PEDIATRICS
DIFFERENTIAL
■ Seizures
■ Syncope
DIAGNOSIS
Clinical diagnosis based mainly upon history
TREATMENT
Reassure parents, and educate them not to reinforce child’s behavior.
Obstructive Lung Disease
BRONCHOPULMONARYDYSPLASIA(BPD)
BPD is associated with prematurity and very low birth weight. Typically these
infants will have a history of an O 2 requirement. The precise pathophysiology
of BPD is unknown, but the condition is the end result of numerous pul-
monary insults during the neonatal period (eg, infections, meconium aspira-
tion, prolonged ventilator support). Infants with BPD will usually present to
the ED with acute deterioration of respiratory function from some additional
insult.
SYMPTOMS/EXAM
■ Respiratory distress
■ Tachypnea
■ Hypoxia is common.
DIAGNOSIS
■ Clinical diagnosis
■ Viral infections are the most common trigger of an acute exacerbation,
especially RSV (see Table 5.14).
TABLE 5.14. Causes of Acute Respiratory Distress in Infants with BPDRespiratory infection
Sepsis
Aspiration
■ Gastroesophageal reflux
■ Incoordinate sucking or swallowing
Bronchospasm
Pulmonary edema or congestive heart failure
Dehydration
■ Gastroenteritis
■ Diuretic therapy
Anemia(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emer-
gency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill,
2004:769.)