Pneumonia in children
The content of the article:
- Risk factors and causes of pneumonia in children
- Forms of the disease
- Symptoms of pneumonia in children
- Diagnostics
- Treatment of pneumonia in children
- Potential consequences and complications
- Forecast
- Prevention
Pneumonia in children is an acute or chronic inflammatory process of bacterial or viral etiology that affects the lower respiratory tract. The disease is widespread, with a frequency of 522.8 cases for every 100,000 children under the age of 14. In the autumn-winter period, the incidence increases.
Pneumonia in children is an urgent problem of pediatric pulmonology and pediatrics, since, despite all the advances in pharmacotherapy, the disease is often accompanied by the development of dangerous complications, including those that can lead to death.
Pneumonia in a child on an X-ray
Risk factors and causes of pneumonia in children
There are a number of factors that contribute to the development of pneumonia in children. These include:
- recent acute respiratory viral infection;
- renal failure;
- cardiovascular diseases;
- chronic obstructive pulmonary disease;
- cystic fibrosis;
- diabetes;
- diseases and injuries of the central nervous system;
- seizures;
- disturbances of consciousness;
- prematurity;
- asphyxia;
- hypotrophy;
- immunodeficiency states;
- chronic foci of infection in the body (tonsillitis, sinusitis, carious teeth);
- hypothermia;
- stress;
- early postoperative period;
- artificial ventilation of the lungs.
The causes of pneumonia in children are largely determined by the conditions of infection and the age of the child. In newborns, pneumonia is usually caused by either intrauterine or nosocomial infection. The most common causative agents of congenital pneumonia in children are:
- chlamydia;
- cytomegalovirus;
- Varicella Zoster virus (the causative agent of chickenpox and shingles);
- herpes simplex virus type 1 or 2.
Various infections can cause pneumonia in children
Hospital-acquired pneumonia in newborns usually causes:
- klebsiella;
- colibacillus;
- Staphylococcus aureus;
- hemolytic streptococcus group B.
In newborns (full-term and premature), measles, parainfluenza, influenza viruses, and respiratory syncytial virus play an important role in the development of pneumonia. In children of the first year of life, in 70-80% of cases, community-acquired pneumonia is caused by pneumococcus. Much less often, Moraxella, Haemophilus influenzae act as causative agents of the disease.
In preschool children, the following are traditional pathogens:
- Staphylococcus aureus;
- Pseudomonas aeruginosa;
- enterobacter;
- klebsiella;
- Proteus;
- colibacillus;
- haemophilus influenzae.
In the structure of the incidence of pneumonia in schoolchildren, the proportion of atypical forms of the disease caused by chlamydial or mycoplasma infection is increasing.
The infection enters the lungs, as a rule, by an aerogenic route, that is, during inhalation of air infected with pathogenic microflora. Intrauterine pneumonia is caused by aspiration of amniotic fluid in combination with intrauterine infection.
In young children, aspiration pneumonia is often observed, the pathological mechanism of development of which is based on:
- dysphagia;
- vomiting;
- gastroesophageal reflux;
- habitual aspiration of food with constant regurgitation;
- microaspiration of nasopharyngeal secretion.
Pneumonia in children can be caused, among other things, by the introduction of pathogenic flora into the lungs by blood flow from any other focus of infection in the body (hematogenous pathway).
Artificial ventilation of the lungs, bronchoscopy, inhalation, bronchoalveolar lavage, tracheal aspiration become predisposing factors for the occurrence of hospital pneumonia.
The development of a bacterial infection in the lungs is often preceded by a viral infection with damage to the mucous membranes of the respiratory tract, a violation of their barrier functions, a decrease in local immunity, an increase in mucus secretion and a violation of mucociliary clearance. As a result, favorable conditions are created for the penetration of pathogenic bacteria into the terminal bronchioles. It is here that the inflammatory process begins, which spreads from the walls of the bronchioles to the pulmonary parenchyma, that is, the lung tissue itself.
In the affected bronchioles, sputum accumulates, containing a significant amount of pathogens. During a cough, it enters the other terminal bronchioles through the large bronchi, causing an inflammatory process in them. The formation of an inflammatory focus is largely promoted by bronchial obstruction, leading to the appearance of hypoventilation areas in the lung tissue.
The inflammatory process in the lungs is accompanied by microcirculation disorders, parenchymal infiltration, and the formation of interstitial edema. This causes a disturbance in gas exchange, which, in turn, leads to hypercapnia, hypoxemia and respiratory acidosis. Clinically, these changes are manifested by acute respiratory failure.
Forms of the disease
In clinical practice, when classifying pneumonia in children, the cause of the disease, its duration and severity, X-ray morphological features, and conditions of infection are taken into account.
