December 2014 : ‘flu vaccination for children, calprotectin, paintballing bruises, eczema and some useful links to atopy downloads. Do leave comments:
Tag Archives: infectious disease
October 2014 published
October 2014 holds quite a few topics: scalp ringworm, sleep and behaviour, support for victims of sexual abuse, immunotherapy for peanut allergy, link to parental asthma booklet and what to do with babies with chicken pox. Do leave comments below…
How to manage a 3 week old baby with chicken pox
With thanks to Dr Vicky Agunloye, paediatric registrar and new Waltham Forest mum, for kicking off her parental FAQ series with a question that many GPs ring and ask me – and I always have to look it up…
Chicken pox , Varicella-Zoster Virus (VZV), is a common infection spread by droplet inhalation of the VZV from contacts with either chicken pox or shingles.
Most children have a mild disease course; however those that are immuno-compromised are at a significant risk of severe or fatal disease and need human Varicella Zoster Immunogloblin (VZIG) as soon as possible. Some neonates (<=7 days old) come into this category.
Who needs VZIG? :
- Infants whose mothers develop chickenpox (but not herpes zoster) in the period 7 days before to 7 days after delivery. VZIG can be given without antibody testing in these infants.
- An infant who has had significant contact with a case of varicella when < 7 days of age and whose contact of VZV was not the mother and mother has no positive history of VZV herself. In these cases, the VZIG should not be given past 7 days after the initial contact.
(Confirm patient has had significant contact, Box 1 in: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/327762/Chickenpox_immunoglobulin_Oct_2008.pdf )
Who does not need VZIG?
- Term infants > 7 days old, even if they have had significant contact
- An infant that has not had significant contact, see above.
- A term infant who is < 7 days old, whose mother has a positive protective history of VZV.
- Infants who have been exposed >10 days ago.
Whose VZV anti-bodies need checking before you can decide if VZIG is needed?
- Infants <7 days whose mothers are unsure of their VZV status (you can check mothers or infants). However do not delay more than 7 days waiting for results.
Inform mothers that up to 50% of neonates exposed to maternal VZV who get VZIG still go on to get chickenpox, most are mild cases.
If infant becomes symptomatic despite VZIG, IV acyclovir is needed.
Other useful links:
- http://cks.nice.org.uk/chickenpox#!scenariorecommendation:9
- Page 434-435: http://www.clinicalguidelines.scot.nhs.uk/Renal%20Unit%20Guidelines/Nephrotic%20syndrome%20Guideline/Varicella%20doc.pdf
November/December 2013
Seasonal treats this month in the form of bronchiolitis treatments and the use of antipyretics in febrile convulsions. Perennial subjects include obesity, BCG lymphadenitis and a concise reminder of the management of UTI in children.
October 2013 newsletter
Lots of writing on this month’s PDF digest, much of it thanks to our registrars. Rotavirus oral vaccination, wheezing in the under 2s, bradycardia, conduct disorder, Kawasaki disease and force feeding. Do leave comments below.
August 2013 PDF published
Thermal injuries from a safeguarding point of view this month, updated fever guidelines, quarantine periods for infectious diseases, house dust mite allergy and facial injuries this month as the last in the minor injuries series. Do leave comments below.
June 2013 ready to go!
Lots of things to talk about this month. Reminder of what Koplik spots look like, good e-learning on human trafficking, a link to the new primary care guidelines page, night terrors v. nightmares, some good allergy websites and Jess Spedding again on scaphoid injuries. Do leave comments below.
April/May 2013
April wasn’t quite long enough this year for me to get the newsletter out in time – or something like that anyway. With thanks to Stephen Flanagan of the London PHE for his input into the measles textbox and Paul Gringras for help with the sleep series again. Jess has put together another superb article for her minor injuries series and I hope you find the links to the healthy weight clinics helpful for your patients locally. Click here for the April/May 2013 newsletter.
BTS 2011 guideline on community acquired pneumonia in children
In October 2011 the British Thoracic Society updated its guidelines on community acquired pneumonia in children. Dr Michael Eyres looked at it in more detail for Paediatric Pearls. He was also part of our local audit team contributing to the national audit. The results showed that we, despite insisting on as few investigations as possible, are still doing too many chest x-rays, blood cultures and CRP measurements. Think – will it change management?
Here are the basics:
When to consider pneumonia
Persistent fever > 38.5°C + chest recessions + tachypnoea
Investigations
• CXR should not be considered routine and is not required in children who do not need admission.
• Acute phase reactants including CRP are not useful in distinguishing viral from bacterial infection and should not
be tested routinely. Blood cultures also do not need to be routinely taken.
• Daily U&Es are required in children receiving IV fluids.
Severity assessment
• Children with oxygen saturations <92% need hospital referral.
• Auscultation findings of absent breath sounds with dullness to percussion need hospital referral.
• Children should be reassessed if symptoms persist.
General management
• Give parents information on managing fever, preventing dehydration and identifying deterioration.
• Children with oxygen saturations <92% need oxygen.
• NG tubes should be avoided in severe respiratory compromise and in infants.
• Chest physio is not beneficial and should not be performed in pneumonia.
Antibiotics
• All children with a clear clinical diagnosis of pneumonia should receive antibiotics as bacterial and viral
infections cannot be reliably distinguished. However most children younger than 2 years presenting with mild symptoms of respiratory distress (this would
include the bronchiolitics) do not usually require antibiotics.
• Amoxicillin is the oral first-line for all children as it is effective, well tolerated and cheap.
• Macrolides if no response to first-line / suspected mycoplasma or chlamydia / very severe disease.
• Augmentin if pneumonia associated with influenza.
• Oral agents are effective even in severe pneumonia; IV is needed only if unable to tolerate oral or there are
signs of septicaemia, empyema or abscess.
Follow-up
• Children with severe pneumonia or complications should be followed up after discharge until they have recovered completely and
CXR is near normal. Follow-up CXR is not otherwise required, but may be considered in round pneumonia, collapse or if symptoms persist.
July 2012 – just in time for summer!
A busy newsletter this month with an eclectic mix of fussy eaters and QTc calculators, female genital mutilation and tonsillitis, healthy start vitamins and syncope. Do leave comments below.