Common Pediatric Respiratory Emergencies

Emergency Medicine Clinics of North America

Volumn 30, Issue 2, 2012, Pages 529-563

  Choi, Joseph ^a   Lee, Gary L ^b  

^a ROYAL VICTORIA HOSPITAL   (Canada)

^b MONTREAL CHILDREN S HOSPITAL   (Canada)

Author keywords

Asthma; Bronchiolitis; Croup; Pediatric; Pneumonia

Indexed keywords

ACICLOVIR; ADRENALIN; AMOXICILLIN; AMPICILLIN; BETA ADRENERGIC RECEPTOR STIMULATING AGENT; BUDESONIDE; CEFOTAXIME; CEFUROXIME; CLARITHROMYCIN; CLINDAMYCIN; CLOXACILLIN; CORTICOSTEROID; DEXAMETHASONE; DEXAMETHASONE ACETATE; ERYTHROMYCIN; GENTAMICIN; HELIOX; IPRATROPIUM BROMIDE; LEUKOTRIENE RECEPTOR BLOCKING AGENT; LEVALBUTEROL; MAGNESIUM SULFATE; METHYLPREDNISOLONE; MONTELUKAST; PALIVIZUMAB; PLACEBO; PREDNISOLONE; PREDNISONE; SALBUTAMOL; UNINDEXED DRUG; VANCOMYCIN;

ABSCESS; ALLERGIC ASTHMA; ANTIBIOTIC THERAPY; ASTHMA; ASTHMATIC STATE; BACTERIAL ARTHRITIS; BACTERIAL SUPERINFECTION; BRONCHIOLITIS; BRONCHOSPASM; CHILD HOSPITALIZATION; COMMUNITY ACQUIRED PNEUMONIA; COUGHING; CROUP; DIFFERENTIAL DIAGNOSIS; DISEASE CLASSIFICATION; DISEASE EXACERBATION; DRUG INTERMITTENT THERAPY; EFFUSION; EMERGENCY CARE; EMPYEMA; EXERCISE INDUCED ASTHMA; HEART DISEASE; HOARSENESS; HUMAN; HYPOKALEMIA; INTENSIVE CARE; MENINGITIS; METERED DOSE INHALER; NEBULIZER; NONINVASIVE VENTILATION; OSTEOMYELITIS; PATHOPHYSIOLOGY; PEAK EXPIRATORY FLOW; PHYSICAL EXAMINATION; PNEUMATOCELE; PNEUMONIA; PRIORITY JOURNAL; RESPIRATORY FAILURE; RESPIRATORY SYNCYTIAL PNEUMOVIRUS; RESPIRATORY SYNCYTIAL VIRUS INFECTION; REVIEW; SEPSIS; STRIDOR; TACHYCARDIA; THORAX RADIOGRAPHY; UNSPECIFIED SIDE EFFECT; WHEEZING;

EID: 84859488080     PISSN: 07338627     EISSN: 07338627     Source Type: Journal    
DOI: 10.1016/j.emc.2011.10.009     Document Type: Review

References (203)

1. American Lung Association, Epidemiology and Statistics Unit. Trends in asthma morbidity and mortality. Washington, DC. Available at: Accessed April 13, 2011. http://www.lungusa.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf.
2. Global Initiative for Asthma. Global strategy for asthma management and prevention 2010, Global Initiative for Asthma, Bethesda (MD).
3. National Heart, Lung, and Blood Institute (US). Expert panel report 3: guidelines for the diagnosis and management of asthma 2007, National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services, National Institutes of Health, Bethesda (MD).
4. Busse W.W., Lemanske R.F. Asthma. N Engl J Med 2001, 344(5):350-362.
5. Stevenson D., Szczeklik A. Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006, 118(4):773-786. [quiz: 787-8].
6. Global Initiative for Asthma. Global strategy for the diagnosis and management of asthma in children 5 years and younger 2009, Global Initiative for Asthma, Bethesda (MD).
7. Brand P.L., Baraldi E., Bisgaard H., et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008, 32(4):1096-1110.
8. Panickar J., Lakhanpaul M., Lambert P., et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009, 360(4):329-338.
9. British Thoracic Society and the Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma 2009, The British Thoracic Society, London, England.
