Pneumonia in Children

Introduction

Pneumonia is an acute respiratory infection of the lungs causing inflammation of the lungs air sacs. The air sacs may become filled with fluid or pus.
One or both lungs are involved. It can be caused by viruses, bacteria, or fungi.
Pneumonia accounts for 15% of all under
five deaths (including neonatal death due to pneumonia).

  • Burden of disease mainly in the younger age groups;
  • 81% of deaths from pneumonia in children less than 2 years.
  • Male to female ratio is 1.5:1.
  • Classified clinically as lobar pneumonia or bronchopneumonia

Clinical Features

  • Cough
  • Fast breathing.
  • Fever is very common in childhood
    pneumonia.
  • Vomiting
  • Poor feeding
  • Diarrhea
  • Convulsion
  • Chest pain (due to pleuritis) in older children.
  • Tachypnoea is a sensitive marker of pneumonia and is commonly present and/or difficult breathing
  • Dull or resonant percussion note on percussion
  • Bronchial breath sounds and or crepitations on auscultation

For neonates:

  • Fever or hypothermia
  • Poor feeding
  • Vomiting
  • Lethargy or irritability
  • Abdominal distension
  • Convulsion
  • Jaundice
  • Tachypnoea (≥ 60 breaths/min)
  • Tachycardia etc

Complications

Complications can be acute or chronic.
Acute:

  • Heart failure
  • Pleural effusion
  • Empyema
  • 3 Ps: Pneumatocoele, pneumothorax, pyopneumothorax,
  • Atelectasis
  • Septicaemia
  • Acute respiratory failure

Chronic:

  • Lung abscess
  • Bronchiectasis

Diagnostic Criteria

  • Gold standard for diagnosis is chest
    radiography,( although this does not reveal the aetiology.)

Investigations

  • Chest radiography
  • Blood culture to determine the bacterial aetiology
  • Full blood count will determine anaemia and suggest a bacterial (polymorphonuclear leukocytosis) or viral aetiology (lymphocytosis).
  • Electrolye and urea, may show
    hyponatraemia and azotaemia especially in those children with accompanying diarrhea and vomiting, and poor feeding.

Treatment

  • Clear the airway using gentle suction
  • Supplemental oxygen if oxygen saturation is less than 90% in room air or signs of severe respiratory distress are present.
  • If pulse oximetry is not available give oxygen if signs of respiratory distress and or cyanosis are present.
  • Give oxygen via nasal prongs or
    nasal catheters: 0.5-1L/min for children 0-2months, 2-3L/min for children 3 months to 5 years; maximum of 4L/min for older children)
  • Allow small frequent feeds if tolerated; feeding may also be done using nasogastric tube
  • If feeds are not tolerated give intravenous isotonic fluid. Ensure it contains at least 5% glucose (e.g. 5% dextrose in 0.9% saline or Ringer’s lactate with added glucose)
  • Nursing care should be provided at least every 3 hours: check vital signs including oxygen saturation
  • The doctor should review the child at least twice each day
  • For high grade fever (temperature 239°C), give paracetamol 10-15mg/ kg 4-6 hourly or ibuprofen 6mg/kg.
  • If widespread wheeze is present (high-pitch musical sound during
    expiration only or during both phases of respiration) give first dose of short acting bronchodilator such as salbutamol or albuterol and re-assess.

Treatment Guideline Summary in under-5s  Children 

Notes:

  1. Step down to appropriate oral
    antibiotics when improvement is
    sustained. For instance, cefpodoxime after ceftriaxone.
  2. Target pathogens in outpatients’ treatment are Streptococcus pneumoniae and Haemophilus influenzae type B; whereas in cases on admission, these as well as Staphylococcus aureus and other bacilli are included.
  3. Maximum dose of gentamicin should not exceed 120mg.

Alternatives:

  • Consider alternatives when first line drugs are not available or applicable or child has not responded to the first line drugs.