Acute pneumonia in children

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

The incidence of pneumonia is about 15-20 per 1000 children of 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 secondary, complicating other diseases.

According to the accepted classification (1995), according to morphological forms distinguish focal, segmental, focal, drainage, croup and interstitial pneumonia. Interstitial pneumonia is a rare form in pneumocystis, sepsis and some other diseases. Isolation of morphological forms has a certain prognostic significance and can influence the choice of starting therapy.

The nature of the pathogen and its drug sensitivity largely depend on the conditions in which infection occurred. This makes it expedient to isolate the following major groups of pneumonia. In each group the most likely pathogens are indicated:

• Community-acquired pneumonia: pneumococcus, hemophilic rod, staphylococcus, streptococcus, mycoplasma, chlamydia, legionella, viruses;
• vnutribolnichnaya pneumonia: staphylococcus, E. Coli, Klebsiella, proteus, pseudomonas, viruses;
• with perinatal infection: chlamydia, ureaplasma, cytomegalovirus, viruses;
• in patients with immunodeficiency: various bacteria, pneumocysts, fungi, cytomegalovirus, mycobacteria, viruses.

[1], [2], [3], [4], [5], [6],

Causes of acute pneumonia in children

Typical bacterial pathogens of community-acquired pneumonia in children are Streptococcus pneumoniae, Haemophilus influenzae, less often Staphylococcus aureus; so-called atypical pathogens - Mycoplasma pneumoniae, Legionella pneumophila - play a certain role. In children in the first months of life, pneumonia is caused more often by Haemophilus influenzae, Staphylococcus, Proteus and less often by Streptococcus pneumoniae. Viral pneumonia is much less common, respiratory syncytial viruses, influenza and adenoviruses can play a role from viruses in the etiology. The respiratory virus causes destruction of cilia and ciliated epithelium, violation of mucociliary clearance, edema of interstitium and interalveolar septa, dilatation of alveoli, disorders of hemodynamics and lymphocirculation, impaired vascular permeability, that is, it has a "dressing" effect on the mucous of the lower respiratory tract. It is also known immunosuppressive effect of viruses.

[7], [8], [9], [10]

Risk factors for pneumonia

Intrauterine infections and ZVUR, perinatal pathology, congenital malformations of the lungs and heart, prematurity, immunodeficiency, rickets and dystrophy, polyhypovitaminosis, the presence of chronic foci of infection, allergic and lymphatic-hypoplastic diathesis, unfavorable social conditions, contacts when visiting pre-school institutions, especially in children under 3 years of age.

Causes of acute pneumonia in summer

Symptoms of acute pneumonia in children

The main way of penetration of the infection into the lungs is bronchogenic with the spread of the infection along the course of the respiratory tract to the respiratory department. The hematogenous pathway is possible with septic (metastatic) and intrauterine pneumonia. The lymphogenous path is a rarity, but on the lymphatic pathways the process passes from the pulmonary focus to the pleura.

SARS play an important role in the pathogenesis of bacterial pneumonia. Viral infection increases the production of mucus in the upper respiratory tract and reduces its bactericidal activity; violates the mucociliary apparatus, destroys epithelial cells, reduces local immunological defense, 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, causative agent 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 is more likely to develop during ARVI and in most cases during the first week of a viral illness.

Symptoms of pneumonia are characterized by the appearance and growth of intoxication: lethargy, adynamia, tachycardia, not corresponding to a fever, pallor of the skin, restless sleep, anorexia, may be vomiting. Appears febrile temperature more than 3-4 days (after 1-2 days of decline in the background of acute respiratory viral infection), cyanosis in the nasolabial triangle (early symptom), cough becomes deep and wet. An important diagnostic symptom of pneumonia in young children is a change in the ratio of respiratory rate to pulse (from 1: 2.5 to 1: 1.5 at a rate of 1: 3), while in the act of respiration, the auxiliary musculature - inflating of the wings of the nose, intercostal spaces of the jugular fossa in the absence of bronchial obstructive syndrome. In severe condition, breathing becomes moaning, groaning.