10. Ducharme F., Chalut D., Plotnick L., et al. The pediatric respiratory assessment measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr 2008, 152(4):476-480. 480.e471.
11. Chalut D.S., Ducharme F.M., Davis G.M. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr 2000, 137(6):762-768.
12. Gorelick M., Stevens M., Schultz T., et al. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med 2004, 11(1):10-18.
13. Gouin S., Robidas I., Gravel J., et al. Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age. Acad Emerg Med 2010, 17(6):598-603.
14. Goldberg R., Chan L., Haley P., et al. Critical pathway for the emergency department management of acute asthma: effect on resource utilization. Ann Emerg Med 1998, 31(5):562-567.
15. Eid N., Yandell B., Howell L., et al. Can peak expiratory flow predict airflow obstruction in children with asthma?. Pediatrics 2000, 105(2):354-358.
16. Gorelick M., Stevens M., Schultz T., et al. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care 2004, 20(1):22-26.
17. 2 and peak expiratory flow rate in acute asthma: a randomized trial. Chest 2003, 124(4):1312-1317.
18. Camargo C.A., Spooner C.H., Rowe B.H. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003, 4. CD001115.
19. Papo M.C., Frank J., Thompson A.E. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med 1993, 21(10):1479-1486.
20. Cates C.C.J., Bara A., Crilly J.A., et al. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2003, 3. CD000052.
21. Closa R.M., Ceballos J.M., Gmez-Pap A., et al. Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing. Pediatr Pulmonol 1998, 26(5):344-348.
22. Wildhaber J.H., Devadason S.G., Hayden M.J., et al. Aerosol delivery to wheezy infants: a comparison between a nebulizer and two small volume spacers. Pediatr Pulmonol 1997, 23(3):212-216.
23. Rubilar L., Castro Rodriguez J.A., Girardi G. Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age. Pediatr Pulmonol 2000, 29(4):264-269.
24. Doan Q., Shefrin A., Johnson D. Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department. Pediatrics 2011, 127(5):e1105-e1111. peds.2010-2963.
25. Asmus M.J., Hendeles L. Levalbuterol nebulizer solution: is it worth five times the cost of albuterol?. Pharmacotherapy 2000, 20(2):123-129.
26. Milgrom H., Skoner D.P., Bensch G., et al. Low-dose levalbuterol in children with asthma: safety and efficacy in comparison with placebo and racemic albuterol. J Allergy Clin Immunol 2001, 108(6):938-945.
27. Nelson H.S., Bensch G., Pleskow W.W., et al. Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma. J Allergy Clin Immunol 1998, 102(6):943-952.
28. Gawchik S.M., Saccar C.L., Noonan M., et al. The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients. J Allergy Clin Immunol 1999, 103(4):615-621.
29. Carl J., Myers T., Kirchner H.L., et al. Comparison of racemic albuterol and levalbuterol for treatment of acute asthma. J Pediatr 2003, 143(6):731-736.
30. Tripp K., McVicar W., Nair P., et al. A cumulative dose study of levalbuterol and racemic albuterol administered by hydrofluoroalkane-134a metered-dose inhaler in asthmatic subjects. J Allergy Clin Immunol 2008, 122(3):544-549.
31. Lam S., Chen J. Changes in heart rate associated with nebulized racemic albuterol and levalbuterol in intensive care patients. Am J Health Syst Pharm 2003, 60(19):1971-1975.
32. Plotnick L.H., Ducharme F.M. Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev 2000, 4. CD000060.
33. Rodrigo G.J., Castro Rodriguez J.A. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005, 60(9):740-746.
34. Rowe B.H., Edmonds M.L., Spooner C.H., et al. Corticosteroid therapy for acute asthma. Respir Med 2004, 98(4):275-284.
35. Fiel S., Vincken W. Systemic corticosteroid therapy for acute asthma exacerbations. J Asthma 2006, 43(5):321-331.
36. Smith M., Iqbal Shaikh Mohammed S.I., Rowe Brian H., et al. Corticosteroids for hospitalised children with acute asthma. Cochrane Database Syst Rev 2003, 1. Available at:, Accessed May 1, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002886/frame.html.
