Overview
Interstitial lung disease (ILD) in childhood encompasses a heterogeneous group of disorders affecting the interstitium of the lungs, often leading to respiratory symptoms and impaired lung function. Diagnosis and management require careful consideration of imaging techniques and procedural sedation due to the need for immobile patients during diagnostic imaging.Diagnosis
Key Diagnostic Criteria: Clinical symptoms (dyspnea, cough), physical examination findings (crackles), and characteristic imaging features (HRCT showing interstitial patterns).
Recommended Tests: High-resolution computed tomography (HRCT) of the chest 4.
Grading: Utilize the Pediatric Interstitial Lung Disease Consensus Classification for grading severity 4.Management
First-Line Treatments: Corticosteroids for inflammatory forms; immunosuppressive agents like cyclophosphamide or mycophenolate mofetil in severe cases 4.
Adjunctive Treatments: Oxygen therapy, pulmonary rehabilitation, and monitoring for complications such as infection or pulmonary hypertension 4.
Procedural Sedation: For imaging, sedation or anaesthesia may be necessary; propofol and dexmedetomidine are effective with careful monitoring 567.Special Populations
Pediatrics: Emphasize the importance of dose optimization in imaging to minimize radiation exposure 1. Paediatric sedation/anaesthesia requires specialized training and monitoring to ensure safety 567.
Comorbidities: Consider the impact of underlying conditions on imaging requirements and sedation protocols 56.Key Recommendations
Rigorously justify the use of ionizing radiation in diagnostic imaging for paediatric patients to minimize long-term risks (Evidence: Strong 4).
Ensure that all personnel involved in paediatric imaging and sedation/anaesthesia have appropriate training and access to continuing professional development (Evidence: Moderate 2).
Implement paediatric diagnostic reference levels (PiDRLs) for optimizing radiation dose in imaging procedures to protect paediatric patients (Evidence: Moderate 1).
Use non-ionizing imaging modalities when feasible to reduce radiation exposure in children (Evidence: Strong 4).
For MRI sedation, propofol under anaesthesiologist supervision is effective and safe for most children, while dexmedetomidine may be preferred in low-risk patients (Evidence: Moderate 67).References
1 Lackay O, Horn-Lodewyk J, Muller H. A practical guide for paediatric diagnostic reference levels (PiDRLs). Journal of medical imaging and radiation sciences 2022. link
2 Halliday K, Drinkwater K, Howlett DC. Evaluation of paediatric radiology services in hospitals in the UK. Clinical radiology 2016. link
3 Arthurs OJ, Sury M. Anaesthesia or sedation for paediatric MRI: advantages and disadvantages. Current opinion in anaesthesiology 2013. link
4 Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K et al.. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Annals of the ICRP 2013. link
5 Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. The British journal of radiology 2012. link
6 Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Current opinion in anaesthesiology 2010. link
7 Marchi A, Orrù A, Manai ME, Chelo C, Lettieri B, Corbucci GG. Deep sedation for magnetic resonance imaging. Personal experience. Minerva anestesiologica 2004. link
8 Lovejoy FH. Introduction to preventive pediatrics. Pediatrics 1984. link