In accordance with the conditions of infection, pneumonia in children is divided into the following types:
- congenital (intrauterine) - symptoms of the disease occur in the first 72 hours of a baby's life;
- neonatal - develop in children of the first month of life, but not earlier than 72 hours after birth;
- hospital (nosocomial) - this group includes pneumonia that developed at the time the child was in the hospital (not earlier than 72 hours from the moment of hospitalization) or within 72 hours from the moment of discharge;
- home (community-acquired) - develop outside the walls of a medical institution, most often as a complication of ARVI.
Hospital pneumonia is characterized by a severe course and frequent development of complications, which is explained by the resistance of the microflora that caused them to most antibacterial drugs.
Depending on the cause of pneumonia in children, they are divided into bacterial, viral, parasitic, fungal, chlamydial, mycoplasma and mixed.
Based on X-ray morphological features, the following forms of pneumonia in children are distinguished:
- Focal (focal-drainage). In one or more segments of the lung, there are foci of infiltration up to 1 cm in diameter. The inflammation is catarrhal in nature and is accompanied by the formation of serous exudate in the alveoli. In cases where several separate inflammatory foci merge with each other, they speak of a focal-confluent form of the disease. In this case, the lesion can become of significant size, sometimes even occupy a whole lobe of the lung.
- Segmental. The inflammation immediately covers the whole segment of the lung and becomes the cause of its atelectasis (collapse). The disease often takes a protracted or chronic course, the outcome of which is deforming bronchitis or pulmonary fibrosis.
- Croupous. Characterized by an infectious-allergic inflammation with a violent course, which in its development successively goes through several stages (hot flush, red hepacy, gray hepacy, resolution). In croupous pneumonia in children, the pathological process is localized sublobar or lobar and affects the pleura, leading to the development of pleuropneumonia.
- Interstitial. Its causative agents are fungi, viruses, pneumocysts. The patient has proliferation and infiltration of the connective (interstitial) tissue of the lungs, which is either focal or diffuse.
Types of pneumonia in children, depending on the location of the lesion
According to the severity of the clinical course of pneumonia in children, they are divided into uncomplicated and complicated ones, accompanied by the development of cardiovascular disorders, the formation of septic foci, abscess or gangrene of the lung, pleurisy, pulmonary edema, and respiratory failure.
According to the duration of the course, acute and protracted pneumonia in children is distinguished. Acute pneumonia resolves within 4–6 weeks. Clinical and radiological signs of an inflammatory process in the lungs with a protracted course of pneumonia persist for more than 6 weeks.
Symptoms of pneumonia in children
The clinical picture of pneumonia in children is determined by the form of the disease. Focal pneumonia is usually a complication of ARVI and develops 5-7 days after the onset of ARVI. In this case, the signs of pneumonia in children are:
- an increase in body temperature up to 38-39 ° С;
- sleep disorders;
- lethargy;
- general weakness;
- lack of appetite;
- pallor of the skin;
- persistent regurgitation or vomiting (in infants);
- dyspnea;
- cough (at the beginning of the disease dry, and then wet).
For the focal-confluent form of pneumonia, a more severe course is characteristic. In children, cyanosis of the perioral region appears, and auxiliary muscles take part in the act of breathing. Often, the disease is accompanied by the development of pleurisy, toxic syndrome and respiratory failure.
The main symptoms of pneumonia in children are weakness, shortness of breath, high fever, and cough.
For segmental pneumonia in children, fever, respiratory failure of varying severity and intoxication syndrome are characteristic. This type of pneumonia is prone to a protracted course with the formation of bronchiectasis and fibroatelectasis.
Croupous pneumonia in children begins suddenly and proceeds with a rapid increase in symptoms:
- an increase in body temperature to febrile values (above 38 ° C), accompanied by tremendous chills;
- chest pain, aggravated by a deep breath and cough;
- severe respiratory failure;
- coughing up rusty sputum due to blood.
In children of the first years of life, croupous pneumonia can also be accompanied by the development of abdominal syndrome, which is characterized by abdominal pain, nausea, vomiting, and mild symptoms of peritoneal irritation.
The clinical picture of interstitial pneumonia in children is dominated by:
- weakening of breathing;
- painful, paroxysmal cough with difficult sputum;
- cyanosis of the nasolabial triangle;
- dyspnea.
With a severe course of pneumonia, signs of right ventricular heart failure may appear (lowering blood pressure, increased heart rate, acrocyanosis, swelling of the jugular veins and their pulsation, etc.).
Diagnostics
Diagnosis of pneumonia in children is carried out on the basis of the characteristic clinical picture of the disease, physical examination data (crepitant or fine bubbling rales, weakened breathing, shortening of percussion sound are detected) and the results of laboratory and instrumental examination, including:
- a general blood test (leukocytosis is detected, an acceleration of ESR, a shift in the leukocyte formula to the left);
- bacteriological blood test to identify the pathogen and determine its sensitivity to antibiotics - a positive result is observed in about 30% of children with community-acquired pneumonia, especially if blood was taken before antibiotic therapy was started;
- bacterioscopic examination of sputum with Gram stain;
- bacteriological examination of sputum with the definition of an antibioticogram;
- research of the immune status - performed if the child is suspected of having an immunodeficiency state;
- survey radiography of the chest organs (areas of infiltration of the lung tissue that have different localization, size and shape are found);
- chest X-ray in the supine position - indicated for the detection of pleurisy or empyema;
- computed tomography of the lungs - performed if a neoplasm is suspected or the development of a destructive process;
- bronchoscopy - indicated for prolonged course of the disease, suspected neoplasm or pulmonary hemorrhage;
- the study of the function of external respiration - allows for differential diagnosis with the syndrome of respiratory distress.