37. Becker J.M., Arora A., Scarfone R.J., et al. Oral versus intravenous corticosteroids in children hospitalized with asthma. J Allergy Clin Immunol 1999, 103(4):586-590.
38. Barnett P.L., Caputo G.L., Baskin M., et al. Intravenous versus oral corticosteroids in the management of acute asthma in children. Ann Emerg Med 1997, 29(2):212-217.
39. Kravitz J., Dominici P., Ufberg J., et al. Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial. Ann Emerg Med 2011, 58(2):200-204.
40. Greenberg R., Kerby G., Roosevelt G. A comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department. Clin Pediatr 2008, 47(8):817-823.
41. Shefrin R. Use of dexamethasone and prednisone in acute asthma exacerbations in pediatric patients. Can Fam Physician 2009, 55(7):704-706.
42. Altamimi M. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care 2006, 22(12):786-793.
43. Gordon S., Tompkins T., Dayan P. Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. Pediatr Emerg Care 2007, 23(8):521-527.
44. Gries D.M., Moffitt D.R., Pulos E., et al. A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children. J Pediatr 2000, 136(3):298-303.
45. FitzGerald J.M., Becker A., Sears M.R., et al. Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations. Thorax 2004, 59(7):550-556.
46. Edmonds M.L., Camargo C.A., Pollack C.V., et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev 2003, 3. CD002308.
47. Schuh S., Dick P., Stephens D., et al. High-dose inhaled fluticasone does not replace oral prednisolone in children with mild to moderate acute asthma. Pediatrics 2006, 118(2):644-650.
48. Schuh S., Reisman J., Alshehri M., et al. A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma. N Engl J Med 2000, 343(10):689-694.
49. Upham B.D., Mollen C.J., Scarfone R.J., et al. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med 2011, 18(7):665-673.
50. Spivey W.H., Skobeloff E.M., Levin R.M. Effect of magnesium chloride on rabbit bronchial smooth muscle. Ann Emerg Med 1990, 19(10):1107-1112.
51. Ciarallo L., Sauer A.H., Shannon M.W. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr 1996, 129(6):809-814.
52. Noppen M., Vanmaele L., Impens N., et al. Bronchodilating effect of intravenous magnesium sulfate in acute severe bronchial asthma. Chest 1990, 97(2):373-376.
53. Rowe B.H., Bretzlaff J.A., Bourdon C., et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med 2000, 36(3):181-190.
54. Rowe B.H., Bretzlaff J.A., Bourdon C., et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000, 2. CD001490.
55. Gallegos-Solorzano M.C., Perez-Padilla R., Hernandez-Zenteno R.J. Usefulness of inhaled magnesium sulfate in the coadjuvant management of severe asthma crisis in an emergency department. Pulm Pharmacol Ther 2010, 23(5):432-437.
56. Hughes R., Goldkorn A., Masoli M., et al. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial. Lancet 2003, 361(9375):2114-2117.
57. Bessmertny O., DiGregorio R.V., Cohen H., et al. A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults. Ann Emerg Med 2002, 39(6):585-591.
58. Blitz M., Blitz S., Beasely R., et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev 2005, 4. Available at:, Accessed May 1, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003898/frame.html.
59. Harmanci K., Bakirtas A., Turktas I., et al. Oral montelukast treatment of preschool-aged children with acute asthma. Ann Allergy Asthma Immunol 2006, 96(5):731-735.
60. Nelson K., Smith S., Trinkaus K., et al. Pilot study of oral montelukast added to standard therapy for acute asthma exacerbations in children aged 6 to 14 years. Pediatr Emerg Care 2008, 24(1):21-27.
61. Dockhorn R.J., Baumgartner R.A., Leff J.A., et al. Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients. Thorax 2000, 55(4):260-265.
62. Camargo C., Smithline H., Malice M.P., et al. A randomized controlled trial of intravenous montelukast in acute asthma. Am J Respir Crit Care Med 2003, 167(4):528-533.
63. Gupta V.K., Cheifetz I.M. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med 2005, 6(2):204-211.
64. Kim I., Phrampus E., Venkataraman S., et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics 2005, 116(5):1127-1133.
