Breathing difficulties in the young infant

Learning objectives

After completion of this session the participant should be able to:

• Describe how a YI with difficulties in breathing may present
• List the most likely causes
• Describe the management of the YI with breathing difficulties

YIs with breathing difficulties will present with fast breathing and difficulties with feeding. On examination there may be grunting, head bobbing, fever, cyanosis, intercostal, sternal and subcostal recession. On auscultation there may be crepitations.

The main differential diagnoses in this age group are

• Pneumonia
• Pneumocystis jiroveci pneumonia (PJP) if exposed to HIV
• Bronchiolitis

Supportive treatment

Nutrition

• If the baby is breathing < 60/minute, breast feeding may be tried, if they are struggling to feed, change to NG feeds NG feeds
• If the baby is breathing fast (e.g. 60-80/minute) feed by oro- or nasogastric feeds every two hours with expressed breast milk (restricted maintenance).
• If the baby is breathing very fast >80/minute, consider IV fluids (100mls/kg/day).

Oxygen therapy- escalate stepwise

Administer oxygen via nasal prongs or nasal catheter, start with 0.5 litres/minute and escalate quickly if O2 saturations remain <90%.

Specific treatment

Treat with IV antibiotics if pneumonia is suspected (fever, crepitation’s on examination) Doses

High dose cotrimoxazole and steroids if PJP is suspected.