To identify the cause of pneumonia in children, a bacteriological examination of sputum with Gram stain is performed
Pneumonia in children requires differential diagnosis with bronchiolitis, acute bronchitis, cystic fibrosis, tuberculosis, pulmonary contusion, hypersensitive pneumonitis, pulmonary vasculitis.
Treatment of pneumonia in children
Indications for hospitalization of children with pneumonia in a hospital:
- severe respiratory distress;
- involvement in the pathological process of more than two pulmonary lobes;
- infancy and early childhood;
- severe encephalopathy;
- pleurisy;
- chronic respiratory diseases, for example, bronchial asthma;
- congenital defects of the heart and large vessels;
- severe course of kidney disease (pyelonephritis, glomerulonephritis);
- immunodeficiency state.
In the acute period, children are prescribed strict bed rest, rational drinking load and dietary food. Food is taken 6-7 times a day. Liquid or pureed meals are recommended. The diet should contain a sufficient amount of protein, corresponding to the age needs of a sick child, and an increased content of vitamins A, C and group B. Limit the amount of table salt and carbohydrates. The diet should include foods containing:
- calcium salts (milk, kefir, yogurt, cottage cheese, mild cheese);
- vitamin P (lemons, black currants, rose hips, black chokeberry);
- B vitamins (meat, fish, yeast, decoction of wheat bran);
- nicotinic acid (cheese, eggs, white chicken meat);
- vitamin A and carotene (red and orange fruits, berries and vegetables).
Vitamin-rich nutrition can help speed up recovery from pneumonia
Correctly organized medical nutrition plays an important role in the complex treatment of pneumonia in children. It helps to accelerate the regeneration of the epithelium of the respiratory tract, prevents antibiotics from suppressing the normal intestinal microflora and thereby speeds up the child's recovery.
Immediately after the diagnosis is established, the child is prescribed empiric antibiotic therapy (broad-spectrum antibacterial drugs are used). After receiving the results of bacteriological examination and antibioticogram, the antibiotic is replaced with the most effective one for the given case. Most often, beta-lactams, cephalosporins, macrolides, fluoroquinolones, imipenems are used in the treatment of pneumonia in children. If the ongoing therapy does not lead to a significant improvement in the condition within 36–48 hours, it is necessary to replace the antibiotic with another one belonging to a different pharmacological group.
Pathogenetic and symptomatic treatment of pneumonia in children consists in the use of:
- antihistamines;
- bronchodilators;
- mucolytics;
- non-steroidal anti-inflammatory drugs.
Children with severe cyanosis, shortness of breath, hypoxia are given oxygen therapy.
After normalization of the temperature, physiotherapeutic procedures are shown (percussion and general chest massage, inhalation, electrophoresis, inductothermy, microwave), physical therapy in order to avoid congestion in the lungs.
Potential consequences and complications
Pneumonia in children can lead to the development of a number of serious complications:
- lung abscess;
- gangrene of the lung;
- empyema of the pleura;
- infectious toxic shock;
- pleurisy;
- respiratory distress syndrome;
- cardiovascular insufficiency;
- DIC syndrome;
- sepsis;
- multiple organ failure.
Forecast
Most cases of pneumonia in children, subject to timely diagnosis and adequate therapy, result in complete recovery. With a protracted course of the disease, there is a high risk of developing chronic obstructive pulmonary disease. Poor prognosis in the following cases:
- the inflammatory process in the lung tissue is caused by a highly virulent and aggressive microbial flora;
- the disease proceeds against the background of immunodeficiency, severe somatic pathology;
- the development of purulent-destructive complications is observed.
Prevention
The specific prevention of pneumococcal pneumonia has been developed. It consists in setting up a vaccination against pneumonia for children, especially those at risk, which can protect them from infection with pneumococcus. This vaccine protects against a number of diseases caused by pneumococcal infection (Streptococcus pneumoniae), which include not only pneumonia, but also endocarditis, otitis media, meningitis, purulent arthritis.
Non-specific prevention of pneumonia consists in carrying out general measures aimed at increasing the child's immunity:
- good child care;
- hardening procedures;
- proper nutrition that meets age-related needs;
- timely and adequate treatment of any disease.
After suffering pneumonia, children should be registered with a pediatrician for a year. Deregistration is carried out only after the examination (chest x-ray, complete blood count), examination of the child by an otolaryngologist, immunologist, allergist and pulmonologist.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