65. Lee D., Hsu C.W., Lee H., et al. Beneficial effects of albuterol therapy driven by heliox versus by oxygen in severe asthma exacerbation. Acad Emerg Med 2005, 12(9):820-827.
66. Rivera M., Kim T., Stewart G., et al. Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized controlled trial. Am J Emerg Med 2006, 24(1):38-42.
67. Travers A., Jones A.P., Kelly K., et al. Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev 2001, 2. CD002988.
68. Mitra A., Bassler D., Goodman K., et al. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane Database Syst Rev 2005, 2. CD001276.
69. Ream R.S., Loftis L.L., Albers G.M., et al. Efficacy of IV theophylline in children with severe status asthmaticus. Chest 2001, 119(5):1480-1488.
70. Akingbola O., Simakajornboon N., Hadley E., et al. Noninvasive positive-pressure ventilation in pediatric status asthmaticus. Pediatr Crit Care Med 2002, 3(2):181-184.
71. Bernet V., Hug M., Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 2005, 6(6):660-664.
72. Carroll C., Schramm C. Noninvasive positive pressure ventilation for the treatment of status asthmaticus in children. Ann Allergy Asthma Immunol 2006, 96(3):454-459.
73. Essouri S., Chevret L., Durand P., et al. Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 2006, 7(4):329-334.
74. Padman R., Lawless S.T., Kettrick R.G. Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Crit Care Med 1998, 26(1):169-173.
75. Thill P., McGuire J., Baden H., et al. Noninvasive positive-pressure ventilation in children with lower airway obstruction. Pediatr Crit Care Med 2004, 5(4):337-342.
76. Ram F.S., Wellington S., Rowe B., et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev 2005, 3. CD004360.
77. Brown R.H., Wagner E.M. Mechanisms of bronchoprotection by anesthetic induction agents: propofol versus ketamine. Anesthesiology 1999, 90(3):822-828.
78. Allen J., Macias C. The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma. Ann Emerg Med 2005, 46(1):43-50.
79. Howton J.C., Rose J., Duffy S., et al. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med 1996, 27(2):170-175.
80. Green S., Roback M., Krauss B. Anticholinergics and ketamine sedation in children: a secondary analysis of atropine versus glycopyrrolate. Acad Emerg Med 2010, 17(2):157-162.
81. Green S.M., Roback M.G., Kennedy R.M., et al. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med 2011, 57(5):449-461.
82. Bellomo R., McLaughlin P., Tai E., et al. Asthma requiring mechanical ventilation. A low morbidity approach. Chest 1994, 105(3):891-896.
83. Cox R.G., Barker G.A., Bohn D.J. Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus. Pediatr Pulmonol 1991, 11(2):120-126.
84. Darioli R., Perret C. Mechanical controlled hypoventilation in status asthmaticus. Am Rev Respir Dis 1984, 129(3):385-387.
85. Dworkin G., Kattan M. Mechanical ventilation for status asthmaticus in children. J Pediatr 1989, 114(4):545-549.
86. Hickling K.G., Walsh J., Henderson S., et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med 1994, 22(10):1568-1578.
87. Menitove S.M., Goldring R.M. Combined ventilator and bicarbonate strategy in the management of status asthmaticus. Am J Med 1983, 74(5):898-901.
88. Sin D., Bell N., Svenson L., et al. The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: a population-based study. Am J Med 2002, 112(2):120-125.
89. Zeiger R.S., Heller S., Mellon M.H., et al. Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. J Allergy Clin Immunol 1991, 87(6):1160-1168.
90. Zorc J., Scarfone R., Li Y., et al. Scheduled follow-up after a pediatric emergency department visit for asthma: a randomized trial. Pediatrics 2003, 111(3):495-502.
91. Baren J., Boudreaux E., Brenner B., et al. Randomized controlled trial of emergency department interventions to improve primary care follow-up for patients with acute asthma. Chest 2006, 129(2):257-265.
92. Sin D., Man S.F. Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma. Arch Intern Med 2002, 162(14):1591-1595.
93. Edmonds M., Brenner Barry E., Camargo Carlos A., et al. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database Syst Rev 2000, 3. Available at:, Accessed May 1, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002316/frame.html.
94. Cowie R.L., Revitt S.G., Underwood M.F., et al. The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. Chest 1997, 112(6):1534-1538.
