standard nasal prong therapy, or mask oxygen if preferred. There is no need for a prolonged weaning process, either be on humidified high flow, or standard low flow. PERTUSSIS Pertussis (whooping cough) usually presents as episodes of severe, prolonged coughing, but may present as apnoea in young infants. A whoop (loud stridor on inspiration after a paroxysm) is rare in children <6 mo old. Patients often appear well between paroxysms; persistent respiratory distress suggests that there is pneumonia. Mortality is highest in very young infants, and with a white cell count >100,000 (especially neutrophils >50,000). Diagnosis is by immunofluorescence or PCR of nasophayngeal aspirate. Severe illness may be associated with circulatory failure (from pulmonary hypertension), respiratory failure (often pneumonia), and encephalopathy with coma or convulsions (probably from hypoxic-ischaemic injury). 1. Give clarithromycin 7.5 mg/kg/dose 12H for 7 days oral or NG. If parenteral treatment is required, give azithromycin 15 mg/kg (max 500 mg) IV day 1, then 5 mg/kg (max 200 mg) daily for 7 days. Treat contacts if they are not fully immunised and either <12 mo old, or chronic cardio-respiratory illness, or in last month of pregnancy. 2. Oxygen therapy is often indicated even though the child is well oxygenated between paroxysms; reduces cyanosis during paroxysms of coughing. 3. There are copious thick secretions, and effective suctioning is very important (particularly after intubation). 4. In severe disease, consider giving methylprednisolone. 5. Humidified high flow or Nasal CPAP may be helpful for apnoea (but may stimulate coughing paroxysms). 6. Pulmonary hypertension may cause severe circulatory or respiratory failure; it may be caused by leukocyte aggregates in pulmonary vessels. If there is
standard nasal prong therapy, or mask oxygen if preferred. There is no need for a prolonged weaning process, either be on humidified high flow, or standard low flow. PERTUSSIS Pertussis (whooping cough) usually presents as episodes of severe, prolonged coughing, but may present as apnoea in young infants. A whoop (loud stridor on inspiration after a paroxysm) is rare in children <6 mo old. Patients often appear well between paroxysms; persistent respiratory distress suggests that there is pneumonia. Mortality is highest in very young infants, and with a white cell count >100,000 (especially neutrophils >50,000). Diagnosis is by immunofluorescence or PCR of nasophayngeal aspirate. Severe illness may be associated with circulatory failure (from pulmonary hypertension), respiratory failure (often pneumonia), and encephalopathy with coma or convulsions (probably from hypoxic-ischaemic injury). 1. Give clarithromycin 7.5 mg/kg/dose 12H for 7 days oral or NG. If parenteral treatment is required, give azithromycin 15 mg/kg (max 500 mg) IV day 1, then 5 mg/kg (max 200 mg) daily for 7 days. Treat contacts if they are not fully immunised and either <12 mo old, or chronic cardio-respiratory illness, or in last month of pregnancy. 2. Oxygen therapy is often indicated even though the child is well oxygenated between paroxysms; reduces cyanosis during paroxysms of coughing. 3. There are copious thick secretions, and effective suctioning is very important (particularly after intubation). 4. In severe disease, consider giving methylprednisolone. 5. Humidified high flow or Nasal CPAP may be helpful for apnoea (but may stimulate coughing paroxysms). 6. Pulmonary hypertension may cause severe circulatory or respiratory failure; it may be caused by leukocyte aggregates in pulmonary vessels. If there is
PICU%20Guidelines%20Nov%2015th%202017.docx