Consequences after pneumonia in children. Dangerous consequences of pneumonia in children. Evaluation of the effectiveness of the treatment of pneumonia in children

A common disease that poses a real threat to life is pneumonia in children, in the treatment of which modern medicine has advanced far ahead. Even 30-40 years ago, according to statistics, doctors managed to save only every 3-4 children with pneumonia.

Modern methods of therapy have reduced the mortality rate from this disease by dozens of times, but this does not make the disease less serious. Forecasts in the treatment of each child always depend not only on the correct diagnosis and treatment plan, but also on the timeliness of contacting a doctor.

Inflammation of the lungs, called pneumonia, is a common disease that occurs not only in children of all ages, but also in adults.

The concept of pneumonia does not include other diseases of the lungs, for example, their vascular or allergic lesions, bronchitis and various disorders in their work caused by physical or chemical factors.

In children, this disease is common, as a rule, about 80% of all lung pathologies in babies are due to pneumonia. The disease is an inflammation of the lung tissue, but unlike other lung diseases, such as bronchitis or tracheitis, with pneumonia, pathogens penetrate into the lower parts of the respiratory system.

The affected part of the lung cannot perform its functions, release carbon dioxide and absorb oxygen. For this reason, the disease, especially acute pneumonia in children, is much more severe than other respiratory infections.

The main danger of childhood pneumonia is that, without adequate treatment, the disease progresses rapidly and can lead to pulmonary edema of varying severity, and even death.

In children with a weak immune system, the disease proceeds in very severe forms. For this reason, pneumonia in infants is considered the most dangerous, since their immune system is not yet sufficiently formed.

The state of the immune system plays an important role in the development of the disease, but it is important to correctly determine the cause of pneumonia, since only in this case its treatment will be successful.

Causes of pneumonia

For the successful treatment of pneumonia in children, it is important to correctly diagnose the disease and identify the pathogen. The disease can be caused not only by viruses, but also by bacteria, as well as fungi.

Often the cause is the microbe pneumococcus, as well as mycoplasma. Therefore, the nature of the onset of pneumonia may be different, but this very moment is important for organizing effective treatment, since drugs to fight bacteria, viruses and fungi are completely different.

Pneumonia can have various origins:

1. bacterial origin. The disease can occur not only against the background of another disease of the respiratory system, as a complication, but also independently. Antibiotics for pneumonia in children are used specifically for this form of the disease, since it requires careful and urgent antibiotic therapy.
2. viral origin. This form of the disease is the most common (detected in about 60% of cases) and the mildest, but requires adequate treatment.
3. fungal origin. This form of pneumonia is rare; in children, it usually occurs after inadequate treatment of respiratory diseases with antibiotics or their abuse.

Inflammation of the lungs can be unilateral, when one lung or part of it is affected, or it can be bilateral, covering both lungs at once. As a rule, with any etiology and form of the disease, the temperature rises greatly in a child.

Pneumonia itself is not a contagious disease, and even with a viral or bacterial form, it is very rarely transmitted from one child to another.

The only exception is atypical pneumonia, the cause of which was the activation of a certain type of mycoplasma. In this case, the disease in children is very difficult, accompanied by high temperatures.

Special mycoplasmas of pneumonia, which cause respiratory mycoplasmosis and pneumonia, are easily transmitted by airborne droplets, causing various forms of respiratory diseases, the severity of which depends on the state of the child's immune system.

The symptoms of this type of pneumonia are somewhat different:

• At the very beginning of the disease, the child's temperature rises sharply, the values ​​​​of which reach 40 °, but after that it decreases and passes into subfebrile with persistent values ​​​​of 37.2–37.5 °. In some cases, there is a complete normalization of indicators.
• In some cases, the disease begins with the usual symptoms of SARS or a cold, such as a sore throat, frequent sneezing, and a severe runny nose.
• Then shortness of breath and a very strong dry cough appear, but acute bronchitis has the same symptoms, this fact complicates the diagnosis. Often, children begin to be treated for bronchitis, which greatly complicates and aggravates the disease.
• Listening to the lungs of a child, the doctor cannot determine pneumonia by ear. Wheezing is rare and of a different nature, there are practically no traditional signs when listening, which greatly complicates the diagnosis.
• When examining a blood test, as a rule, there are no pronounced changes, but an increase in ESR is found, as well as neutrophilic leukocytosis, supplemented by leukopenia, anemia and eosinophilia.
• When conducting an x-ray, the doctor sees in the pictures foci of heterogeneous infiltration of the lungs with an enhanced expression of the pulmonary pattern.
• Mycoplasmas, like chlamydia, which cause atypical pneumonia, can exist for a long time in the cells of the epithelium of the lungs and bronchi, and therefore the disease is usually protracted and, having appeared once, can often recur.
• Treat SARS in children with macrolides, which include clarithromycin, josamycin and azithromycin, since it is to them that pathogens are most sensitive.

Indications for hospitalization

Only a doctor can decide where and how to treat a child with pneumonia. Treatment can be carried out not only in stationary conditions, but also at home, however, if the doctor insists on hospitalization, this should not be prevented.

Children are subject to hospitalization:

• with a severe form of the disease;
• with pneumonia complicated by other diseases, for example, pleurisy, heart or respiratory failure, acute impairment of consciousness, lung abscess, drop in blood pressure, sepsis or infectious toxic shock;
• in whom there is a lesion of several lobes of the lung at once or a croupous variant of pneumonia;
• up to a year. In infants under one year old, the disease is very severe and poses a real threat to life, so their treatment is carried out exclusively in hospitals, where doctors can provide them with emergency assistance in a timely manner. Children under 3 years of age also undergo inpatient treatment, regardless of the severity of the disease. Older children can be treated at home, provided that the disease is not in a complicated form;
• who have chronic diseases or severely weakened immunity.

Treatment

In most cases, the basis of therapy for pneumonia is the use of antibiotics, and if the doctor has prescribed them to the child, in no case should they be abandoned.

No folk remedies, homeopathy, and even traditional methods of treating SARS can help with pneumonia.

Parents, especially in outpatient care, must strictly follow all doctor's prescriptions and strictly follow all instructions in terms of taking medicines, eating, drinking, resting and caring for a sick child. In the hospital, all necessary measures must be carried out by medical personnel.

It is necessary to treat pneumonia correctly, which means that some rules should be followed:

• Reception of antibiotics prescribed by a doctor should take place strictly according to the established schedule. If, according to the doctor's prescription, it is necessary to drink antibiotics 2 times a day, then an interval of 12 hours should be observed between doses. When appointing a three-time intake, the interval between them will be 8 hours, and this rule cannot be violated. It is important to observe the terms of taking the drugs. For example, cephalosporin and penicillin antibiotics are taken for no longer than 7 days, and macrolides should be used for 5 days.
• To assess the effectiveness of treatment, expressed in improving the general condition of the child, improving appetite, reducing shortness of breath and lowering the temperature, is possible only after 72 hours from the start of therapy.
• The use of antipyretic drugs will be justified only when the temperature in children from a year exceeds 39 °, and in babies up to a year - 38 °. A high temperature is an indicator of the immune system's fight against the disease, while there is a maximum production of antibodies that destroy pathogens. For this reason, if the baby normally tolerates a high temperature, it is better not to knock it down, since in this case the treatment will be more effective. But, if the baby has at least once experienced febrile convulsions against the background of an increase in temperature, an antipyretic should be given already when the indicators rise to 37.5 °.
• Food. Lack of appetite in pneumonia is a natural condition. You don't have to force your child to eat. During the treatment period, light meals should be prepared for the baby. Optimal nutrition will be liquid cereals, steam cutlets from lean meat, soups, boiled potatoes or mashed potatoes, as well as fresh fruits and vegetables rich in vitamins.
• It is also necessary to monitor the drinking regimen. The child should consume plenty of pure non-carbonated water, green tea with raspberries, natural juices. If the child refuses to drink the required amount of liquid, small portions of special pharmacy solutions should be given to him to restore the water-salt balance, for example, Regidron.
• In the child's room, it is necessary to carry out wet cleaning daily, as well as monitor the humidity of the air, for this you can use humidifiers or put a container of hot water in the room several times a day.
• It should also be remembered that immunomodulators and antihistamines should not be used in the treatment of pneumonia. They will not help, but they can lead to side effects and aggravate the condition of the child.
• The use of probiotics is necessary for pneumonia, since taking antibiotics causes disruption of the intestines. And for the removal of toxins formed from the vital activity of pathogens, the doctor usually prescribes sorbents.