95. Cherry J. Clinical practice. Croup. N Engl J Med 2008, 358(4):384-391.
96. Segal A., Crighton E., Moineddin R., et al. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics 2005, 116(1):51-55.
97. Peltola V., Heikkinen T., Ruuskanen O. Clinical courses of croup caused by influenza and parainfluenza viruses. Pediatr Infect Dis J 2002, 21(1):76-78.
98. Groblewski J., Shah R., Zalzal G. Microdebrider-assisted supraglottoplasty for laryngomalacia. Ann Otol Rhinol Laryngol 2009, 118(8):592-597.
99. Antony R., Al Rawas A., Irwin M. Stridor in a newborn. CMAJ 2005, 173(6):601-602.
100. Mancuso R.F. Stridor in neonates. Pediatr Clin North Am 1996, 43(6):1339-1356.
101. Koplewitz B., Springer C., Slasky B., et al. CT of hemangiomas of the upper airways in children. AJR Am J Roentgenol 2005, 184(2):663-670.
102. Rahbar R., Litrovnik B., Vargas S., et al. The biology and management of laryngeal neurofibroma. Arch Otolaryngol Head Neck Surg 2004, 130(12):1400-1406.
103. Durden F., Sobol S. Balloon laryngoplasty as a primary treatment for subglottic stenosis. Arch Otolaryngol Head Neck Surg 2007, 133(8):772-775.
104. Spanos W., Brookes J., Smith M., et al. Unilateral vocal fold paralysis in premature infants after ligation of patent ductus arteriosus: vascular clip versus suture ligature. Ann Otol Rhinol Laryngol 2009, 118(10):750-753.
105. Strife J.L. Upper airway and tracheal obstruction in infants and children. Radiol Clin North Am 1988, 26(2):309-322.
106. Westley C.R., Cotton E.K., Brooks J.G. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child 1978, 132(5):484-487.
107. Bjornson C.L., Johnson D.W. Croup-treatment update. Pediatr Emerg Care 2005, 21(12):863-870. [quiz: 871-3].
108. Sparrow A., Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child 2006, 91(7):580-583.
109. Russell K., Liang Y., O'Gorman K., et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2011, 1. CD001955.
110. Cetinkaya F., Tfeki B., Kutluk G. A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup. Int J Pediatr Otorhinolaryngol 2004, 68(4):453-456.
111. Geelhoed G.C., Macdonald W.B. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995, 20(6):362-368.
112. Dobrovoljac M., Geelhoed G. 27 years of croup: an update highlighting the effectiveness of 0.15 mg/kg of dexamethasone. Emerg Med Australas 2009, 21(4):309-314.
113. Chub Uppakarn S., Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol 2007, 71(3):473-477.
114. Duman M., Ozdemir D., Atasever S. Nebulised L-epinephrine and steroid combination in the treatment of moderate to severe croup. Clin Drug Investig 2005, 25(3):183-189.
115. Klassen T.P., Craig W.R., Moher D., et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial. JAMA 1998, 279(20):1629-1632.
116. Geelhoed G.C. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care 2005, 21(6):359-362.
117. Bjornson C., Russell Kelly F., Vandermeer B., et al. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev 2011, 2. Available at:, Accessed May 1, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006619/frame.html.
118. Taussig L.M., Castro O., Beaudry P.H., et al. Treatment of laryngotracheobronchitis (croup). Use of intermittent positive-pressure breathing and racemic epinephrine. Am J Dis Child 1975, 129(7):790-793.
119. Scolnik D., Coates A., Stephens D., et al. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA 2006, 295(11):1274-1280.
120. Neto G., Kentab O., Klassen T., et al. A randomized controlled trial of mist in the acute treatment of moderate croup. Acad Emerg Med 2002, 9(9):873-879.
121. Moore M., Little P. Humidified air inhalation for treating croup. Cochrane Database Syst Rev 2006, (3). Available at:, Accessed May 1, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002870/frame.html.
122. Weber J.E., Chudnofsky C.R., Younger J.G., et al. A randomized comparison of helium-oxygen mixture (Heliox) and racemic epinephrine for the treatment of moderate to severe croup. Pediatrics 2001, 107(6):E96.