Symptoms of acute pneumonia

Treatment of acute pneumonia in children

The main principles of antibacterial therapy are the following:

• etiotropic therapy with an established diagnosis or with a serious condition of the patient begin immediately, when doubting the diagnosis of a non-severe patient, the decision is made after radiography;
• indications for the transition to alternative drugs is the lack of clinical effect of the drug of first choice for 36-48 hours for mild and 72 hours for severe pneumonia; development of undesirable side effects from the drug of the first choice;
• pneumococci are resistant to gentamicin and other aminoglycosides; therefore, community-acquired pneumonia therapy with antibiotics of this group is unacceptable;
• in uncomplicated, moderate pneumonia, preference should be given to prescribing per os, replacing them with parenteral administration if ineffective; if the therapy was started parenterally, after a drop in temperature, you should switch to taking an antibiotic per os;
• after a course of antibiotic therapy, it is advisable to prescribe biological products.

Other types of pneumonia treatment

Bed rest is indicated for the entire febrile period. Food should be age appropriate and must be full.

• The volume of fluid per day for children up to a year, including breast milk or milk mixtures, is 140-150 ml / kg of body weight. It is advisable to give 1/3 of the daily volume of liquid in the form of glucose-salt solutions (rehydron, oralite), which in 80-90% of patients allows to refuse from infusion therapy.
• If necessary (exsicosis, collapse, disturbance of microcirculation, threat of DIC syndrome), a third of the daily volume is injected into the vein. With excessive infusion of crystalloids, it is possible to develop pulmonary edema.
• In the room where the child is, there must be a cool (18-19 ° C), moistened air, which helps reduce and deepen breathing, and also reduces water losses.
• Antipyretics are not prescribed, as this may make it difficult to evaluate the effectiveness of antibiotic therapy. The exception is children who have premorbid indications for lowering body temperature.
• The appointment of microwave in the acute period (10-12 sessions), inductothermy; electrophoresis with 3% potassium iodide solution.
• Massage and exercise therapy are necessary immediately after the temperature is normalized.
• In the hospital children are placed in a separate box. A child can be discharged from the hospital immediately after reaching a clinical effect in order to avoid a cross infection. Preservation 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
• Fighting complications of acute pneumonia
• Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
• Sanatorium treatment and rehabilitation for pneumonia

Treatment of complications of pneumonia in children

When respiratory failure is carried out oxygen therapy through the nasal cannula. The optimal method of oxygen therapy is spontaneous ventilation of an oxygen-enriched gas mixture with a positive end-expiratory pressure. An obligatory condition for successful oxygen therapy is cleansing of the airways after application of mucolytic agents, stimulation of cough and / or removal of sputum by sucking.

Lung edema usually develops with excessive infusion of crystalloids, so stopping the infusion is a prerequisite for its treatment. In severe condition, the ventilator is operated in the positive exhalation pressure mode.

Intrapulmonary cavities and abscesses after self-emptying or surgical intervention are usually well suited to conservative treatment. The strained cavities are drained or the bronchoscopic occlusion of the leading bronchus is performed.

Heart failure. Of cardiac agents in emergency cases, intravenously administered strophanthin (0.1 ml of 0.05% solution per year of life) or korglikon (0.1-0.15 ml of 0.06% solution per year of life). With energy-dynamic heart failure, the inclusion of panangin in therapy is shown, corticosteroids are used as a means to combat shock, cerebral edema, cardiopathy, pulmonary edema and microcirculation disorders. Immunotherapy of directed action is performed with severe pneumonia of a certain etiology (for example, staphylococcal).

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

Iron preparations with a decrease in hemoglobin in the acute period are not prescribed, since infectious anemia is adaptive and is usually resolved spontaneously at the 3-4th week of the disease.

Blood transfusions are carried out only for vital indications with 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, it is better to spend in a sanatorium. The gradual increase in physical activity, exercise therapy in combination with respiratory gymnastics is shown.

Prevention is:

• a complex of social and hygienic measures;
• rational nutrition, hardening, improving the ecology of the dwelling;
• prevention of ARVI, vaccine prophylaxis of pneumonia (conjugated vaccine against H. Influenzae, pneumococcus, vaccine against influenza);
• prevention of nosocomial pneumonia (hospitalization in boxes).