Subject to all prescriptions, the sick child is transferred to a normal regimen and walks in the fresh air are allowed from about 6–10 days of therapy. With uncomplicated pneumonia, the child after recovery is given exemption from physical activity for 1.5-2 months. If the disease proceeded in a severe form, sports will be allowed only after 12-14 weeks.

Prevention

It is necessary to pay special attention to preventive measures, especially after a child has had an illness. It is important to prevent accumulation of sputum in the lungs, which is why the development of the disease occurs.

Maintaining adequate humidity in your baby's room will not only help ensure easy breathing, but will also be an excellent measure to prevent mucus from thickening and drying out in the lungs.

Sports activities and high mobility of children are excellent preventive measures to help eliminate sputum from the lungs and respiratory tract and prevent the formation of accumulations.

Drinking plenty of fluids not only helps to keep the baby's blood in a normal state, but also helps to thin the mucus in the airways and lungs, which makes it easier to remove it naturally.

Pneumonia can be effectively treated only if all doctor's prescriptions are followed. But, of course, it is much easier to prevent it, and for this, any diseases of the respiratory system should be eliminated in a timely manner and completely.

It must be remembered that pneumonia in most cases becomes a complication when colds or other diseases of the respiratory system are neglected, as well as when therapy is not carried out in time or treatment is stopped prematurely. Therefore, in order to avoid possible complications and the development of pneumonia, one should not self-medicate colds, but consult a doctor for any of their manifestations.

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In addition to incorrect and delayed treatment, complications of pneumonia can be caused by the general condition of the body before the onset of the inflammatory process (chronic diseases, age, pregnancy). They are also provoked by an infection that caused pneumonia:

• Pneumococcus;
• staphylococcus;
• streptococcus;
• other pathogens - Afanasiev-Pfeiffer bacillus, Chlamydophila pneumoniae, etc.

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Pneumonia is also viral, candidal, aspergillus. All pathogens to a small extent affect not only the respiratory organs (lungs, alveoli), but also the sense organs, the gastrointestinal tract, and the musculoskeletal system. If the disease has affected the child's body, then complications from the nervous and genitourinary systems may occur.

Pleurisy is the accumulation of fluid in the pleural region. Symptoms of the disease: weakening of breathing, chest pain. With pleurisy, fluid is pumped out of the lungs by performing a pleural puncture, after which a course of strong antibiotics is usually prescribed.

Respiratory failure is a condition that occurs when there is a severe form of pneumonia. It causes a decrease in the performance of the respiratory muscles, severe edema, in which the patient cannot breathe on his own. In the early stages of insufficiency, it is necessary to reduce swelling so that the patient can breathe on his own, then treat with antibiotics and pump out fluid from the lungs. In this condition, cyanosis of the skin may appear, which manifests itself in the blue of the feet, fingertips and lips. The solution to the problem lies in the artificial saturation of tissues with oxygen.

The main symptoms of pneumonia are fever, cough and weakness. After complete recovery, patients most often complain of various pains: in the chest, ribs, and back. More than 40% of patients (most often women) who have had pneumonia turn to therapists with another problem - pain in the legs. There is a scientific explanation for this.

With pneumonia, the movement of blood in a large and small circle is disturbed. The result of such a violation is the accumulation of cells in the lymph nodes, whose task is to eliminate the infection that provokes the disease.

Another cause of pain in the limbs is a consequence of taking antibiotics, which disrupt blood circulation. Massage, application of painkillers tonic balms on the joints can eliminate unpleasant symptoms. Pain in the legs will disappear after the full recovery of the body affected by pneumonia.

Other types of complications

Even with timely and proper treatment, there is a risk of negative consequences of pneumonia. It can be diseases of the circulatory system, muscles, sensory organs. Due to the harmful effects of microorganisms, a patient who has had pneumonia has a risk of developing endocarditis and bacteremia.

Endocarditis is an infection in the inner lining of the heart. After the body is damaged by bacteria and microorganisms, they enter the bloodstream, and from there - into the endocardium, which covers the chambers of the heart. Symptoms of the disease - shortness of breath, regular dry cough, chest pain. Without timely treatment, an infectious lesion can develop into acute heart failure and provoke a myocardial infarction.

Bacteremia is the entry into the blood of a large number of microorganisms due to pneumonia. Determining that a person has this condition is not always easy, because the symptoms resemble the flu:

• high body temperature (up to 39-40 degrees);
• violent cough with thick green, grey-green and yellow mucus;
• septic shock - hypotension (low blood pressure), clouding of consciousness, oliguria (slow urine formation).

Bacteremia can be detected by examining the patient's blood. Treatment of the disease should be carried out immediately, otherwise the infection will spread to all vital organs - the liver, heart, spinal cord. The treatment uses antibiotics, immunostimulants and ultraviolet light.

Treatment of diseases in young children is a long process in which the smallest details must not be overlooked. At the age of 3 years, the child's immunity is just being formed, and complications of pneumonia are quite common. They concern the general condition of the body, the sense organs and the nervous system. In addition to the complications that affect the body of adults, age-related changes of a negative nature can be observed in children. They are divided into pulmonary and extrapulmonary. The first type includes changes directly in the respiratory system, the second - deterioration in the work of other organs.

In children of early and school age, after pneumonia, complications in the respiratory process may occur - acute respiratory failure, pleurisy. Infections that cause pneumonia in a child often spread to the cardiovascular system and cause pericarditis, heart murmurs, and toxic shock.

The first visible complication of the extrapulmonary type is a violation of the speech apparatus. Often, 1-1.5-year-old babies already begin to express their thoughts in words, but after suffering pneumonia they stop talking altogether, sometimes up to 4 years. The same disorders are observed in the musculoskeletal system of a child aged 7-14 months. The main reason for such unpleasant “braking” is insufficient blood circulation.

A complication from the nervous system of the child after the treatment of pneumonia is neurotoxicosis, which has several stages. The first is a sharp excitability, nervousness of the child. The second stage is a sharp inhibition of reactions, in which the baby loses his appetite, he reacts badly to the appeal of adults to him. After this, the final stage comes - the terminal one, in which the child's body temperature rises sharply (up to 40 degrees), convulsions appear, sometimes breathing stops (the so-called apnea).

The consequences of pneumonia in a strong children's body are not so terrible as its improper treatment. Antibiotics are the main drugs that are used to relieve inflammation, if their type is incorrectly prescribed, then the child may experience hearing problems, intestinal disorders caused by a change in the composition of the microflora.

Pneumonia refers to a disease that can often be found in children of different ages. Inflammation of the lungs is a complex disease of the respiratory tract, both in the approval of the diagnosis and in the appointment of treatment. Everything will depend on how extensively the lungs are affected. Given the age, signs of pneumonia in a child of 3 years old may occur with their own characteristics. Based on the clinical severity of the disease, the diagnosis can be made immediately or additional studies will be required. Symptoms and treatment of a child with pneumonia will be individual.

Pneumonia is an infection of the lung tissue. With a disease, the infection penetrates into the lowest parts of the respiratory system, as a result of which the affected part of the organ is not able to perform its respiratory function (take in oxygen, release carbon dioxide). Therefore, this disease is much more severe than other respiratory infections.

During the disease, damage to the alveoli and lung tissue often occurs. Inflammation can be of various origins, it can be caused by:

Based on the area of ​​\u200b\u200bthe disease, pneumonia happens:

• focal;
• segmental;
• equity;
• drain;
• total.

When one of the lungs is affected, the inflammation is called unilateral. With inflammation of 2 lungs, then this is a bilateral inflammation.

Also, the disease can develop independently or be a complication of a previous infection.

