It is technically a type of bronchitis (infection of the bronchi). The highest incidence of pneumonia is during infancy. This gradually decline with age, before rising again in older age groups.
- In ½ of cases, no causatory organism is identified
- Viral causes are more common in young infants
- Bacterial causes are more common in older children
- It is difficult to differentiate viral and bacterial pneumonia clinically
- Viral disease fluctuates with the seasons (more common in winter), whilst bacterial disease is fairly constant all year round.
Pathogens tend to depend upon the age of the child:
- Organisms from mother’s genital tract: Streptococcus B, Gram-negative enterococci
Infants and young children
- Viral – RSV is especially common
- Bacterial –less common, but can include streptococcus pneumoniae, and haemophilus influenzae. Bordetella pertussis and chlamydia trachomatis are also sometimes seen.
Children over 5
- Usually bacterial – mycoplasma pneumoniae, streptococcus pneumoniae, and chlamydia pneumoniae are the most common.
All ages – TUBERCULOSIS (Myobacterium Tuberculosis)
- Low birthweight
- Vit A defiency
- Non-breast fed
- Cough (may or may not be present)
- Localised pain. Can be neck, chest or abdominal, and is particularly suggestive of pneumonia.
- Nasal flaring
- Chest hyperinflation
- Consolidation – with associated dullness to percussion – a classic sign in adults, is not usually present in paediatric cases.
- Head nodding
- Chest recession
- CXR with cavities, fluid and air is usually caused by staphylococcus
- Bluting of costophrenic recess – is a rare sign of effusion, known as parapneumonic effusion. This can be drained if needed. In some cases however, this can become an empyema, which is much more difficult to drain.
- Most cases of parapneumonic effusion will resolve themselves. In cases that become empyemous, then a pigtail catheter, may be inserted, and urokinase administered through it to help break down any septic ‘lumps’. In some cases, surgery may be required.
- O2 <93%
- Poor feeding
- O2 therapy
- IV fluids – Be careful not to give too much, or you can end up with Inappropriate ADH secretion.
- Physiotherapy is not useful
- Newborns – Wide spectrum, IV antibiotics
- Older Children – Often amoxicillin is the first line. Co-amoxiclav is used as second line, as well as in complicated, or special cases.
- Age >5 – Amoxicillin first line. Erythromycin second line.
- Any with empyema
- Any with collapse