Acute pneumonia in children

Acute pneumonia in children is an acute inflammatory disease of the lungs with a reaction of the vascular system in the interstitial tissue and disturbances in the microcirculatory bed, with local physical symptoms, with focal or infiltrative changes on the radiograph, having a bacterial etiology, characterized by infiltration and filling of the alveoli with exudate containing predominantly polynuclear neutrophils, and manifested by a general reaction to infection.

The incidence of pneumonia is about 15-20 per 1000 children in the first year of life and about 5-6 per 1000 children over 3 years of age per year.

Pneumonia can occur as a primary disease or secondarily, complicating other diseases.

According to the accepted classification (1995), according to morphological forms, focal, segmental, focal-confluent, croupous and interstitial pneumonia are distinguished. Interstitial pneumonia is a rare form in pneumocystosis, sepsis and some other diseases. The allocation of morphological forms has a certain prognostic value and can influence the choice of initial therapy.

The nature of the pathogen and its drug sensitivity largely depend on the conditions in which the infection occurred. This makes it appropriate to distinguish the following main groups of pneumonia. Each group contains the most likely pathogens:

• community-acquired pneumonia: pneumococcus, Haemophilus influenzae, staphylococcus, streptococcus, mycoplasma, chlamydia, legionella, viruses;
• hospital-acquired pneumonia: staphylococcus, E. coli, Klebsiella, Proteus, pseudomonas, viruses;
• in case of perinatal infection: chlamydia, ureaplasma, cytomegalovirus, viruses;
• in patients with immunodeficiency: various bacteria, pneumocystis, fungi, cytomegalovirus, mycobacteria, viruses.

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Causes of Acute Pneumonia in Children

Typical bacterial pathogens of community-acquired pneumonia in children are Streptococcus pneumoniae, Haemophilus influenzae, and less commonly Staphylococcus aureus; the so-called atypical pathogens, Mycoplasma pneumoniae and Legionella pneumophila, are of some importance. In children in the first months of life, pneumonia is most often caused by Haemophilus influenzae, Staphylococcus, Proteus, and less commonly by Streptococcus pneumoniae. Viral pneumonias are much less common; respiratory syncytial viruses, influenza viruses, and adenoviruses may play a role in the etiology. The respiratory virus causes destruction of cilia and ciliated epithelium, disruption of mucociliary clearance, edema of the interstitium and interalveolar septa, desquamation of the alveoli, disorders of hemodynamics and lymph circulation, disruption of vascular permeability, i.e. it has a "etching" effect on the mucous membranes of the lower respiratory tract. The immunosuppressive effect of viruses is also known.

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Risk factors for pneumonia

Intrauterine infections and intrauterine growth restriction, perinatal pathology, congenital defects of the lungs and heart, prematurity, immunodeficiencies, rickets and dystrophy, polyhypovitaminosis, the presence of chronic foci of infection, allergic and lymphaticohypoplastic diathesis, unfavorable social and living conditions, contacts when visiting preschool institutions, especially in children under 3 years of age.

Causes of Acute Pneumonia in Summer

Symptoms of Acute Pneumonia in Children

The main route of infection penetration into the lungs is bronchogenic with the spread of the infection along the respiratory tract to the respiratory section. The hematogenous route is possible with septic (metastatic) and intrauterine pneumonia. The lymphogenous route is rare, but the process passes from the pulmonary focus to the pleura through the lymphatic pathways.

ARIs play an important role in the pathogenesis of bacterial pneumonia. Viral infection increases mucus production in the upper respiratory tract and reduces its bactericidal properties; disrupts the mucociliary apparatus, destroys epithelial cells, reduces local immunological protection, which facilitates the penetration of bacterial flora into the lower respiratory tract and promotes the development of inflammatory changes in the lungs.

Symptoms of pneumonia depend on the age, morphological form, pathogen and premorbid background of the child.

In young children, focal community-acquired pneumonia is more common, caused by Streptococcus pneumoniae or Haemophilus influenzae. Pneumonia in young children often develops during the period of acute respiratory viral infections and in most cases during the first week of the viral disease.

Symptoms of pneumonia are characterized by the appearance and increase of intoxication phenomena: lethargy, adynamia, tachycardia that does not correspond to fever, pale skin, restless sleep, loss of appetite, and vomiting may occur. Febrile temperature appears for more than 3-4 days (after 1-2 days of decrease due to acute respiratory viral infection), cyanosis in the nasolabial triangle (early symptom), the cough becomes deep and wet. An important diagnostic sign of pneumonia in young children is a change in the ratio of respiratory rate to pulse (from 1:2.5 to 1:1.5 with a norm of 1:3), while the accessory muscles participate in the act of breathing - distention of the wings of the nose, retraction of the intercostal spaces of the jugular fossa in the absence of broncho-obstructive syndrome. In severe conditions, breathing becomes moaning, groaning.