Infection factors include:

• hospital (nosocomial) pneumonia;
• out-of-hospital;
• illness resulting from medical intervention;
• aspiration;
• atypical.

The cure for pneumonia in children aged 3 years is aimed at eliminating the pathogen, reducing the manifestation of symptoms, and supporting the protective function of the body. The main thing is to correctly determine the factor in the development of the disease, then the treatment will be effective.

It is important to know that the infectiousness of the disease depends on the pathogen. Pneumonia is often contagious. This is a typical pneumonia that is caused by pneumococcus. In addition to inflammation of the lungs, this microbe affects the middle ear, manifesting itself as otitis media, and meningitis also develops. Even a patient who has had an infection can be an asymptomatic carrier of pneumonia. Therefore, you can not notice who became the carrier of the infection, from which the child became infected.

However, the manifestation of pneumonia also depends on viral illnesses that occur for a long time. In this case, a bacterial disease is adjusted to a viral infection, since the child's immunity is reduced.

Causes of the manifestation of the disease

The disease in children may differ in manifestations and speed of development. Often it is severe and requires treatment in a hospital.

Pneumonia in young children is rarely contagious, more often manifested as a complication of tonsillitis, bronchitis.

Factors that contribute to the development of pneumonia in children aged 3 years.

1. Oxygen starvation of the baby during pregnancy or during childbirth.
2. Injuries, complications during childbirth.
3. Problems with the opening of the lungs that arose after birth.
4. Prematurity of the child.
5. Anemia, rickets.
6. Lag in development.
7. Infection by the mother of the child with chdamydia, herpes.
8. Weak immunity.
9. Heart disease.
10. hereditary diseases.
11. Digestive disorder.
12. Lack of vitamins.

Pneumonia also develops when inhaling chemical fumes, allergic processes in the body, with hypothermia, overheating of the respiratory tract. In a three-year-old child, various processes that weaken the tissue of an organ can provoke an inflammatory process.

Most often, the disease manifests itself against the background of an acute respiratory disease or influenza. Due to the action of the virus, the protective function of the body weakens, for this reason, pathogenic microorganisms cause inflammation. Bacteria are present in the air, on surrounding objects, toys. Also, children can become infected from a patient who has a purulent-inflammatory formation.

It is not easy for children at the age of three to cough up sputum, for this reason it accumulates in the organs, which leads to the development of pathogens.

The cause of pneumonia in a child can be improper treatment of a respiratory disease. In this case, you should not engage in self-treatment of the child. This is especially true for preventive courses and antibiotic therapy.

Why does the disease reappear?

Quite often, the disease affects children under the age of three. Not an exception and the repetition of the disease. This is due to the fact that the causative agent of the disease has not been completely eliminated from the body. Therefore, during a decrease in the immune system, bacteria again cause an inflammatory process in the lungs.

Repetitions of pneumonia pose a danger to the child by severe intoxication of the body.

Causes that lead to recurrence of inflammation include:

• chronic illnesses (heart defects);
• cystic fibrosis;
• the wrong drug is prescribed, which is aimed at fighting bacteria during the cure of pneumonia of the primary manifestation;
• weakened immunity.

If children often have pneumonia, a complete examination is necessary to identify a factor that contributes to the weakening of the protective function of the body.

Signs of the disease

With a high activity of the infectious agent or with a weakened protective function of the body against this pathogen, when the use of effective medications does not bring a positive result, any parent can guess from individual symptoms that his child needs serious treatment and an urgent examination by a pediatrician.

Most often, the occurrence of pneumonia depends on the level and extent of infection of the organ. If the area of ​​inflammation is large and develops actively, then the disease can manifest itself brightly and it is difficult to develop. However, in most cases, pneumonia does not develop severely and can be treated.

The main symptoms of pneumonia in a child aged 3 years are as follows:

• stuffy nose or runny nose;
• sneezing
• weak and lethargic state;
• constantly want to sleep;
• decreased appetite;
• pale skin;
• increased temperature;
• cough.

Focal (bronchopneumonia) is characterized by the occurrence as a complication or development of SARS. The disease at the initial stage is manifested by a common cold. The child has a runny nose, he is snotty, coughing. Concerning the measure of the development of pulmonary disease, the infection falls lower. Rarely, viral infections initially affect the bronchi, and then move to the lungs. Then the microbial flora joins, the child's health worsens, after 5 days of illness.

The child suffers from shortness of breath, it occurs during physical exertion, while crying. Also, shortness of breath can manifest itself, even in a calm position and in a dream.

During the breathing of a child at a distance, noises in the lungs can be heard. The wings of the nose swell, and breathing is also carried out by the muscles of the chest.

Basically, the disease is accompanied by an increase in temperature, it reaches 39 degrees, at some points higher, it is not easy to lower it. Although in young children of this age, pneumonia can occur without temperature or with its decrease due to the lack of the body's defenses and temperature mechanisms.

In children of two years of age, with fever, convulsions occur when the temperature is high and does not subside for a long time. Heat-reducing drugs in this situation do not bring effect.

Fever can be present for several days, even if the treatment is timely, as it refers to a typical symptom for this disease.

In some cases, a two-year-old baby is active, which can not immediately be suspected of the presence of pneumonia. Further, when the body is depleted by compensatory mechanisms, the baby's behavior changes, he becomes capricious, very excited. There are skin rashes. The child's skin is moist and hot when touched, the stool is disturbed, he refuses to eat, which leads to vomiting. The cough is severe and can cause nosebleeds.

Examining the child, one can observe pale skin, blue is noticeable around the mouth and nose. He is restless, does not want to eat, sleeps a lot. When the doctor listens to the chest, symptoms of heavy breathing are allowed, which indicates an inflammatory process in the place of the bronchi and upper respiratory tract. In addition, small wheezing is heard, which are noted above the surface of the lungs. The rales are moist and do not go away when the child coughs. This is the accumulated fluid in the alveoli, which slams against its walls.

You can also note the presence of tachycardia (increased heart rate), and possibly muffled heart sounds against the background of toxicosis. There may also be symptoms:

• nausea;
• vomit;
• stomachache;
• diarrhea that prompts an intestinal infection;
• the liver is enlarged;
• swelling of the intestinal loop.

With these signs, the child's health is assessed as severe.

Symptoms can also be determined during additional examinations of the child.

1. Auscultation, listening to the lungs.
2. X-ray of the chest.
3. Blood test indicators.

In the x-ray of the lungs, the symptom of the disease in babies is determined by focal tissues with the contours of the nerves, in addition, the pattern of the lung is enhanced, and the expansion of the pulmonary roots is noticed.

In the study of blood, an increase in ESR was determined, leukocytes were elevated, there was a shift in the leukocyte formula.

How to treat the disease

Most often, a pulmonary disease in children is treated in a hospital. The only treatment for inflammation is antibiotics, often by injection.

There are a lot of funds. Which drugs are suitable for your child, the attending physician will decide, based on the results of a thorough examination. When one of the prescribed antibiotics does not bring the desired result, the doctor will prescribe another.

It is important to follow the doctor's instructions and not shy away from the use of drugs, because pneumonia is often the cause of death of the patient. The use of folk remedies as the main treatment does not have a positive effect, they are only an auxiliary component.

Antibiotics should be taken strictly on time. When it is prescribed to take the drug twice a day, it is necessary to take a break between doses of 12 hours. The following antibiotics are prescribed:

• penicillin - take 7 days;
• cephalosporin - take 7 days;
• macrolides (josamycin, azithromycin, clarithromycin) - take 5 days.

The effectiveness of drugs occurs 72 hours after administration. The child's appetite improves, the temperature decreases, shortness of breath disappears.

Means that reduce the temperature are used in case of exceeding the temperature of more than 39 degrees. At the initial stage of the development of the disease, antipyretics are not used, since they make it difficult to assess the effectiveness of treatment.

It is important to remember that at a high temperature in the body, the maximum amount of antibodies against the pathogen is produced. Therefore, when a child is able to endure a temperature of 38 degrees, it should not be lowered. In this case, the body will quickly cope with the harmful microorganism that caused the illness in the child.

