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Open Access 03-01-2024 | Disease of the Respiratory Tract and Lungs in Pediatrics | GUIDELINE

Clinical recommendations for the inpatient management of lower respiratory tract infections in children and adolescents with severe neurological impairment in Germany

Authors: Maximilian David Mauritz, Ulrich von Both, Christian Dohna-Schwake, Christian Gille, Carola Hasan, Johannes Huebner, Markus Hufnagel, Markus Knuf, Johannes G. Liese, Hanna Renk, Henriette Rudolph, Ulf Schulze-Sturm, Arne Simon, Florian Stehling, Tobias Tenenbaum, Boris Zernikow

Published in: European Journal of Pediatrics | Issue 3/2024

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Abstract

Children and adolescents with severe neurological impairment (SNI) require specialized care due to their complex medical needs. In particular, these patients are often affected by severe and recurrent lower respiratory tract infections (LRTIs). These infections, including viral and bacterial etiology, pose a significant risk to these patients, often resulting in respiratory insufficiency and long-term impairments. Using expert consensus, we developed clinical recommendations on the management of LRTIs in children and adolescents with SNI. These recommendations emphasize comprehensive multidisciplinary care and antibiotic stewardship. Initial treatment should involve symptomatic care, including hydration, antipyretics, oxygen therapy, and respiratory support. In bacterial LRTIs, antibiotic therapy is initiated based on the severity of the infection, with aminopenicillin plus a beta-lactamase inhibitor recommended for community-acquired LRTIs and piperacillin-tazobactam for patients with chronic lung disease or tracheostomy. Ongoing management includes regular evaluations, adjustments to antibiotic therapy based on pathogen identification, and optimization of supportive care. Implementation of these recommendations aims to improve the diagnosis and treatment of LRTIs in children and adolescents with SNI.
What is Known:
• Children and adolescents with severe neurological impairment are particularly affected by severe and recurrent lower respiratory tract infections (LRTIs).
• The indication and choice of antibiotic therapy for bacterial LRTI is often difficult because there are no evidence-based treatment recommendations for this heterogeneous but vulnerable patient population; the frequent overuse of broad-spectrum or reserve antibiotics in this patient population increases selection pressure for multidrug-resistant pathogens.
What is New:
• The proposed recommendations provide a crucial framework for focused diagnostics and treatment of LRTIs in children and adolescents with severe neurological impairment.
• Along with recommendations for comprehensive and multidisciplinary therapy and antibiotic stewardship, ethical and palliative care aspects are taken into account.
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Metadata
Title
Clinical recommendations for the inpatient management of lower respiratory tract infections in children and adolescents with severe neurological impairment in Germany
Authors
Maximilian David Mauritz
Ulrich von Both
Christian Dohna-Schwake
Christian Gille
Carola Hasan
Johannes Huebner
Markus Hufnagel
Markus Knuf
Johannes G. Liese
Hanna Renk
Henriette Rudolph
Ulf Schulze-Sturm
Arne Simon
Florian Stehling
Tobias Tenenbaum
Boris Zernikow
Publication date
03-01-2024

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