics indicate that in recent years, approximately three fourths of all outpatient antibiotics have been prescribed for otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection.1Antimicrobial drug use rates are highest for children1; therefore, the pediatric age group represents the focus for the present guidelines. The evidence-based principles presented here are focused on situations in which antimicrobial therapy could be curtailed without compromising patient care. They are not formulated as comprehensive management strategies. For most upper respiratory infections that require antimicrobial treatment, there are several appropriate oral agents from which to choose. Although the general principles of selecting narrow-spectrum agents with the fewest side effects and lowest cost are important, the principles that follow include few specific antibiotic selection recommendations.

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