If episodes of febrile convulsions were noticed, the temperature can be brought down at 37.5 degrees.

When children have no appetite during an illness, this phenomenon is considered normal and refusal to eat indicates a serious effect on the liver. Therefore, forcing a child to eat is not worth it. Light meals should be prepared whenever possible. It can be cereals, soups, steamed cutlets, boiled potatoes, which are easily digestible, as well as vegetables and fruits. Do not give fried, fatty foods.

Drink fresh juices for the child (from carrots, apples). It can also be raspberry tea, rosehip infusion, water, adding water-electrolyte solutions (rehydron) to the drink.

It is necessary to ventilate and carry out wet cleaning in the room every day. Use a humidifier, it will help to alleviate the patient's condition.

It is impossible to use drugs that have a general strengthening effect, as well as antihistamine and immunomodulatory drugs, as this can lead to side effects and will not improve the development and outcome of the disease.

During treatment with antibacterial drugs, a child experiences a violation in the intestinal microflora. In this case, the pediatrician will prescribe probiotics.

1. Rioflora Immuno.
2. Acipol.
3. Bifiform.
4. Normobact.
5. Lactobacterin.

To remove toxins after the end of treatment, the doctor may prescribe sorbents.

1. Polysorb.
2. Enterosgel.
3. Filtrum.

If the disease is caused by a viral infection, antibiotics are not needed. You will need treatment in the intensive care unit and oxygen breathing.

Fulfilling all the doctor's prescriptions, observing bed rest, in the absence of complications, the child will recover, while residual cough and slight weakness in the body will appear for a month. If an atypical form of pneumonia is present, therapy may be delayed.

In the course of effective treatment, the child can be transferred to the usual regimen and walks on the 6-10th day of the disease. It is allowed to resume hardening after 3 weeks. If the course of the disease is not severe, physical, sports activities are allowed after 6 weeks. With complicated pneumonia after 12 weeks.

It is important not to forbid children to walk and move more, while trying to prevent overheating and hypothermia by dressing the child according to the weather.

Pneumonia in a child is an acute infectious disease of a predominantly bacterial nature, characterized by focal lesions of the respiratory sections of the lungs, respiratory disorders and intraalveolar exudation, as well as infiltrative changes on the radiographs of the lungs. The presence of radiological signs of infiltration of the pulmonary parenchyma is the "gold standard" for the diagnosis of pneumonia, which makes it possible to distinguish it from bronchitis and bronchiolitis.

ICD-10 code

• J12 Viral pneumonia, not elsewhere classified.
• J13 Pneumonia due to Streptococcus pneumoniae.
• J14 Pneumonia due to haemophilus influenzae(Afanasiev-Pfeiffer wand).
• J15 Bacterial pneumonia, not elsewhere classified.
• J16 Pneumonia due to other infectious agents, not elsewhere classified.
• J17 Pneumonia in diseases classified elsewhere
• J18 Pneumonia without specification of the causative agent.

ICD-10 code

J10-J18 Influenza and pneumonia

J12 Viral pneumonia, not elsewhere classified

J13 Pneumonia due to Streptococcus pneumoniae

J14 Pneumonia due to Haemophilus influenzae [Afanasiev-Pfeffer wand]

J15 Bacterial pneumonia, not elsewhere classified

J16 Pneumonia due to other infectious agents, not elsewhere classified

J17* Pneumonia in diseases classified elsewhere

J18 Pneumonia without specification of pathogen

Epidemiology of pneumonia in children

Pneumonia is diagnosed in approximately 15-20 cases per 1000 children of the first year of life, in approximately 36-40 cases per 1000 children at preschool age, and in school and adolescence, the diagnosis of "pneumonia" is established in approximately 7-10 cases per 1000 children and adolescents .

The frequency of nosocomial pneumonia depends on the contingent and age of patients (up to 27% of cases of all nosocomial infections), it is maximum in young children, especially in newborns and premature babies, as well as in children who have undergone surgery, trauma, burns, etc.

Mortality from pneumonia (together with influenza) averages 13.1 per 100,000 population. Moreover, the highest mortality is observed in the first 4 years of life (it reaches 30.4 per 100,000 population), the lowest (0.8 per 100,000 population) is observed at the age of 10-14 years.

Mortality from nosocomial pneumonia, according to the US National Surveillance System for Nosocomial Infections, at the turn of the last and present centuries was 33-37%. In the Russian Federation, the mortality of children from nosocomial pneumonia during this period has not been studied.

Causes of pneumonia in children

The most common causative agents of community-acquired pneumonia are Streptococcus pneumoniae (20-60%), Mycoplasma pneumoniae (5-50%), Chlamydia pneumoniae (5-15%), Chlamydia trachomatis (3-10%),

Haemophilus influenzae (3-10%), Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, etc. - 3-10%), Staphylococcus aureus (3-10%), Streptococcus pyogenes, Chlamydia psittaci, Coxiella bumeti, etc. However, it must be taken into account that that the etiology of pneumonia in children and adolescents is very closely related to age.

In the first 6 months of a child's life, the etiological role of pneumococcus and Haemophilus influenzae is insignificant, since antibodies to these pathogens are transmitted from the mother in utero. The leading role at this age is played by E. coli, K. pneumoniae and S. aureus. The etiological significance of each of them does not exceed 10-15%, but it is they that cause the most severe forms of the disease, which are complicated by the development of infectious toxic shock and lung destruction. Another group of pneumonia of this age is pneumonia caused by atypical pathogens, mainly C. trachomatis, which children become infected with from their mother intranatally, rarely in the first days of life. It is also possible infection with R. carinii, which is especially important for premature babies.

From 6 months to 6-7 years of age, pneumonia is mainly caused by S. pneumoniae (60%). Often, a capsular hemophilic bacillus is also sown. H. influenzae type b is less common (7-10%), it usually causes severe pneumonia complicated by lung destruction and pleurisy.

Pneumonia caused by S. aureus and S. pyogenis is detected in 2-3% of cases, usually as complications of severe viral infections such as influenza, chicken pox, measles and herpes. Pneumonia caused by atypical pathogens in children of this age is mainly due to M. pneumoniae and C. pneumoniae. I must say that the role of M. pneumoniae has clearly increased in recent years. Mycoplasma infection is mainly diagnosed in the second or third year of life, and C. pneumoniae infection is diagnosed in children older than 5 years.

Viruses in children of this age group can be both an independent cause of the disease and a participant in viral-bacterial associations. The most important is the respiratory syncytial (PC) virus, which occurs in approximately half of the cases of the disease of a viral and viral-bacterial nature. In a quarter of cases, parainfluenza viruses types 1 and 3 become the etiological factor. Influenza A and B viruses and adenoviruses play a small role. Rhinoviruses, enteroviruses, coronaviruses are rarely detected. Pneumonia caused by measles, rubella, and varicella viruses has also been described. As already mentioned, in addition to its independent etiological significance, a respiratory viral infection in children of early and preschool age is an almost obligatory background for the development of bacterial inflammation.

The causes of pneumonia in children over 7 years of age and adolescents are practically the same as in adults. Most often, pneumonia is caused by S. pneumoniae (35-40%) and M. pneumoniae (23-44%), less often by C. pneumoniae (10-17%). N. influenzae type b, and pathogens such as Enterobacteriaceae (K. pneumoniae, E. coli, etc.) and S. aureus are practically not found.

Of particular note is pneumonia in immunocompromised patients. In children with primary cellular immunodeficiencies, in HIV-infected patients and AIDS patients, pneumonia is more often caused by Pneumocysticus carinii and fungi of the genus Candida, as well as M. avium-intracellare and cytomegalovirus. With humoral immunodeficiency, S. pneumoniae, as well as staphylococci and enterobacteria are more often sown, with neutropenia - gram-negative enterobacteria and fungi.

Causes of community-acquired pneumonia in patients with immunodeficiency

The pathogenesis of pneumonia in children

Of the features of the pathogenesis of pneumonia in young children, the most important is the low level of anti-infective protection. In addition, one can note the relative insufficiency of mucociliary clearance, especially with a respiratory viral infection, with which, as a rule, pneumonia begins in a child. The tendency to edema of the mucous membrane of the respiratory tract and the formation of viscous sputum also contributes to the violation of mucociliary clearance.

