- Clinical grades of stridor.

Clinical grades of stridor.

1.Grade 1 (Exertional stridor) :
Stridor appears during crying or exercise.
2.Grade 2 (Continuous stridor or stridor at rest) : 
Stridor is present at rest & become worse with exertion.
 3.Grade 3 (Stridor with retractions) : 
Stridor is continuous & accompanied with suprasternal& supraclavicular retractions. The patient looks anxious, irritable, struggling for breathing.
4.Grade 4 (Stridor with cyanosis) :
 In addition to continuous stridor & retractions, cyanosis& altered consciousness occur denoting severe respiratory failure. ET intubation may be considered.

- Newborn with Focal colonic fits.

Newborn aged 3 days delivered by Caesarean section with history of perinatal asphyxia and prolonged resuscitation and need intubation in delivery room admitted into our NICU on mechanical ventilator and show right upper limb colonic fits.

- Causes of stridor In pediatrics.

Causes of stridor according to site of obstruction.

-Nose and pharynx: (by laryngeal compression)

• Lingual thyroid or thyroglossal cyst 
• Macroglossia(Beckwith-Wiedemann syndrome, hypothyroidism, Pompe disease, trisomy 21, hemangioma).
• Micrognathia (Pierre Robin syndrome, Treacher Collins syndrome,DiGeorge syndrome)
• Hypertrophic tonsils/adenoids
• Retropharyngeal or peritonsillar abscess / hematoma
• Tongue teratoma or dermoid 
• Masses: e.g. cystic hygroma or other malformation

-Larynx:
Not acute:

• Laryngomalacia
• Congenital subglottic stenosis
• Vocal cord paralysis
• Laryngeal atresia/web 
• Congenital Subglottic hemangioma
• Vascular ring compression syndrome.
• Laryngocele/cyst
• Laryngeal papillomas 
• GERD

- Infant girl with whooping cough (Video)

Infant girl with whooping cough

Mother holding infant girl in Intensive Care Unit. The baby has pertussis (whooping cough) and is coughing severely.

- Baby with viral croup (video).

2 years old female presenting with barking cough, stridor

The child have:

• stridor at rest 
• Subcostal and suprasternal retraction 

As classified by Westley score  minimally she has Moderate croup

- Pathogenesis of Acute Bronchiolitis.

Pathogenesis of Acute Bronchiolitis. 

RSV initially multiplies in the epithelium of the nasopharynx.
It then forms a syncytium and invades nearby cells.
 Hence, progression within few days of illness from an upper respiratory infection to a lower respiratory tract involvement is from cell to cell rather than hematogenous, extra-cellular fluid or any other route.
 The virus mainly multiplies within the bronchial epithelium and the alveolar macrophages.

 It finally results in:
o Destruction of the bronchiolar lining epithelium and loss of ciliated epithelial cells.
o Peribronchial infiltration of white blood cells.
o oedema of the submucosa and adventitia.
o ↑ Secretion
o Plugs of sloughed, necrotic epithelium and fibrin in the airways cause significant small airway obstruction (bronchospasm) resulting in hyperinflation, obstructive emphysema, atelectasis and ventilation/perfusion mismatch leading to hypoxemia.

N.b: Bronchial muscles are spared in bronchiolitis.

- Hospital and PICU admission criteria in cases of acute bronchiolitis.

Hospital and PICU admission criteria in cases of acute bronchiolitis.

Hospital Admission Criteria:

• Hypoxemia <90% on room air
• Dehydration with inability to maintain hydration
• Major comorbidity
• Need to rule out alternative diagnosis
• heart rate >180 bpm
• Moderate to Severe distress
• Inability to care for child at home.
• Strongly consider in infants with high-risk criteria:

- LBW
- age <6 wk,
- Prematurity
- Cardiac (Pulmonary hypertension,heart failure or cyanotic heart disease) .
- Pulmonary disease (BPD, cystic fibrosis or congenital anomalies of airway)
- Immunodeficiency
- neuromuscular disease

Critical care admission criteria:

• Recurrent apneas
• Concern regarding impending respiratory failure, increasing oxygen requirements
• High risk criteria…