Pneumonia (Children)

Contents

1 Introduction
2 Risk Factors
3 Clinical Features
4 Investigations
5 Management
6 Prognosis
7 Related Articles

Introduction

Pneumonia is an infection of the lungs, characterised by inflammation of the lung parenchyma and production of fluid in the alveoli.

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:
Newborns

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)

Risk Factors

Low birthweight
Vit A defiency
Non-breast fed

Clinical Features

Usually there is a preceding URTI, followed by :

Fever
SOB
Cough (may or may not be present)
Lethargy
Localised pain. Can be neck, chest or abdominal, and is particularly suggestive of pneumonia.
Tachypnoea
Nasal flaring
Chest hyperinflation
Wheeze
Consolidation – with associated dullness to percussion – a classic sign in adults, is not usually present in paediatric cases.

Although it is difficult to distinguish clinically between bacterial and viral infection, wheeze and hyperinflation are more typical of viral infection. Nasal aspirate samples may be taken to confirm or rule out any causatory organisms.

WHO guidelines for diagnosis

Cough
Fever
Tachypnoea
Head nodding
Chest recession

Investigations

CXR – may help to confirm the diagnosis, but cannot differentiate bacterial and viral causes.

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.

Management

Most cases can be managed at home! This might include analgesia and careful monitoring.

Indications for admission:

O2 <93%
Tachypnoea
Grunting
Apnoea
Poor feeding

In hospital, additional management step may include:

O2 therapy
IV fluids – Be careful not to give too much, or you can end up with Inappropriate ADH secretion.
Physiotherapy is not useful

Antibiotics

Dependent on the age of the child, severity of illness, and appearance of x-ray.

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.