There are four main causes of pneumonia:

• aspiration of oropharyngeal secretions;
• inhalation of an aerosol containing microorganisms;
• hematogenous spread of microorganisms from the extrapulmonary focus of infection;
• direct spread of infection from neighboring affected organs.

In children, microaspiration of oropharyngeal secretions is of the greatest importance. Aspiration of a large amount of the contents of the upper respiratory tract and / or stomach is typical for newborns and children in the first months of life. Less common is aspiration during feeding and/or vomiting and regurgitation. In children of early and preschool age, airway obstruction is most significant, especially in the case of the development of broncho-obstructive syndrome.

Factors predisposing to aspiration/microaspiration

• Encephalopathy of various origins (posthypoxic, with malformations of the brain and hereditary diseases, convulsive syndrome).
• Dysphagia (vomiting syndrome, regurgitation, esophageal-tracheal fistulas, achalasia of the cardia, gastroesophageal reflux).
• Broncho-obstructive syndrome in respiratory, including viral, infections.
• Mechanical violations of protective barriers (nasogastric tube, tracheal intubation, tracheostomy, esophagogastroduodenoscopy).
• Repeated vomiting with intestinal paresis, severe infectious and somatic diseases.

Symptoms of pneumonia in children

The classic symptoms of pneumonia in children are non-specific - shortness of breath, cough (with and without sputum), fever, weakness, symptoms of intoxication. Pneumonia should be suspected if the child develops cough and/or shortness of breath, especially when accompanied by fever. Corresponding percussion and auscultatory changes in the lungs, namely, shortening of percussion sound, weakening or, conversely, the appearance of bronchial breathing, crepitus or fine bubbling rales, are determined only in 50-77% of cases. It should be remembered that in early childhood, especially in children of the first months of life, these manifestations are typical for almost any acute respiratory infection, and physical changes in the lungs with pneumonia in most cases (with the exception of lobar pneumonia) are practically indistinguishable from changes in bronchitis.

According to WHO, for the symptoms of pneumonia in children are characterized by the following features:

• febrile state with body temperature above 38 ° C for 3 days or more;
• shortness of breath (with the number of respiratory movements more than 60 per minute for children under 3 months, more than 50 per minute - up to 1 year, more than 40 per minute - up to 5 years);
• retraction of compliant places of the chest.

Classification

Pneumonia in children is usually divided, depending on the conditions of their occurrence, into community-acquired (home) and hospital-acquired (hospital, nosocomial). The exception is pneumonia in newborns, which are divided into congenital and acquired (postnatal). Postnatal pneumonia, in turn, can also be community-acquired and hospital-acquired.

Community-acquired pneumonia (CAP) is understood as a disease that has developed in the normal conditions of a child's life. Under nosocomial pneumonia (HP) - a disease that developed after a three-day stay of a child in a hospital or during the first 3 days after his discharge.

It is customary to consider ventilator-associated hospital-acquired pneumonia (VAHP) and ventilator-non-associated hospital-acquired pneumonia (VnAHP). Allocate VAHD early, developing in the first 3 days of artificial lung ventilation (ALV), and late, developing starting from the 4th day of ALV.

Pneumonia can affect an entire lobe of the lung (lobar pneumonia), one or more segments (segmental or polysegmental pneumonia), alveoli or groups of alveoli (focal pneumonia) adjacent to the bronchi (bronchopneumonia), or affect the interstitial tissue (interstitial pneumonia). These differences are revealed mainly during physical and radiological examination.

According to the severity of the course, the degree of damage to the pulmonary parenchyma, the presence of intoxication and complications, mild and severe, uncomplicated and complicated pneumonia are distinguished.

Complications of pneumonia include infectious-toxic shock with the development of multiple organ failure, destruction of the lung parenchyma (bulls, abscesses), involvement of the pleura in the infectious process with the development of pleurisy, empyema or pneumothorax, mediastinitis, etc.

Complications of pneumonia in children

Intrapulmonary destruction

Intrapulmonary destruction is a suppuration with the formation of bulls or abscesses at the site of cellular infiltration in the lungs caused by certain serotypes of pneumococcus, staphylococcus, H. influenzae type b, hemolytic streptococcus, Klebsiella, Pseudomonas aeruginosa. Pulmonary suppuration is accompanied by fever and neutrophilic leukocytosis until emptying, which occurs either in the bronchus, accompanied by increased coughing, or in the pleural cavity, causing pyopneumothorax.

Synpneumonic pleurisy

Synpneumonic pleurisy can be caused by any bacteria and viruses, starting with pneumococcus and ending with mycoplasma and adenovirus. Purulent exudate is characterized by low pH (7.0-7.3), cytosis above 5000 leukocytes per 1 µl. In addition, the exudate may be fibrinous-purulent or hemorrhagic. With adequate antibiotic therapy, the exudate loses its purulent character and pleurisy gradually resolves. However, full recovery occurs after 3-4 weeks.

Metapneumonic pleurisy

Metapneumonic pleurisy usually develops in the stage of resolution of pneumococcal, less often - hemophilic pneumonia. The main role in its development belongs to immunological processes, in particular, the formation of immune complexes in the pleural cavity against the background of the decay of microbial cells.

As already mentioned, metapneumonic pleurisy develops in the stage of resolution of pneumonia after 1-2 days of normal or subnormal temperature. The body temperature again rises to 39.5-40.0 ° C, a violation of the general condition is expressed. The feverish period lasts an average of 7 days, and antibiotic therapy does not affect it. Radiologically, pleurisy with fibrin flakes is detected, in some children, echocardiography reveals pericaditis. In the analysis of peripheral blood, the number of leukocytes is normal or reduced, and the ESR is increased to 50-60 mm / h. Fibrin resorption occurs slowly, within 6-8 weeks, due to the low fibrinolytic activity of the blood.

Pyopneumothorax

Pyopneumothorax develops as a result of a breakthrough of an abscess or bulla into the pleural cavity. There is an increase in the amount of air in the pleural cavity and, as a result, the displacement of the mediastinum.

Pyopneumothorax usually develops unexpectedly: there is an acute pain syndrome, respiratory disorders up to respiratory failure. With a tense valvular pyopneumothorax, urgent decompression is indicated.

Diagnosis of pneumonia in children

During a physical examination, special attention is paid to identifying the following signs:

• shortening (dulling) of percussion sound over the affected area of ​​the lung;
• local bronchial breathing, sonorous small bubbling rales or inspiratory crepitus during auscultation;
• increased bronchophony and voice trembling in older children.

In most cases, the severity of these symptoms depends on many factors, including the severity of the disease, the prevalence of the process, the age of the child, and the presence of concomitant diseases. It must be remembered that physical symptoms and cough may be absent in approximately 15-20% of patients.

Peripheral blood testing should be done in all patients with suspected pneumonia. A white blood cell count of about 10-12x10 9 /l indicates a high probability of a bacterial infection. Leukopenia less than 3x10 9 /l or leukocytosis more than 25x10 9 /l are unfavorable prognostic signs.

Chest x-ray is the main diagnostic tool for pneumonia. The main diagnostic sign is an inflammatory infiltrate. In addition, the following criteria are evaluated, which indicate the severity of the disease and help in the choice of antibiotic therapy:

• lung infiltration and its prevalence;
• presence or absence of pleural effusion;
• the presence or absence of destruction of the lung parenchyma.

Repeated radiography allows you to assess the dynamics of the process against the background of the treatment and the completeness of recovery.

Thus, the clinical and radiological criteria for the diagnosis of community-acquired pneumonia are the presence of changes in the lungs of an infiltrative nature, detected by chest X-ray, in combination with at least two of the following clinical signs:

• acute febrile onset of the disease (T>38.0 °C);
• cough;
• auscultatory signs of pneumonia;
• leukocytosis > 10x10 9 /l and/or stab shift >10%. It is important to remember that a clinical and radiological diagnosis cannot be equated with an etiological diagnosis!