Symptoms of acute pneumonia

Treatment of acute pneumonia in a child

The basic principles of antibacterial therapy are as follows:

• etiotropic therapy, if the diagnosis is established or if the patient is in a serious condition, is started immediately; if there is doubt about the diagnosis in a non-serious patient, the decision is made after an X-ray;
• Indications for switching to alternative drugs are the absence of a clinical effect from the first-choice drug within 36-48 hours for mild pneumonia and 72 hours for severe pneumonia; the development of undesirable side effects from the first-choice drug;
• pneumococci are resistant to gentamicin and other aminoglycosides, therefore, treatment of community-acquired pneumonia with antibiotics of this group is unacceptable;
• in uncomplicated mild pneumonia, preference should be given to prescribing drugs per os, replacing them with parenteral administration if ineffective; if therapy was started parenterally, after the temperature has decreased, it is necessary to switch to taking the antibiotic per os;
• After a course of antibacterial therapy, it is advisable to prescribe biopreparations.

Other Treatments for Pneumonia

Bed rest is recommended for the entire febrile period. Nutrition should be age-appropriate and must be complete.

• The daily volume of liquid for children under one year, taking into account breast milk or milk formulas, is 140-150 ml/kg of weight. It is advisable to give 1/3 of the daily volume of liquid in the form of glucose-salt solutions (regidron, oralit), which allows 80-90% of patients to refuse infusion therapy.
• If necessary (exicosis, collapse, microcirculation disorder, risk of DIC syndrome), 1/3 of the daily volume is injected into the vein. Excessive infusion of crystalloids may lead to pulmonary edema.
• The room where the child is located should have cool (18-19 °C), humidified air, which helps to slow down and deepen breathing, and also reduces water loss.
• Antipyretics are not prescribed, as this may complicate the assessment of the effectiveness of antibacterial therapy. The exception is children with premorbid indications for reducing body temperature.
• The use of microwave therapy in the acute period (10-12 sessions), inductothermy, and electrophoresis with a 3% solution of potassium iodide are indicated.
• Massage and exercise therapy are necessary immediately after the temperature returns to normal.
• In hospital, children are placed in a separate box. The child can be discharged from the hospital immediately after achieving a clinical effect in order to avoid cross-infection. Persistence of increased ESR, wheezing in the lungs or residual radiographic changes is not a contraindication to discharge.

Treatment of acute pneumonia

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Combating complications of acute pneumonia
• Physiotherapy, exercise therapy, breathing exercises for pneumonia
• Sanatorium and resort treatment and rehabilitation for pneumonia

Treatment of complications of pneumonia in a child

In case of respiratory failure, oxygen therapy is administered via nasal cannulas. The optimal method of oxygen therapy is spontaneous ventilation with an oxygen-enriched gas mixture with positive pressure at the end of exhalation. A prerequisite for successful oxygen therapy is clearing the airways after the use of mucolytic agents, stimulating coughing and/or removing sputum using suction.

Pulmonary edema usually develops with excessive crystalloid infusion, so stopping the infusion is a prerequisite for its treatment. In severe cases, mechanical ventilation is performed in positive expiratory pressure mode.

Intrapulmonary cavities and abscesses after spontaneous emptying or surgical intervention usually respond well to conservative treatment. Tense cavities are drained or bronchoscopic occlusion of the afferent bronchus is performed.

Heart failure. In emergency cases, cardiac agents include intravenous administration of strophanthin (0.1 ml of 0.05% solution per year of life) or corglycon (0.1-0.15 ml of 0.06% solution per year of life). In case of energetic-dynamic heart failure, panangin is indicated in therapy, corticosteroids are used as a means of combating shock, cerebral edema, cardiopathy, pulmonary edema and microcirculation disorders. Targeted immunotherapy is used for severe pneumonia of a certain etiology (for example, staphylococcal).

DIC syndrome is an indication for the administration of fresh frozen plasma, heparin (100-250 U/kg/day depending on the stage).

Iron preparations are not prescribed for decreased hemoglobin in the acute period, since infectious anemia is adaptive in nature and usually resolves spontaneously in the 3rd-4th week of the disease.

Blood transfusions are performed only for vital indications in the case of a purulent destructive process in children with hemoglobin below 65 g/l, as well as in septic patients.

Rehabilitation of children who have had pneumonia is best done in a sanatorium. A gradual increase in physical activity, exercise therapy in combination with breathing exercises is recommended.

Prevention consists of:

• a set of social and hygienic measures;
• rational nutrition, hardening, improving the ecology of the home;
• prevention of acute respiratory viral infections, vaccination against pneumonia (conjugate vaccine against H. influenzae, pneumococcus, vaccination against influenza);
• prevention of hospital-acquired pneumonia (hospitalization in isolation wards).