123. Terregino C.A., Nairn S.J., Chansky M.E., et al. The effect of heliox on croup: a pilot study. Acad Emerg Med 1998, 5(11):1130-1133.
124. Vorwerk C., Coats T. Heliox for croup in children. Cochrane Database Syst Rev 2010, 2. CD006822.
125. Everard M. Acute bronchiolitis and croup. Pediatr Clin North Am 2009, 56(1):119-133.
126. Ducharme F.M. Management of acute bronchiolitis. BMJ 2011, 342:d1658.
127. Mansbach J.M., McAdam A.J., Clark S., et al. Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Acad Emerg Med 2008, 15(2):111-118.
128. Midulla F., Scagnolari C., Bonci E., et al. Respiratory syncytial virus, human bocavirus and rhinovirus bronchiolitis in infants. Arch Dis Child 2010, 95(1):35-41.
129. Miron D., Srugo I., Kra-Oz Z., et al. Sole pathogen in acute bronchiolitis-is there a role for other organisms apart from RSV?. Pediatr Infect Dis J 2010, 2010(29):e7-e10.
130. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis Diagnosis and management of bronchiolitis. Pediatrics 2006, 118(4):1774-1793.
131. Shay D.K., Holman R.C., Newman R.D., et al. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA 1999, 282(15):1440-1446.
132. Shay D.K., Holman R.C., Roosevelt G.E., et al. Bronchiolitis-associated mortality and estimates of respiratory syncytial virus-associated deaths among US children, 1979-1997. J Infect Dis 2001, 183(1):16-22.
133. Swingler G.H., Hussey G.D., Zwarenstein M. Duration of illness in ambulatory children diagnosed with bronchiolitis. Arch Pediatr Adolesc Med 2000, 154(10):997-1000.
134. Petruzella F.D., Gorelick M.H. Duration of illness in infants with bronchiolitis evaluated in the emergency department. Pediatrics 2010, 126(2):285-290.
135. Bialy L., Foisy M., Smith M., et al. The Cochrane library and the treatment of bronchiolitis in children: an overview of reviews. Evid Base Child Health 2011, 6(1):258-275.
136. Goutzamanis J. Bronchiolitis. Admission & discharge decisions in emergency medicine 2002, 246-250. Hanley & Belfus, Inc, Philadelphia. L.R. Frank, K.A. Jobe (Eds.).
137. Everard M. What link between early respiratory viral infections and atopic asthma?. Lancet 1999, 354(9178):527-528.
138. Gern J.E. Viral respiratory infection and the link to asthma. Pediatr Infect Dis J 2008, 27(10):S97-S103.
139. Stein R.T., Sherrill D., Morgan W.J., et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999, 354(9178):541-545.
140. Swingler G.H., Hussey G.D., Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet 1998, 351(9100):404-408.
141. Schuh S., Lalani A., Allen U., et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr 2007, 150(4):429-433.
142. Mahabee-Gittens E.M., Bachman D.T., Shapiro E.D., et al. Chest radiographs in the pediatric emergency department for children ≤18 months of age with wheezing. Clin Pediatr 1999, 38(7):395-399.
143. Purcell K., Fergie J. Lack of usefulness of an abnormal white blood cell count for predicting a concurrent serious bacterial infection in infants and young children hospitalized with respiratory syncytial virus lower respiratory tract infection. Pediatr Infect Dis J 2007, 2007(26):311-315.
144. Peltola V., Mertsola J., Ruuskanen O. Comparison of total white blood cell count and serum C-reactive protein levels in confirmed bacterial and viral infections. J Pediatr 2006, 149(5):721-724.
145. Liebelt E.L., Qi K., Harvey K. Diagnostic testing for serious bacterial infections in infants aged 90 days or younger with bronchiolitis. Arch Pediatr Adolesc Med 1999, 153(5):525-530.
146. Antanow J., Hansen K., McKinstry C.A. Sepsis evaluations in hospitalized infants with bronchiolitis. Pediatr Infect Dis J 1998, 17(3):231-236.
147. Thorburn K., Harigopal S., Reddy V., et al. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 2006, 61(7):611-615.