A biochemical blood test is a standard method for examining children with severe pneumonia who need hospitalization. Determine the activity of liver enzymes, the level of creatinine and urea, electrolytes in the blood. In addition, determine the acid-base state of the blood. In young children, pulse oximetry is performed.

Blood cultures are performed only in severe pneumonia and, if possible, before the use of antibiotics in order to make an etiological diagnosis.

Microbiological examination of sputum in pediatrics is not widely used due to the technical difficulties of sputum sampling in children under 7-10 years old. It is carried out mainly with bronchoscopy. As a material for research, expectorated sputum, aspirates from the nasopharynx, tracheostomy and endotracheal tube, cultures of punctate of pleural contents are taken.

Serological research methods are also used to determine the etiology of the disease. An increase in the titers of specific antibodies in paired sera taken during the acute period and during the recovery period may indicate a mycoplasmal, chlamydial or legionella infection. This method, however, does not affect the tactics of treatment and has only epidemiological significance.

Computed tomography has a 2-fold higher sensitivity in detecting infiltration foci in the lower and upper lobes of the lungs. It is used in differential diagnosis.

Fibrobronchoscopy and other invasive techniques are used to obtain material for microbiological examination in patients with severe immune disorders and in differential diagnosis.

Differential Diagnosis

The differential diagnosis of pneumonia in children is closely related to the age of the child, as it is determined by the characteristics of pulmonary pathology in different age periods.

In infancy, the need for differential diagnosis arises in diseases that are difficult to treat with standard treatment. In these cases, it should be remembered that, firstly, pneumonia can complicate another pathology, and secondly, the clinical manifestations of respiratory failure may be due to other conditions:

• aspiration;
• foreign body in the bronchi;
• previously undiagnosed tracheoesophageal fistula, gastroesophageal reflux;
• malformations of the lung (lobar emphysema, coloboma), heart and large vessels;
• cystic fibrosis and antititrypsin deficiency.

In children 2-3 years of age and at an older age, the following should be excluded:

• Kartagener's syndrome;
• hemosiderosis of the lungs;
• nonspecific alveolitis;
• selective IgA immunodeficiency.

Diagnostic search in patients of this age is based on endoscopic examination of the trachea and bronchi, scintigraphy and angiography of the lungs, tests for cystic fibrosis, determination of the concentration of agantitrypsin, etc. Finally, in all age groups, it is necessary to exclude pulmonary tuberculosis.

In patients with severe immunity defects, with the appearance of shortness of breath and focal infiltrative changes in the lungs, it is necessary to exclude:

• progression of the underlying disease;
• involvement of the lungs in the main pathological process (for example, with systemic diseases of the connective tissue);
• consequences of the therapy (drug lung damage, radiation pneumonitis).

Treatment of pneumonia in children

Treatment of pneumonia in children begins with the determination of the place where it will be carried out (for community-acquired pneumonia) and the immediate administration of antibiotic therapy to any patient with suspected pneumonia.

Indications for hospitalization for pneumonia in children are the severity of the disease, as well as the presence of risk factors for an unfavorable course of the disease (modifying risk factors). These include:

• the age of the child is less than 2 months, regardless of the severity and prevalence of the process;
• the age of the child up to 3 years with the lobar nature of lung damage;
• damage to two or more lobes of the lungs (regardless of age);
• children with severe encephalopathy of any origin;
• children of the first year of life with intrauterine infection;
• children with malnutrition II-III degree of any genesis;
• children with congenital malformations, especially with congenital malformations of the heart and large vessels;
• children suffering from chronic diseases of the lungs (including bronchopulmonary dysplasia and bronchial asthma), cardiovascular system, kidneys, as well as oncohematological diseases;
• patients with immunodeficiency (long-term use of glucocorticoids, cytostatics);
• the impossibility of adequate care and fulfillment of all medical prescriptions at home (socially disadvantaged families, poor social and living conditions, religious beliefs of parents, etc.);

The indication for hospitalization in the intensive care unit (ICU) or intensive care unit (ICU), regardless of modifying risk factors, is suspicion of pneumonia in the presence of the following symptoms:

• respiratory rates more than 80 per minute for children of the first year of life and more than 60 per minute for children older than one year;
• retraction of the jugular fossa during breathing;
• groaning breathing, respiratory rhythm disturbances (apnea, gasps);
• signs of acute cardiovascular insufficiency;
• intractable or progressive hypothermia;
• disturbances of consciousness, convulsions.

Indication for hospitalization in the surgical department or in the ICU / ICU with the possibility of providing adequate surgical care is the development of pulmonary complications (synpneumonic pleurisy, metapneumonic pleurisy, pleural empyema, lung destruction, etc.).

Antibacterial treatment of pneumonia in a child

The main method of treating pneumonia in children is antibiotic therapy, which is prescribed empirically until the results of bacteriological examination are obtained. As is known, the results of bacteriological examination become known after 2-3 days or more after sampling. In addition, in the vast majority of cases of a mild course of the disease, children are not hospitalized and bacteriological examination is not carried out. That is why it is so important to know about the likely etiology of pneumonia in different age groups.

Indications for the replacement of the antibiotic / antibiotics - the absence of a clinical effect within 36-72 hours, as well as the development of side effects.

Criteria for the lack of effect of antibiotic therapy:

• maintaining body temperature over 38 °C;
• deterioration in general condition;
• an increase in changes in the lungs or in the pleural cavity;
• increase in dyspnea and hypoxemia.

With an unfavorable prognosis, treatment is carried out according to the de-escalation principle, i.e. start with antibacterial drugs with the widest possible spectrum of action, followed by a transition to drugs with a narrower spectrum.

Features of the etiology of pneumonia in children of the first 6 months of life make the drugs of choice even with mild pneumonia inhibitor-protected amoxicillin () or a second generation cephalosporin (cefuroxime or cefazolin), with severe pneumonia - third generation cephalosporins (ceftriaxone, cefotaxime) in monotherapy or in combination with aminoglycosides , or in a combination of amoxiclav + clavulanic acid with aminoglycosides.

In a child under 6 months with normal or subfebrile temperature, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, one can think of pneumonia caused by C. trachomatis. In these cases, it is advisable to immediately prescribe a macrolide antibiotic (azithromycin, roxithromycin or spiramycin) orally.

In premature infants, the possibility of P. carinii pneumonia should be considered. In this case, along with antibiotics, co-trimoxazole is prescribed. Upon confirmation of pneumocystis etiology, they switch to monotherapy with co-trimoxazole for at least 3 weeks.

In pneumonia aggravated by the presence of modifying factors or with a high risk of adverse outcome, the drugs of choice are inhibitor-protected amoxicillin in combination with aminoglycosides or third- or fourth-generation cephalosporins (ceftriaxone, cefotaxime, cefepime) alone or in combination with aminoglycosides, depending on the severity of the disease , carbapenems (imipenem + cilastatin from the first month of life, meropenem from the second month of life). For staphylococcal etiology, linezolid or vancomycin is prescribed alone or in combination with aminoglycosides, depending on the severity of the disease.

Alternative drugs, especially in cases of development of destructive processes in the lungs, are linezolid, vancomycin, carbapenems.

The choice of antibacterial drugs in children of the first 6 months of life with pneumonia

At the age of 6-7 months to 6-7 years, when choosing the starting antibiotic therapy, three groups of patients are distinguished:

• patients with non-severe pneumonia who do not have modifying factors or have modifying factors of the social plan;
• patients with severe pneumonia and patients with modifying factors that aggravate the prognosis of the disease;
• patients with severe pneumonia and a high risk of adverse outcome.

For patients of the first group, it is most advisable to prescribe oral antibacterial drugs (amoxicillin, amoxicillin + clavulanic acid or cephalosporin II generation cefuroxime). But in some cases (lack of confidence in the fulfillment of prescriptions, a rather serious condition of the child, if the parents refuse to be hospitalized, etc.), a stepwise method of treatment is justified: in the first 2-3 days, antibiotics are administered parenterally, and then, with improvement or stabilization of the condition, the same drug is prescribed orally. For this, amoxicillin + clavulanic acid is used, but it must be administered intravenously, which is difficult at home. Therefore, cefuroxime is more often prescribed.

