Introduction (Article introduction authored by ICU Editorial Team) Children and adolescents facing severe neurological impairment (SNI) encounter complex medical challenges, often grappling with severe and recurrent lower respiratory tract infections (LRTIs).
These infections, stemming from viruses and bacteria, present a substantial threat, potentially leading to respiratory insufficiency and enduring impairments.
Clinical experts have collaborated on developing guidelines for managing LRTIs in this patient group, emphasizing comprehensive multidisciplinary care and prudent use of antibiotics. Initial treatment focuses on addressing symptoms through hydration, antipyretics, oxygen therapy, and respiratory support.
For bacterial LRTIs, antibiotic therapy is customized according to the severity of infection. Recommendations include using aminopenicillin combined with a beta-lactamase inhibitor for community-acquired cases and piperacillin-tazobactam for individuals with chronic lung disease or those with a tracheostomy.
Continued management involves regular evaluations, adjustments based on identified pathogens, and optimizing supportive therapies.
Implementing these guidelines aims to improve the diagnosis and management of LRTIs in children and adolescents with severe neurological impairment. Materials and methods These recommendations were developed by the German Society for Pediatric Infectious Diseases (DGPI) in accordance with the guidelines of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften: working group of the German Scientific Medical Societies).
Six professional societies collaborated in their formulation, each appointing an expert in the field: DGKJ (German Society for Pediatrics and Adolescent Medicine), DGPI (German Society for Pediatric Infectious Diseases), DGP (German Society for Palliative Medicine), GNP (Society for Neuropediatrics), GNPI (Society for Neonatology and Pediatric Intensive Care Medicine), and GPP (Society for Pediatric Pneumology).
A literature search conducted in September 2022 focused on pneumonia, lower respiratory tract infections, and neurological impairment in children.
The expert panel reviewed the literature and drafted treatment recommendations. Two online conferences were convened in January 2023 for further discussion and consensus-building. Following approval by the expert group, the recommendations underwent online consensus from the entire panel.
The manuscript was submitted to professional societies for review, and the final version was circulated to experts for approval.
The German version of these recommendations is published in the AWMF guideline register, with all expert group members disclosing potential conflicts of interest.