148. Bilavsky E., Shouval D., Yarden-Bilavsky H. A prospective study of the risk for serious bacterial infections in hospitalized febrile infants with or without bronchiolitis. Pediatr Infect Dis J 2008, 27(3):269-282.
149. Duttweiler L., Nadal D., Frey B. Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Arch Dis Child 2004, 89(12):1155-1157.
150. Hartling L., Bialy Liza M., Vandermeer B., et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev 2011, (6). Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003123/frame.html.
151. Hartling L., Fernandes R.M., Bialy L., et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ 2011, 342:d1714.
152. Chavasse Richard J.P.G., Seddon P., Bara A., et al. Short acting beta2-agonists for recurrent wheeze in children under two years of age. Cochrane Database Syst Rev 2002, 2. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002873/frame.html.
153. Everard M., Bara A., Kurian M., et al. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev 2005, 3. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001279/frame.html.
154. Fernandes Ricardo M., Bialy Liza M., Vandermeer B., et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2010, 10. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004878/frame.html.
155. Zhang L., Mendoza-Sassi Raúl A., Wainwright C., et al. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2008, 4. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006458/frame.html.
156. Liet J.M., Ducruet T., Gupta V., et al. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev 2010, 4. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006915/frame.html.
157. Bronchiolitis Guideline Team, Cincinatti Children's Hospital Medical Team. Evidenced-based care guideline for management of bronchiolitis in infants 1 year of age or less with a first time epidose. Cincinnatti (OH): Bronchiolitis Pediatric Evidence-Based Care Guidelines, Cincinnatti Children's Hospital Medical Center. Available at: Accessed October 27, 2011. http://www.cincinnatichildrens.org/service/j/anderseon-center/evidence-based-care/bronchiolitis/.
158. Turner T., WIlkinson F., Harris C. Evidence-based guideline for the management of bronchiolitis. Aust Fam Physician 2008, 37(6):6-13.
159. Bronchiolitis in children-a national clinical guideline 2006, Scottish Intercollegiate Guidelines Network, Available at:, Accessed April 13, 2011. http://www.sign.ac.uk/pdf/sign91.pdf.
160. Gadomski Anne M., Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2010, 12. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001266/frame.html.
161. Seiden J.A., Scarfone R.J. Bronchiolitis: an evidence-based approach to management. Clin Pediatr Emerg Med 2009, 10(2):75-81.
162. Grewal S., Ali S., McConnell D.W., et al. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med 2009, 163(11):1007-1012.
163. Corneli H.M., Zorc J.J., Mahajan P., et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007, 357(4):331-339.
164. Plint A.C., Johnson D.W., Patel H., et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009, 360(20):2079-2089.
165. Wark P., McDonald Vanessa M. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev 2009, 2. Available at:, Accessed April 13, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001506/frame.html.
166. Chaudhry K., Sinert R. Is nebulized hypertonic saline solution an effective treatment for bronchiolitis in infants?. Ann Emerg Med 2010, 55(1):120-122.
167. Kuzik B.A., Flavin M.P., Kent S., et al. Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial. CJEM 2010, 12(6):477.
168. Kim I.K., Corcoran T. Recent developments in heliox therapy for asthma and bronchiolitis. Clin Pediatr Emerg Med 2009, 10(2):68-74.
169. Mansbach J.M., Clark S., Christopher N.C., et al. Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics 2008, 121(4):680-688.
170. Willwerth B.M., Harper M.B., Greenes D.S. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med 2006, 48(4):441-447.
171. Norwood A., Mansbach J.M., Clark S., et al. Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department. Acad Emerg Med 2010, 17(4):376-382.
172. Marlais M., Evans J., Abrahamson E. Clinical predictors of admission in infants with acute bronchiolitis. Arch Dis Child 2011, 96(7):648-652.
173. Black R.E., Cousens S., Johnson H.L., et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375(9730):1969-1987.
174. Homier V., Bellevance C., Xhignesse M. Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department. CJEM 2007, 9(5):347-351.
175. Evidence-Based (EB) Clinical Decision Support Team & Community-Acquired Pneumonia Content Expert Team - Texas Children's Hospital. Community-acquired pneumonia (CAP) clinical guideline. Available at: Accessed October 27, 2011. http://www.bcm.edu/web/pediatrics/documents/rp_archive_21.pdf.