In addition to ß-lactams, treatment can be carried out with macrolides. But, given the etiological significance of Haemophilus influenzae (up to 7-10%) in children of this age group, only azithromycin, to which H. influenzae is sensitive, is considered the drug of choice for initial empirical therapy. Other macrolides are an alternative in case of intolerance to ß-lactam antibiotics or their ineffectiveness, for example, in pneumonia caused by atypical pathogens M. pneumoniae and C. pneumoniae, which is quite rare at this age. In addition, when the drugs of choice are ineffective, third-generation cephalosporins are used.

Patients of the second group are shown parenteral administration of antibiotics or the use of a stepwise method. The drugs of choice, depending on the severity and prevalence of the process, the nature of the modifying factor, are amoxicillin + clavulanic acid, ceftreaxone, cefotaxime and cefuroxime. Alternative drugs for the ineffectiveness of starting therapy are III or IV generation cephalosporins, carbapenems. Macrolides in this group are rarely used, since the vast majority of pneumonia caused by atypical pathogens is not severe.

Patients with a high risk of adverse outcome or with severe purulent-destructive complications are prescribed antibacterial drugs according to the de-escalation principle, which involves the use of linezolid alone or in combination with an aminoglycoside at the beginning of treatment, as well as a combination of a glycopeptide or IV generation cephalosporin with aminoglycosides. An alternative is the appointment of carbapenems.

The choice of antibacterial drugs for the treatment of pneumonia in children from 6-7 months to 6-7 years

When choosing antibacterial drugs for pneumonia in children older than 6-7 years and adolescents, two groups of patients are distinguished:

• with mild pneumonia
• with severe pneumonia requiring hospitalization, or pneumonia in a child or adolescent with modifying factors.

The antibiotics of choice for the first group are amoxicillin and amoxicillin + clavulanic acid or macrolides. Alternative drugs are cefuroxime or doxycycline, as well as macrolides, if amoxicillin or amoxicillin + clavulanic acid was previously prescribed.

The antibiotics of choice for the second group are amoxicillin + clavulanic acid or second-generation cephalosporins. Alternative drugs are III or IV generation cephalosporins. Macrolides should be preferred in patients with intolerance to ß-lactam antibiotics and in pneumonia suspected to be caused by M. pneumoniae and C. pneumoniae.

The choice of antibacterial drugs for the treatment of pneumonia in children and adolescents (7-18 years)

For pneumonia in immunocompromised patients, empiric therapy is initiated with a third- or fourth-generation cephalosporin, vancomycin, or linezolid in combination with an aminoglycoside. Then, as the pathogen is clarified, either continue the therapy started, for example, if pneumonia is caused by Enterobacteriaceae (K. pneumoniae, E. coli, etc.), S. aureus or Streptococcus pneumoniae, or co-trimoxazole is prescribed (20 mg / kg for trimethoprim ) when pneumocystosis is detected, or fluconazole is prescribed for candidiasis and amphotericin B for other mycoses. If pneumonia is caused by viral agents, then antiviral drugs are prescribed.

The duration of the course of antibiotics depends on their effectiveness, the severity of the process, the complication of pneumonia and the premorbid background. The usual duration is 2-3 days after receiving a lasting effect, i.e. about 6-10 days. Complicated and severe pneumonia usually require a course of antibiotic therapy for at least 2-3 weeks. In patients with impaired immunity, the course of antibacterial drugs is at least 3 weeks, but may be longer.

The choice of antibacterial drugs for pneumonia in patients with impaired immunity

Doses, routes and frequency of administration of antibacterial drugs in community-acquired pneumonia in children and adolescents

Evaluation of the effectiveness of the treatment of pneumonia in children

The ineffectiveness of therapy and a high risk of an unfavorable prognosis of the disease should be discussed if, within the next 24-48 hours, the following is noted:

• increase in respiratory failure, decrease in the ratio of PaO2 / P1O2;
• a drop in systolic pressure, which indicates the development of an infectious shock;
• an increase in the size of pneumonic infiltration by more than 50% compared with the original;
• other manifestations of multiple organ failure.

In these cases, after 24-48 hours, a transition to alternative drugs and an increase in the functional support of organs and systems are indicated.

Stabilization of the condition during the first 24-48 hours from the start of treatment and some regression of radiographic changes and homeostatic disorders on the 3rd-5th day of therapy indicate the success of the chosen tactics.

The transition to taking antibacterial drugs inside is indicated:

• with persistent normalization of body temperature;
• with a decrease in shortness of breath and cough;
• with a decrease in leukocytosis and neutrophilia in the blood.
• It is usually possible with severe pneumonia on the 5-10th day of treatment.

X-ray examination in dynamics in the acute period of the disease is carried out only in the presence of progression of symptoms of lung damage or when signs of destruction and / or involvement of the pleura in the inflammatory process appear.

With a clear positive dynamics of clinical manifestations, confirmed by dynamic radiographs, there is no need for control radiography at discharge. It is more expedient to carry it out on an outpatient basis no earlier than 4-5 weeks from the onset of the disease. Mandatory X-ray control before discharge of the patient from the hospital is justified only in cases of complicated course of pneumonia.

In the absence of positive dynamics of the process within 3-5 (maximum 7) days of therapy, protracted course, torpidity to therapy, it is necessary to expand the scope of the examination both in terms of identifying unusual pathogens (C. psittaci, P. aerugenoza, Leptospira, C. burneti), and in terms of detection of other lung diseases.

Inflammation of the lungs is a disease that occurs among children quite often. According to statistics, it accounts for about 80% of all pathologies of the respiratory system. Signs of pneumonia detected at an early stage in a child make it possible to start treatment on time and speed up recovery.

Causes of the disease

Pathogens - pathogenic viruses, bacteria, various fungi. Depending on the nature of the disease, the treatment regimen is selected.

Provoking factors for the development of pneumonia are:

• Weakened immunity.
• Lack of vitamins.
• Postponed respiratory disease.
• Penetration of a foreign object into the respiratory tract.
• Stress.

Staphylococcal and streptococcal pneumonia can be associated with other diseases and occur after the flu, measles, whooping cough. Due to insufficiently developed respiratory muscles, a small patient cannot clear himself of sputum accumulating in the bronchi. As a result, ventilation of the lungs is disturbed, pathogenic microorganisms settle in them, which causes an inflammatory process.

Pathogenic bacteria provoke other diseases. Streptococcus pneumonia in the throat often causes acute tonsillitis.

First signs

Symptoms of pneumonia in children manifest themselves in a certain way. It depends on different factors. For example, aspiration pneumonia in children develops gradually, at the initial stage, signs of it may not be noticed. After a while, coughing, chest pains and other symptoms appear depending on the site of aspiration. This form of the disease is distinguished by the absence of chills and fever. With SARS in children, the symptoms are more pronounced - a lump is felt in the throat, the eyes are watery, headaches, dry cough appear.

By the end of the first week of the disease, the cough intensifies, the temperature in pneumonia in children can rise to 40 ° C. Accession of rhinitis, tracheitis is possible. Many parents are interested in what temperature during pneumonia is considered normal. It depends on the state of the child's immune system. Some types of pneumonia occur without fever at all.

At the initial stage of pneumonia, symptoms in children can manifest themselves in different ways.

Signs of pneumonia in a child under one year old:

• Cyanosis of the skin, especially in the region of the nasolabial triangle.
• A sharp rise in temperature.
• Difficulty breathing due to accumulation of mucus in the lungs.
• Cough.
• Lethargy.

How pneumonia manifests itself in infants helps to determine the number of respiratory movements in 1 minute. In a child of 2 months, it is equal to 50 breaths. As it grows, this figure decreases. So, in a child of 3 months, it is already 40, and by the year it decreases to 30 breaths. If this indicator is exceeded, you should contact your pediatrician.

