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    Practice Essentials: View Media Gallery

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    Aza Patullah Zai
    Pediatric pneumonia is responsible for over 800,000 child deaths worldwide each year, mostly in developing countries. Symptoms vary by age but may include cough, fast breathing, and low oxygen levels. Diagnosis involves listening to the chest and potentially other tests. Treatment focuses on respiratory support and antibiotics like amoxicillin depending on severity and suspected germ.

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    Practice Essentials: View Media Gallery

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    Aza Patullah Zai
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    Pediatric pneumonia is responsible for over 800,000 child deaths worldwide each year, mostly in developing countries. Symptoms vary by age but may include cough, fast breathing, and low oxygen levels. Diagnosis involves listening to the chest and potentially other tests. Treatment focuses on respiratory support and antibiotics like amoxicillin depending on severity and suspected germ.

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    Pediatric Pneumonia

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    Pediatric pneumonia is responsible for over 800,000 child deaths worldwide each year, mostly in developing countries. Symptoms vary by age but may include cough, fast breathing, and low oxygen levels. Diagnosis involves listening to the chest and potentially other tests. Treatment focuses on respiratory support and antibiotics like amoxicillin depending on severity and suspected germ.

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    7 views3 pages

    Practice Essentials: View Media Gallery

    Uploaded by

    Aza Patullah Zai
    Pediatric pneumonia is responsible for over 800,000 child deaths worldwide each year, mostly in developing countries. Symptoms vary by age but may include cough, fast breathing, and low oxygen levels. Diagnosis involves listening to the chest and potentially other tests. Treatment focuses on respiratory support and antibiotics like amoxicillin depending on severity and suspected germ.

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    © All Rights Reserved
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    Practice Essentials

    Pediatric pneumonia is responsible for the deaths of more than 800,000


    young children worldwide each year, according to the United Nations
    Children's Fund (UNICEF). [1]  These deaths occur almost exclusively in
    children with underlying conditions, such as chronic lung disease of
    prematurity, congenital heart disease, and immunosuppression. Although
    most fatalities occur in developing countries, pneumonia (see the image
    below) remains a significant cause of morbidity in industrialized nations.

    Right lower lobe consolidation


    in a patient with bacterial pneumonia.
    View Media Gallery
    Signs and symptoms
    Pneumonia can occur at any age; nevertheless, it is more common in
    younger children. Pneumonia accounts for 13% of all infectious illnesses in
    infants younger than 2 years of age.
    Newborns with pneumonia commonly present with poor feeding and
    irritability, as well as tachypnea, retractions, grunting, and hypoxemia.
    Infections with group B Streptococcus, Listeria monocytogenes, or gram-
    negative rods (eg, Escherichia coli, Klebsiella pneumoniae) are common
    causes of bacterial pneumonia. Group B streptococci infections are most
    often transmitted to the fetus in utero. The most commonly isolated virus is
    respiratory syncytial virus (RSV).
    Cough is the most common symptom of pneumonia in infants, along with
    tachypnea, retractions, and hypoxemia. These may be accompanied by
    congestion, fever, irritability, and decreased feeding. Viruses are the most
    common cause of pediatric pneumonia. Streptococcus pneumoniae is  the
    most common bacterial pathogen in infants aged 1-3 months.
    Adolescents experience symptoms similar to those in younger children.
    They may have other constitutional symptoms, such as headache, pleuritic
    chest pain, and nonspecific abdominal pain. Mycoplasma pneumoniae is
    the most frequent cause of pneumonia among older children and
    adolescents.
    See Clinical Presentation for more detail.
    Diagnosis
    The signs and symptoms of pneumonia are often nonspecific
    and vary widely based on the child's age and the infectious organisms
    involved.
    Observing the child’s respiratory effort during a physical examination is an
    important first step in diagnosing pneumonia. The World Health
    Organization (WHO) respiratory rate thresholds for identifying children with
    pneumonia are as follows:
     Children younger than 2 months: Greater than or equal to 60
    breaths/min
     Children aged 2-12 months: Greater than or equal to 50
    breaths/min
     Children aged 1-5 years: Greater than or equal to 40 breaths/min
    Be aware that the WHO definition requires only cough and tachypnea on
    physical examination. [2]  
    Assessment of oxygen saturation by pulse oximetry should be performed
    early in the evaluation when respiratory symptoms are present. Cyanosis
    may be present in severe cases. Capnography may be useful in the
    evaluation of children with potential respiratory compromise.
    Other diagnostic tests may include the following:
     Auscultation by stethoscope
     Cultures
     Serology
     Complete blood cell count (CBC)
     Chest radiography
     Ultrasonography
    Current data show that point-of-care ultrasonography helps accurately
    diagnose most cases of pneumonia in children and young adults.
    Ultrasonography may eventually replace radiographs for diagnosis. [3]
    See Workup for more detail.
    Management
    Initial priorities in children with pneumonia include the identification and
    treatment of respiratory distress, hypoxemia, and hypercarbia. Grunting,
    flaring, severe tachypnea, and retractions should prompt immediate
    respiratory support. Children who are in severe respiratory distress should
    undergo tracheal intubation if they are unable to maintain oxygenation or
    have decreasing levels of consciousness. Increased respiratory support
    requirements such as increased inhaled oxygen concentration, positive
    pressure ventilation, or continuous positive airway pressure (CPAP) are
    commonly required before recovery begins.
    Antibiotics
    The majority of children diagnosed with pneumonia in the outpatient setting
    are treated with oral antibiotics. High-dose amoxicillin is the agent of choice
    for children with uncomplicated community-acquired pneumonia. Second-
    or third-generation cephalosporins and macrolide antibiotics such as
    azithromycin are acceptable alternatives. Combination therapy (ampicillin
    and either gentamicin or cefotaxime) is typically used in the initial treatment
    of newborns and young infants.
    Hospitalized patients can also usually be treated with a narrow-spectrum
    penicillin such as ampicillin. The choice of agent and dosing may vary
    based on local resistance rates (high rates of intermediate or resistant
    pneumococcus may require higher dosing of ampicillin to surmount the
    altered penicillin-binding protein that is the cause of resistant
    pneumococcus). In areas where resistance is very high (>25% of strains
    being nonsusceptible), a third-generation cephalosporin might be indicated
    instead. In addition, older children may receive a macrolide to cover for
    atypical infections.
    Although the fluoroquinolones would cover all the common respiratory
    pathogens of childhood, they are not approved for this indication and have
    significant potential adverse effects, including short-term tendon damage
    and long-term impact on antibiotic resistance. They should be reserved for
    cases in which other therapies have failed and ideally should be used after
    consultation with an infectious disease specialist with whom other options,
    or alternative diagnoses, can be considered.
    Children who are toxic appearing should receive antibiotic therapy that
    includes vancomycin (particularly in areas where penicillin-resistant
    pneumococci and methicillin-resistant Staphylococcus aureus [MRSA] are
    prevalent) along with a second- or third-generation cephalosporin.
    Vaccines
    Aside from avoiding infectious contacts (difficult for many families who use
    daycare facilities), vaccination is the primary mode of prevention. Influenza
    vaccine is recommended for children aged 6 months and older. The
    pneumococcal conjugate vaccine (PCV13) is recommended for all children
    younger than 59 months of age. The 23-valent polysaccharide vaccine
    (PPV23) is recommended for children aged 24 months and older who are
    at high risk for pneumococcal disease.
    See Treatment and Medication for more detail.

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