Академический Документы
Профессиональный Документы
Культура Документы
Quiz Question
What is the most sensitive and specific sign of
pneumonia in children?
A. Difficulty breathing
B. Fever
C. Tachypnea
D. Tachycardia
Quiz Question
If available, a chest x-ray should be done for
children with possible pneumonia:
A. When a diagnosis is made
B. When a history of tachypnea is present
C. When antibiotics are started
D. When complications are suspected
Quiz Question
Which of the following immunization
effectively reduce pneumonia mortality in
children?
A. Haemophilus influenzae b Vaccine
B. Pneumococcal Conjugate Vaccine
C. Measles Vaccine
D. All of the above
What is Pneumonia?
Pneumonia: an acute infection of the
pulmonary parenchyma
The term Lower Respiratory Tract
Infection (LRTI) may include pneumonia,
bronchiolitis and/or bronchitis
Epidemiology
Pneumonia kills more children under the
age of five than any other illness in every
region of the world.
It is estimated that of the 9 million child
deaths in 2007, 20% (1.8 million) were due
to pneumonia
Approximately 98% of children who die of
pneumonia are in developing countries.
Basic Pathophysiology
Most cases of pneumonia are caused by
the aspiration of infective particles into the
lower respiratory tract.
Organisms that colonize a childs upper
airway can cause pneumonia.
Pneumonia can be caused by person to
person transmission via airborne droplets.
Newborn
Group B Streptococci
Gram-negative bacilli
Listeria monocytogenes
Herpes Simplex
Cytomegalovirus
Rubella
1-3 months
Chlamydia trachomatis
Respiratory Syncytial virus
Other respiratory viruses
3-12 months
From: Tintinalli JE et al. (2004). Emergency Medicine, A Comprehensive Study Guide, Sixth Edition.
American College of Emergency Physicians. (pp. 784-789). McGraw-Hill. Toronto, ON.
2-5 years
Respiratory Viruses
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Chlamydia pneumoniae
5-18 years
Mycoplasma pneumoniae
Streptococcus pneumoniae
Chlamydia pneumoniae
Haemophilus influenzae
Influenza viruses A and B
Adenoviruses
Other respiratory viruses
From: Tintinalli JE et al. (2004). Emergency Medicine, A Comprehensive Study Guide, Sixth Edition.
American College of Emergency Physicians. (pp. 784-789). McGraw-Hill. Toronto, ON.
Respiratory
Rate
(breaths/min)
< 2 months
2 to 12 months
12 months to 5
years
Greater than 5
years
> 60
> 50
> 40
> 20
Indication of
severe
infection
(breaths/min)
>70
>50
out---breathing---in
Lower chest wall indrawing: with inspiration,
the lower chest wall moves in
From: Integrated Management of Childhood Illness. Chapter Three: Cough or difficulty breathing. World Health Organization. 2000
https://apps.who.int/chd/publications/referral_care/chap3/chap31.htm. Accessed February 2, 2012
From: Integrated Management of Childhood Illness. Chapter Three: Cough or difficulty breathing. World Health Organization. 2000
https://apps.who.int/chd/publications/referral_care/chap3/chap31.htm. Accessed February 2, 2012
Classify AS
Treatment
Tachypnea
Lower chest wall
indrawing
Stridor in a calm child
Severe Pneumonia
Tachypnea
Non-Severe
Pneumonia
From: Pneumonia The Forgotten Killer of Children. Geneva: World Health Organization (WHO)/United Nations Childrens Fund (UNICEF), 2006.
Severe
Infants
Temperature <38.5 C
RR < 50 breaths/min
Mild recession
Taking full feeds
Temperature >38.5 C
RR > 70 breaths/min
Moderate to severe recession
Nasal Flaring
Cyanosis
Intermittent Apnea
Grunting Respirations
Not feeding
Older Children
Temperature <38.5 C
RR < 50 breaths/min
Mild breathlessness
No vomiting
Temperature >38.5 C
RR > 50 breaths/min
Severe difficulty in breathing
Nasal Flaring
Cyanosis
Grunting Respirations
Signs of dehydration
From: Pneumonia The Forgotten Killer of Children. Geneva: World Health Organization (WHO)/United Nations Childrens Fund (UNICEF), 2006.
Infants
Older Children
In-Patient Management
Consideration must be given to the provision
of adequate hydration, oxygenation, nutrition,
antipyretics and pain control.
Monitoring should include:
Respiratory rate
Work of breathing
Temperature
Heart rate
Oxygen saturation (if available)
Findings on auscultation.
Laboratory Investigations
Routine blood work is not required in children
with uncomplicated lower respiratory tract
infections who will be treated as outpatients
Tests to consider if available:
CBC, particularly WBC
Electrolytes, particularly Sodium
Consider blood cultures, sputum cultures
HIV and TB testing as appropriate
Treatment IV Antibiotics
Common medications for treating pneumonia:
Penicillins: Amoxicillin, Ampicillin, Benzyl
Penicillin
2nd generation Cephalosporins: Cefuroxime
3rd generation Cephalosporins: Cefotaxime
Dose according to childs weight
Key Points
Pneumonia is an acute infection of the
pulmonary parenchyma
Pneumonia kills more children under the age
of five than any other illness.
A diagnosis of pneumonia should be
considered in all children with tachypnea and
difficulty breathing.
Common first-line antibiotics include
amoxicillin and co-trimoxazole .