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with BPD (required >21% oxygen for at least 28 days after birth), (iii) have hemodynamically significant heart disease It may also be considered in the first year of life for infants with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways Children from to years of age should only receive palivizumab if they required oxygen at least 28 days after birth and continue to require medical interventions for their BPD Annual influenza vaccination should also be considered for children with BPD Clinical Indications for Discharge or Admission Indications for admission generally include respiratory distress, tachypnea, increasing hypoxia or hypercarbia, poor feeding, apnea, or new radiographic infiltrates Parental fatigue and stress are also important factors to consider in the decision to hospitalize CYSTIC FIBROSIS CLINICAL PEARLS AND PITFALLS Patients with cystic fibrosis (CF) may have worsening of underlying disease due to several causes including: bacterial colonization and exacerbation, acute viral illness, acute bacterial infection, pneumothorax, hemoptysis, or allergic bronchopulmonary aspergillosis (ABPA) Communication with the patient’s primary CF team should occur in a timely manner CXRs should be obtained in patients with increased respiratory symptoms and compared to prior studies Isolation precautions should be initiated as soon as possible Current Evidence CF is an autosomal recessive genetic disease, predominantly seen in Caucasians The basic genetic defect is a mutation on the long arm of chromosome 7, resulting in an abnormal cystic fibrosis transmembrane conductance regulator (CFTR) protein with wide phenotypic variability These CFTR defects affect function of cells lining the respiratory tract, pancreatic exocrine system, sweat glands, and intrahepatic biliary epithelium In the respiratory and GI tracts, this leads to dehydrated secretions that are difficult to mobilize The manifestation in the respiratory tract is chronic inflammation and chronic infection In the sweat