Introduction:
Acute respiratory infections (ARI) are a leading cause of morbidity and mortality in under-five children worldwide. Approximately 6.6 million children under five die yearly; most belong to developing countries such as India, and one-third of the deaths are due to ARI. It usually involves the respiratory system's upper, middle, or lower parts.
The upper respiratory tract consists of airways from the nostrils to the trachea. In contrast, the lower respiratory tract continues from the trachea to the distal part of the airways or alveoli. Infections limited to the ear, nose, and throat are usually mild. Still, when the lungs are involved, the acute respiratory infection takes the severe form of pneumonia, which can be life-threatening in infants.
Often, they are not confined to the respiratory tract and may have systemic implications because of the possible spread of microbial toxins. Sometimes in high-risk children with low immunity and other associated comorbidities, even a mild infection can take the form of a severe illness.
Both bacteria and viruses can cause acute respiratory infection, but in young children, the most common cause of acute respiratory infection is viral. Acute respiratory viral infections commonly present with tachypnea, wheezing, cyanosis, respiratory distress, and decreased feeding, which may reflect the severity of the illness. Therefore, it is crucial to treat acute respiratory infections timely to prevent complications and disease burdens among young children.
Various tools and scoring systems have been developed to predict the pediatric population's severity of acute respiratory infection. Pediatric respiratory severity score (PRESS) is a validated clinical tool that can help assess the severity of illness in children with acute respiratory illnesses.
This tool utilizes clinical characteristics and investigations to calculate the score, which reflects the severity of the illness. Identifying high-risk children suffering from severe illnesses to provide timely management is important.
What Are the Upper Respiratory Tract Infections?
Acute upper respiratory tract infections involve rhinitis, sinusitis, ear infections, acute pharyngitis, epiglottitis, and laryngitis. Acute pharyngitis and ear infections are the two most common infections which can have severe complications. It is majorly caused by viruses, specifically respiratory syncytial virus ( RSV). Other viruses include parainfluenza and influenza, adenovirus, and rarely by the coronavirus. These infections are usually self-limiting, so the complications pose a potential threat. Acute viral infections predispose children less than five years to bacterial infections of the middle ear and sinuses, and aspirations of the infected secretions may cause lower respiratory tract infections.
Acute Pharyngitis:
It is mostly caused by viruses. The typical clinical presentation involves
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Mild redness with swelling of the pharynx.
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Tonsillitis or tonsillar enlargement.
Streptococcal infections are rarely seen, but in countries with overburdened populations and genetic predisposition, post-streptococcal sequelae may result in acute rheumatic fever and carditis in these children. The pharynx may get covered by a diphtheritic membrane typically caused by Corynebacterium diphtheria. However, diphtheria infections are rarely seen with the diphtheria-tetanus-pertussis (DTP) vaccine.
Acute Ear Infections:
It may lead to a perforated eardrum and chronic ear discharge. It can ultimately result in permanent hearing loss or deafness. Repeated ear infections may lead to chronic ear infections. It can also lead to mastoiditis, where infection can spread and involve the meninges.
What Are the Lower Respiratory Tract Infections?
The most common lower respiratory tract infections involve pneumonia, bronchiolitis, and influenza. The most common clinical presentation with lower respiratory tract infections are cough and rapid breathing; therefore, respiratory rate is an important sign to diagnose lower respiratory tract infections.
The presence of an indrawn lower chest wall signifies a more severe disease. Mostly, it is caused by viruses and RSV virus, followed by the parainfluenza virus. These viruses are highly seasonal. Previously, measles viruses were the most common virus, but with the effective use of measles viruses, morbidity and mortality in children have been reduced.
Pneumonia:
It can be defined as an acute respiratory illness associated with recently developed radiological pulmonary shadowing, which may be segmental, lobar, or multilobar. Pneumonia is usually classified as community or hospital-acquired or in immunocompromised hosts.
Lobar pneumonia is a radiological and pathological term referring to the homogenous consolidation of one or more lungs, often with associated pleural inflammation; bronchopneumonia refers to more patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both lower lobes.
Pneumonia usually presents as an acute illness with systemic features such as fever, rigors, shivering, anorexia, headache, breathlessness, and cough. At first, it is characteristically short, painful, and dry but later accompanied by expectoration of mucopurulent sputum.
Haemoptysis and rust-colored sputum may be seen in patients with strep. Pneumonia infection and pleuritic chest pain can be observed. Proteinaceous fluid and inflammatory cells may congest the airways, leading to the consolidation of lung tissue.
What Is the Respiratory Severity Score?
The pediatric respiratory severity score consists of five components, namely,
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Respiratory Rate: It is evaluated based on the American heart association guidelines.
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Wheezing: It is defined by auscultation performed by experienced pediatricians.
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Accessory Muscle Use: It is defined as the visible retraction of one or more of the sternomastoid/suprasternal, intercostal, and subcostal muscles.
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Oxygen Saturation (SpO2): It is evaluated as above or below 95 % oxygen saturation.
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Feeding Difficulties: It is assessed by using the information provided by the parents.
Each component was given 0 or 1 point, and the PRESS total score was classified as
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Mild (0–1 point).
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Moderate (2–3 points).
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Severe (4–5 points).
Respiratory Severity Score (RSS), the product of mean airway pressure and the fraction of inspired oxygen, may estimate the severity of neonatal lung disease. A higher RSS more than or equal to two is associated with an increased risk of mortality and morbidities in infants born less than or equal to 1250 g.
The scoring method should be quick and straightforward to undertake and interpret. It should not involve complex measurements, descriptions, or equipment and should only include non-invasive parameters. It should apply to children from birth to two years of age, be adequately validated, and be responsive to clinical change.
Though scores should measure what they intend to measure, in this case, an ideal respiratory distress score would be able to assess the severity of all respiratory conditions, including bronchiolitis.
Conclusion:
Respiratory infections are common in young children. Bacteria or viruses can cause them, and the respiratory syncytial virus is the most common cause. The Respiratory Severity score is used to estimate the severity of neonatal pulmonary diseases and identify the need for hospitalization and further examination in emergency setups.
