Pneumonia in infants

Pneumonia is an acute inflammation of the lung parenchyma based on infectious, allergic, physical or chemical noxa at the level of the respiratory bronchioles, alveolar spaces and interstitium.

Etiology of neonatal and infant pneumonia

 * In newborns - early onset:
 * Gram-positive bacteria: Streptococcus agalactiae (GBS),
 * Gram-negative bacteria: Escherichia coli, Listeria monocytogenes, Klebsiella pneumoniae,
 * amniotic fluid aspiration.
 * In newborns - late onset:
 * in addition nosocomial strains: Pseudomonas aeruginosa, Enterobacter, G-rods,
 * rare: Haemophilus influenzae, Streptococcus pneumoniae, Ureaplasma urealyticum, anaerobes, group D streptococci, CMV, HSV.
 * In infants (3 weeks to 3 months of age):
 * respiratory viruses: RS virus, parainfluenza 1-3, adenoviruses, influenza,
 * bacteria: Streptococcus pneumoniae, Chlamydia trachomatis,
 * rare: Ureaplasma urealyticum, Bordetella pertussis, Haemophilus influenzae, CMV, HSV.
 * In children aged 4 months to 5 years:
 * respiratory viruses: adenoviruses, influenza, parainfluenza, rhinoviruses, RS virus,
 * bacteria: Streptococcus pneumoniae,
 * rare: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Moraxella catarrhalis, Staphylococcus aureus, Mycobacterium tuberculosis.

Types of pneumonia

 * Pneumonia × bronchopneumonia - just a book difference, in practice we do not distinguish it.

Bacterial pneumonia

 * Less common
 * agents: pneumococci, staphylococci (most often in the 1st year of life), streptococci, hemophilus,
 * higher susceptibility - in aspiration, in immunodeficiencies, congenital lung anomalies, cystic fibrosis, cilia dysfunction,
 * clinical picture - sudden onset with fever, chills, lethargy, tachypnoea, irritating cough, tachycardia,
 * findings in infants may be small,
 * percussion - shortened,
 * listening - tubular breathing, flu,
 * in infants, the disease may not correlate with an X-ray finding.

Aspiration pneumonia

 * Often lamp oils - the first is an acute inflammation with the dissolution of the surfactant - severe pneumonia,
 * kerosene pneumonia - in x-days, ingested volatile substances are excreted and damage the lungs.

Classification of pneumonia according to severity

 * Mild pneumonia - no dyspnoea, minimal symptoms,
 * outpatient treatment (amoxicillin or clarithromycin),
 * without comorbidities,
 * moderate - dyspnoea, marked auditory finding, X-ray,
 * usually initially hospitalized for 2-3 days, ATB i.v., when it responds well - on an outpatient basis,
 * severe pneumonia - alteration of the condition, hospitalization, sometimes the need for UPV.

Diagnosis of pneumonia

 * Anamnesis - how long, where and how it started (rhinitis,…), whether fast with fever or slowly with low temperatures, ask about aspirations,
 * X-ray, FW, KO, CRP,
 * throat swabs don't matter
 * sputum is better for cultivation, but it must come from DCD, in children from school age,
 * microscopy, culture, PCR (not for every pneumonia - expensive examination),
 * blood culture (although about 80% of pneumonias are without bacteremia),
 * bronchoscopy - very good collection of materials, but can only be used for UPV, for atelectasis,
 * antigen in urine - very sensitive, result in half an hour - on legionella and pneumococcus,
 * antigen in saliva - adenoviruses, RSV,
 * serology - debatable, takes a long time,
 * the clinical picture is determined by the basic health condition,
 * typical pneumonia - often have a productive cough from the beginning, cornea to crepitus, tubular breathing,
 * X-ray, FW higher, CRP high, leukocytosis, left shift,
 * atypical pneumonia - dry cough, extrapulmonary symptoms (fatigue, muscle pain), occasionally crunches,
 * X-ray - interstitial reticulonodulation,
 * FW high (higher than typical) - especially in mycoplasma - forms cold Ig,
 * CRP slightly increased (up to 100),
 * lymphocytosis.

Therapy

 * Empirical antibiotic treatment of neonatal pneumonia:
 * ampicillin + gentamicin i.v., event. ampicillin + cephalosporin III. generation i.v.
 * Empirical antibiotic treatment of community-acquired pneumonia in infants up to 3 months of age:
 * cephalosporins III. generation i.v., event. penicillin G i.v.
 * Empirical antibiotic treatment of community-acquired pneumonia in children from 4 months of age:
 * mild pneumonia - amoxicillin p.o. (50-90 mg / kg / day in 3 doses),
 * severe pneumonia - penicillin G i.v. (100-200,000 IU / kg / day or more in 4-6 doses), in case of allergy cephalosporin III. generation i.v ..
 * Symptomatic treatment:
 * expectorants, mucolytics, antitussives for irritating dry cough,
 * antipyretics,
 * oxygen therapy for respiratory insufficiency,
 * nebulization therapy.
 * Regime measures:
 * adequate supply of fluids, calories, vitamins,
 * respiratory rehabilitation.

Complications of pneumonia

 * In the chest:
 * pleurisy - mainly atypical,
 * lung abscess –B. aureus - ATB 1.v - lincosamides, but mostly ends in surgery,
 * bronchiectasis - viral (adenoviruses) - to distinguish HRCT,
 * empyema - rarely in children,
 * septic (emboli - joints, heart, CNS,…).

Related articles

 * Pneumonia (pediatrics) • Pneumonia • Pneumonia in older children
 * Bacterial pneumonia • Atypical pneumonia • Abscessive pneumonia • Aspiration pneumonia
 * RDG examination in lower respiratory tract inflammation • Clinical evaluation of the severity of pneumonia

Source



 * BENEŠ, Jiří. Studijní materiály [online]. [cit. 2010]. < http://jirben.wz.cz >.