Cyanosis of the skin

With pneumonia in children, the symptoms and treatment differ at different ages. For children of the older age group, the appearance of sputum is characteristic, when the pathological process reaches the bronchi. Suspicion of pneumonia occurs when wheezing, cyanosis of the lips are observed. Recognize inflammation helps the main symptom - shortness of breath. If it does not disappear after a course of treatment, then an additional examination is required.

As Dr. Yevgeny Komarovsky assures, the first symptoms do not cause such harm as the subsequent ones. Therefore, it is important to be able to distinguish the signs of the disease at an early stage.

Peculiar symptoms of pneumonia

Each type of disease manifests itself in its own way, depending on the location of the inflammatory focus.

Left sided pneumonia

With a similar form of the disease, the pathological process develops on the left side. Left-sided pneumonia is much more dangerous compared to other types due to the irreversibility of the consequences that may occur. The lung becomes inflamed against the background of past respiratory diseases, when a weakened immune system cannot resist the effects of pathogens. Left-sided pneumonia is characterized by mild symptoms, which makes diagnosis difficult.

Among the most characteristic:

• Pain in the left side of the chest.
• Nausea.
• Cough with sputum, which may contain purulent inclusions.
• A sharp increase in temperature, accompanied by chills.
• Sensation of severe pain during inhalation.

It happens that left-sided pneumonia occurs without fever and other obvious signs. Delayed treatment in this case can cause serious complications, increases the risk of death.

Right sided pneumonia

A form of the disease, which is characterized by the presence of a lesion in one of the lobes of the lung - the upper, middle or lower. It is much more common than left-sided pneumonia. Each of the five cases are children under 3 years of age. The most severe disease occurs in newborns and children under 2 years of age.

It is distinguished by:

• Cough with copious sputum.
• Tachycardia.
• Cyanosis of the skin, especially in the area of ​​the nasolabial triangle.
• Leukocytosis.

Often, the right-sided form occurs with mild symptoms.

Bilateral pneumonia

A disease in which both lungs become inflamed. It is very difficult, especially in children under one year old. Therefore, bilateral pneumonia in a child is treated only in stationary conditions.

In newborns and children of the 1st year of life, a characteristic sign is pale skin, shortness of breath, cough, asthenic syndrome, bloating, hypotension. Wheezing is heard in the lungs. The development of the disease is rapid, the little man needs urgent hospitalization.

In children 2 years old, symptoms of inflammation often appear as a result of an allergic reaction. In children aged 3–5 years, the disease often develops after acute respiratory infections. When treating, you need to pay attention to elevated temperature, which persists for more than three days.

At the age of over 6 years, pneumonia occurs with alternating sluggish course and exacerbation.

Regardless of age, the following signs help to recognize bilateral pneumonia in a child: a rise in temperature to 40 ° C, rapid breathing, loss of appetite, shortness of breath, cyanosis, cough, drowsiness, weakness. Percussion sound when listening is shortened on the side of the lesion, wheezing is heard in the lower parts of the lungs.

Bilateral pneumonia in a child threatens with the appearance of complications in the form of otitis media, sepsis, meningitis.

With any viral pneumonia in children, the symptoms and treatment are not much different from the manifestations of the disease and therapy for adults.

Bronchopneumonia

The disease often occurs in children who are under 3 years old. Represents an inflammatory process affecting the walls of the bronchioles. The disease has another name - sluggish pneumonia due to the blurring of symptoms.

They have the appearance of a slight shortness of breath, cough, arrhythmia, sometimes manifesting without temperature. Later, they intensify, there is a rise in temperature to 39⁰С, headaches.

Bacterial inflammation of the lungs

Pathogens that cause bacterial pneumonia are pneumococci, staphylococci, streptococci, gram-negative bacteria. The first signs of pneumonia in children are noticed earlier than in adults. They manifest themselves in the form of rapid breathing, vomiting, pain in the abdomen. Children with a temperature in the lower part of the lungs sometimes have a fever.

Mycoplasma and chlamydial pneumonia

The defeat of mycoplasma, in addition to the main symptoms, causes a rash in the throat and pain. Chlamydia pneumonia in infants can trigger the development of a dangerous form of conjunctivitis. With inflammation of the lungs caused by this intracellular bacterium, rhinitis and tracheobronchitis are often diagnosed. Chlamydia pneumonia in children also manifest itself as extrapulmonary symptoms - arthralgia, myalgia. It is believed that this disease takes up to 15% of all community-acquired diseases. During epidemic outbreaks, this figure increases to 25%.

The disease can develop both acutely and gradually, taking a protracted character. The main symptoms are nasal congestion, respiratory failure, hoarse voice, small mucous discharge from the nose. After the appearance of these signs, the inflammatory process lasts from 1 to 4 weeks. Cough, general malaise sometimes persist for several months. The disease can proceed without fever.

Video

Video - pneumonia

Hidden pneumonia

The course of the disease without pronounced symptoms is the greatest danger for babies who are under 2 years old. At this age, they still cannot tell what exactly worries them. Hidden pneumonia in children can be manifested by a barely noticeable malaise. Noticing them, parents often attribute it to a cold, teething. Only when the child's condition deteriorates sharply, treatment begins.

Therefore, it is important to know how to recognize pneumonia in a child, and not to lose sight of such symptoms of pneumonia in children as:

• Paleness of the skin.
• Blush on the cheeks in the form of spots.
• Shortness of breath on slight exertion.
• Increased sweating.
• Breathing with groaning.
• Rise in temperature to 38⁰С.
• Refusal to eat.

With latent pneumonia in children, the symptoms listed above can appear both one at a time and in combination, sometimes without fever. Having found them, you should immediately show the baby to the doctor.

Diagnostics

The question of how to determine pneumonia in a child is easily solved today with the help of modern diagnostic methods. When collecting an anamnesis, the time of detection of the first signs of malaise, which diseases preceded the onset of inflammation, and whether there is an allergy are determined. Visual inspection allows you to identify existing respiratory failure, wheezing, other symptoms characteristic of pneumonia.

Laboratory methods help to diagnose the disease.

A blood test for pneumonia in a child is performed to determine the causative agent of the disease:

• Biochemical analysis determines such indicators as the number of leukocytes, ESR, hemoglobin level.
• Thanks to two blood cultures, it is possible to exclude bacteremia and sepsis.
• Serological analysis reveals the presence of immunoglobulins.

Sputum culture is also performed, scraping of the posterior pharyngeal wall.

It is possible to establish a more accurate diagnosis with determining the degree of lung damage (as well as recognizing bronchitis in a child and any other bronchopulmonary disease) using x-rays.

General principles of treatment

Treatment is usually carried out only in stationary conditions. How many stay in the hospital with pneumonia depends on the severity of the disease, the state of the immune system. The main component of the treatment course in the inflammatory process are antibiotics.

You can cope with the disease only by strictly following all the doctor's prescriptions. Self-medication with such a serious disease is unacceptable. The medicine is taken according to the schedule determined by the doctor. Usually, penicillins, cephalosporins, macrolides are used in the treatment. The effectiveness of the use of a particular drug is evaluated only after 72 hours. In order for the intestinal microflora not to suffer from the action of antibiotics, probiotics are additionally prescribed. In order to cleanse the body of toxins remaining after antibiotic therapy, sorbents are used.

Proper nutrition plays an important role in the healing process. The patient's diet should contain easily digestible food. It can be vegetable soups, liquid cereals, boiled potatoes, fresh vegetables and fruits. As a drink, it is best to give babies rosehip infusion, juices, raspberry tea.

Prevention

• Avoid hypothermia of the child.
• Provide quality nutrition that includes all the necessary vitamins.
• Perform hardening procedures.
• More walks with children in the fresh air.
• Avoid contact with a sick person who can transmit the infection.
• During epidemics, do not visit kindergarten and crowded places.
• Teach your child to wash their hands thoroughly by lathering them for at least 20 seconds.
• Timely treat infectious diseases.

Caring for the health of the baby, starting from the first days of his life, is the best defense against the disease.

Vaccination helps reduce the risk of infection. Vaccination creates immunity to the causative agent of pneumonia. However, the duration of such protection is not more than 5 years.