176. Murphy C.G., Van De Pol A.C., Harper M.B., et al. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med 2007, 14(3):243-249.
177. Shah S., Bachur R., Kim D., et al. Lack of predictive value of tachypnea in the diagnosis of pneumonia in children. Pediatr Infect Dis J 2010, 29:406-409.
178. Korppi M., Don M., Valent F., et al. The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children. Acta Paediatr 2008, 97(7):943-947.
179. Mathews B., Shah S., Cleveland R.H., et al. Clinical predictors of pneumonia among children with wheezing. Pediatrics 2009, 124(1):e29-e36.
180. Korppi M. Antibiotic therapy for pneumonia in the pediatric population. Pediatr Health 2007, 1(1):77.
181. British Thoracic Society BTS guidelines for the management of community-acquired pneumonia in childhood. Thorax 2002, 57(Suppl 1):i1-i24.
182. Lahti E., Peltola V., Virkki R., et al. Development of parapneumonic empyema in children. Acta Paediatr 2007, 96(11):1686-1692.
183. Virkki R., Juven T., Rikalainen H., et al. Differentiation of bacterial and viral pneumonia in children. Thorax 2002, 57(5):438-441.
184. Michelow I.C., Olsen K., Lozano J., et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004, 113(4):701-707.
185. Carrillo-Marquez M., Hulten K., Hammerman W., et al. Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children's Hospital. Pediatr Infect Dis J 2011, 30(7):545-550.
186. Wallin T., Hern H., Frazee B. Community-acquired methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am 2008, 26:431-455.
187. Liu C., Bayer A., Cosgrove S.E., et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011, 52(3):285-292.
188. Graham S., English M., Hazir T., et al. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings. Bull World Health Organ 2008, 86(5):349-355.
189. Clinical Practice Guidelines Group - Toward Optimized Practice (TOP) Program. Guideline for the diagnosis and management of community acquired pneumonia: pediatric - 2008 Update. Available at: Accessed April 26, 2011. http://www.topalbertadoctors.org/cpgs.php?sid=15&cpg_cats=61.
190. Newman M., Scully K., Kim D. Physician assessment of the likelihood of pneumonia in pediatric emergency department. Pediatr Emerg Care 2010, 26(11):817-822.
191. Lynch T., Bialy L., Kellner J. A systematic review on the diagnosis of pediatric bacterial pneumonia: when gold is bronze. PLoS One 2010, 5(8):1-7.
192. Cortellaro F., Colombo S., Coen D., et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J 2010, [Epub ahead of print].
193. Kurian J., Levin T.L., Han B.K., et al. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. Am J Roentgenol 2009, 193(6):1648-1654.
194. Community Acquired Pneumonia Guideline Team, Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for medical management of community acquired pneumonia in children 60 days to 17 years of age. Available at: Accessed October 27, 2011. http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/community-acquired-pneumonia/.
195. Shah S., Dugan M., Bell L., et al. Blood cultures in the emergency department evaluation of childhood pneumonia. Pediatr Infect Dis J 2011, 30:475-479.
196. Hickey R.W., Bowman M.J., Smith G.A. Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department. Ann Emerg Med 1996, 27(6):721-725.
197. Jadavji T., Law B. A practical guide for the diagnosis and treatment of pediatric pneumonia. CMAJ 1997, 156(5):S703.
198. Wilde J.A. Rapid diagnostic testing for the identification of respiratory agents in the emergency department. Clin Pediatr Emerg Med 2002, 3(3):181-190.
199. Bradley J.S., Byington C.L., Shah S.S., et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011, 53(7):e25-e76.
200. Atkinson M., Lakhanpaul M., Smyth A., et al. Comparison of oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children (PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial. Thorax 2007, 62(12):1102-1106.
201. Haider Batool A., Lassi Zohra S., Bhutta Zulfiqar A. Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev 2008, 2. Available at:, Accessed June 12, 2011. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005976/frame.html.
202. Ayieko P., English M. Case management of childhood pneumonia in developing countries. Pediatr Infect Dis J 2007, 26(5):432-440.
203. Virkki R., Juven T., Mertsola J., et al. Radiographic follow-up of pneumonia in children. Pediatr Pulmonol 2005, 40(3):223-227.