Pnemonia

Pneumonia in Children
By
Dr. Arjumand Ali(H.O)
Introduction
Pneumonia is the leading cause of death in children
worldwide.It kills 1.8 million children under five years of
age every year, more than any other illness, in every
region of the world.
 It can be caused by viruses,bacteria or fungi.
 Pneumonia can be prevented by immunization, adequate

nutrition and by addressing environmental factors.
 Pneumonia can be treated with antibiotics, but less than
20% of children with pneumonia receive the antibiotics
they need.
 Pneumonia is a form of acute lower respiratory
infection that affects the lung parenchyma.
When an individual has pneumonia, the alveoli
are filled with pus and fluid, which makes
breathing painful and limits oxygen intake
 Children can be 1)protected from pneumonia,
it can be 2)prevented with simple
interventions, and 3)treated with low-cost,
low-tech medication and care.
Risk Factors
 Asthma/RAD/Bronchiol  Prematurity
itis  Malnutrition
 Immunocompromise  Low Socioeconomic
 Previous Insult to Lungs Status
 Abnormal Anatomy  Cigarette Smoke
(Immotile Cilia)  Day Care
 Cystic Fibrosis, Sickle  Foreign Body
Cell . . .
Etiologic Agent
 Birth to 1 month
 Viruses: CMV
 group B streptococcus, E coli, Klebsiella, Listeria
 1 to 24 months
 Viruses: RSV, parainfulenza, influenza,
adenovirus
 Bacteria: Strep pneumoniae, strep pyogenes, staph
aureus, H. influenza
Etiologic Agent
 2 to 5 years
 Viruses: Influenza, adenovirus
 Bacteria: Strep pneumoniae
 5 to 18 years
 Viruses: RSV, adenovirus
 Bacteria: Mycoplasma, Strep pneumoniae,
Chlamydia pneumoniae
Special Concerns
 Staph aureus
 rapid progression, abscesses
 Grp A Strep
 invasive, necrotizing fasciitis, empyema
 Gram neg bacilli
 recently hospitalized patients
Special Concerns
 B. pertussis
 paroxysmal cough
 C. trachomatis
 maternal exposure, conjunctivitis
 M. pneumoniae
 rash (Erythema Multiforme)
Special Concerns
 RSV mortality rate
 Congenital Heart up to 35%
 Congenital Heart w/ Pulmonary HTN up to
70%
Pathophysiology
 The viruses and bacteria that are commonly found in
a child's nose or throat, can infect the lungs if they are
inhaled.
 They may also spread via air-borne droplets from a
cough or sneeze.
 In addition, pneumonia may spread through blood,
especially during and shortly after birth.
 Aspiration of infective particles into the lower
respiratory tract causes inflamation and consolidation
Symptoms
 cough  tachypnea
 fever  apnea
 chest pain  abdominal pain
 fatigue  nausea
 gasping
Findings
 respiratory distress
 tachypnea, grunting, flaring, retracting
 abnormal auscultatory findings???
 cyanosis
 chest X-ray - infiltrates
CXR Findings
 Viral
 diffuse interstitial infiltrates
 Bacterial
 consolidated, lobar
 Mycoplasma
 diffuse
Lab
 CBC
 elevated WBC, left shift
 Blood Culture
 Cold Agglutins
 Sputum Culture
 ABG
 May help with placement
 RSV
 Influenza
Appearance
 History is not as useful
 Examination is paramount
 Observation
 vigorous crying
 playful
 quiet is bad!
Signs of Respiratory Distress
 Tachypnea  Poor Air Exchange
 Retractions  Skin Color
 Flaring  Change in Level of
 Grunting
Consciousness
 Abdominal Breathing
(seesaw)
 Change in Depth of
 Bradypnea Breathing (volume)
 Signs of Respiratory  Change in I:E
Distress  Positioning
 Wheezing  Tripod
 Stridor
 Sniffing
 Air Hunger
Treatment
 Position/Support/Maintain Airway
 Wipe Nose!
 Remove Foreign Bodies
 Oxygen
 Cool Mist (H2O or NS?)
 Most newborn infants with CAP are
hospitalized and given intravenous ampicillin
and gentamicin for at least ten days. This treats
the common bacteria Streptococcus agalactiae
, Listeria monocytogenes, and Escherichia coli
. If herpes simplex virus is the cause,
intravenous acyclovir is administered for 21
days.
 Children less than five do not typically receive
treatment to cover atypical bacteria. If a child
does not need to be hospitalized, amoxicillin for
seven days is a common treatment. However,
with increasing prevalence of DRSP, other
agents such as cefpodoxime will most likely
become more popular in the future.[12]
Hospitalized children should receive intravenous
ampicillin, ceftriaxone, or cefotaxime
 Atfer 5 The primary microoganisms in this
group are viruses, atypical bacteria, penicillin
sensitive Streptococcus pneumoniae, and
Hemophilus influenzae. Recommended
management is with a macrolide antibiotic
such as azithromycin or clarithromycin for
seven[2] to ten days.
Antibiotics?
 Birth to 1 month - Amp + Gent, Cefotaxime
 1 to 24 months - Amoxil, cephalosporin
 2 to 5 years - Amoxil, cephalosporin
 over 5 years - Zithromax, Biaxin
 Resistant S. pneumoniae - vancomycin
Antibiotics?
 Viral
 support
 acyclovir?
 ribavirin?
Treatment
 Beta agonist
 IVF (except cardiogenic and resp?)
 10-20cc/kg
 normal saline or Ringer’s
 never sugar in bolus (unless calculated)
 Oxygen & Albuterol

Intubation
 Cardio/Respiratory Failure
 Uncompensated Shock
 Unable to maintain airway **
 ETT size
 age/4 + 4, insert 3 x size of tube
 small fingernail
 nares
Disposition - Admit
 Hypoxia
 < 3 months old
 Shock
 Dyspnea
 Activity Level
 Extensive ED Treatment
Complications
 Viral pneumonia
 resolve spontaneously without specific Tx
 Bacterial pneumonia
 dehydration, bronchiolitis obliterans, apnea
 pleural effusions, empyemas, pneumothorax,
pneumatoceles, development of additional
infectious foci
Prevention
 interventions to protect, prevent, and treat
pneumonia in children with actions to:
 protect children from pneumonia include
promoting exclusive breastfeeding and hand
washing, and reducing indoor air pollution;
 prevent pneumonia with vaccinations;
 treat pneumonia by making sure that every sick
child has access to the right kind of care -- either
from a community-based health worker, or in a
health facility if severe -- and can get the
antibiotics and oxygen they need to get well.
Summary
 Recognize Respiratory Distress
 Low Threshold to Consider Pneumonia
 Treatment for Respiratory Distress, then
Pneumonia
 Normal Breath Sounds
 DO NOT R/O PNEUMONIA!

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Pneumonia in Children

 Pneumonia can be prevented by immunization, adequate

 never sugar in bolus (unless calculated)

 Oxygen & Albuterol

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