Pneumonia in children

1. PNUEMONIA IN
CHILDREN
Presented by:
Dr. Jyoti Kaushik
M.D.IstYear
P.G.Deptt. Of Bala
roga
R.G.G.P.G.Ayu.College

2. INTRODUCTION
• Pneumonia is defined as an acute inflammation
of the lower respiratory tract that involves
the airways and lung parenchyma with
consolidation of the alveolar spaces.
• Pneumonia can be classified anatomically as
lobar or lobular, bronchopneumonia and
interstitial pneumonia.
• Pathologically there is consolidation of alveoli
or infiltration of the interstitial tissue with
inflammatory cell or both.

3. SOME DEFINITIONS
Lobar pneumonia Broncho pneumonia Interstitial pneumonia
describes “typical”
pneumonia localized to
one or more lobes of
lung in which the
affected lobe or lobes
are completely
consolidated.
is primarily a spreading
inflammation of the
terminal bronchioles
and their related alveoli
and causes patchy
consolidation of the
adjacent lobules.
refers to inflammation
of interstitium, which is
composed of the wall of
the alveoli, the alveolar
sacs and ducts, and the
bronchioles.

5. ETIOLOGY
Infectious causes
AGE GROUP ETIOLOGY
0-3 months Gram ngative enteribacteriacae
Enterococci
Chlamydia trachomatis
Haemophilus influenzae
Streptococcus pneumoniae
3month-5year Streptococcus pneumoniae
Viruses
Haemophilus influenzae
Staphylococcus
Mycoplasma pneumoniae
>5 year Streptococcus pneumoniae
Mycoplasma pneumoniae
Viruses
Staphylococcus

6. Cont.
Noninfectious causes include:
• Aspiration of food
• Foreign bodies
• Hydrocarbons, and lipid substances
• Hypersensitivity reactions
• Drug or radiation induced pneumonitis.

7. SIGNS AND SYMPTOMS
•Cough
•Fever
• Chest pain.
Tachypnea.
Difficult noisy respiration
• Retractions.
•Signs of consolidation.
• Crepitations, wheezing.
• Cyanosis.
• Abdominal pain.
•Vomitting
•Diarrhoea

8. DIFFERENTIATION B/W BACTERIAL & VIRAL PNEUMONIA
Features Bacterial pneumonia Viral pneumonia
Onset acute gradual
course progressive Self limiting
Temperature +++ +-
Toximia +++ -
Dyspnea ++ +(infants)
URTI - +
Auscultation crepts
Rhonchi/wheeze
++
+-
+-
++
Radiological Confluent infiltrates Diffuse infiltrates
Hyperinflation +- +(RSV infection)
Pleural involvement + -
Pneumatocele + -
WBC count elevated(>20000/ mm3) with a
predominance of neutrophils
often normal(<20000/mm3) or
mildly elevated, with a
predominance of lymphocytes.

9. DIAGNOSIS
• Chest X-ray confirms pneumonia and pleural
effusion or empyema- lobar consolidation is
typically in pneumococcal causes - Viral pneumonia-
hyperinflation with bilateral interstitial infiltrates.
• Bronchoscopy, USG, CT scan in malformation or
tumors
• WBC in viral pneumonia are normal or <20000/mm3
with lymphocyte rises; in bacterial
WBC>20,000/mm3 with neutrophils rises.
• Atypical pneumonia: a higher WBC, ESR and C-
reactive protein.
• DNA, RNA, antibodies tests for the rapid
detection of viruses.

10. DIFFERNTIAL DIAGNOSIS
• Bronchitis
• Bronchial asthma
• Pulmonary tuberculosis
• Pleural effusion
• Empyema

11. D/Dx Pneumonia Bronchitis Asthma Pleural
Effusion
Empyema
Movement
of chest
wall
Reduced on
affected
side
Normal or
symmetrically
diminished
symmetrically
diminished
Reduced &
absent
Reduced &
absent
Percussion
note
Dull Normal Normal Stony dull Stony dull
Breath
sounds
High
pitched
bronchial
Vesicular
with
prolonged
expiration
Vesicular
with
prolonged
expiration
Diminished
or absent
Absent
(occasionally
bronchial)
Vocal
resonance
Increased Normal Normal or
reduced
Reduced or
absent
(occasionally
increased)
Absent or
reduced
Added
sounds
Fine
crepitations
early
,coarse
crepitations
later
Rhonchi ,
some coarse
crepitations
Rhonchi,
mainly
expiratory
and high
pitched
Pleural rub Pleural rub
Temp High grade
& mild fever
Mild fever none High fever High grade
fever

12. TREATMENT
Treatment of suspected bacterial pneumonia is based on the
presumptive cause and the clinical appearance of the child.
For mildly ill children who do not require hospitalization
amoxycillin is recommended .
ANTIBIOTICS:
• Penicillins and betalactams: Amoxycillin
• Cephalosporines- Cefuroxime, Ceftriaxon.
• Quinolones-Ciprofloxacin, Levofloxacin, Gatifloxacin- more
effective in Gram-ve bacteria.
• In atypical pneumonia – macrolides:
Clarithromycin,Azithromycin (7.5-15mg/kg/day)
• Aminoglycosides- dosage according to age, weight and
kidney function (Gentamicin,Netilimycin).
• In viral pneumonia treatment withhold antibiotics.

13. SUPPORTIVE TREATMENT
• good hydration, cough remedies, antipyretics,
oxygen in the central cyanosis.
• For children with wheeze- rapid acting
bronchodilator(Salbutamol.)
• Drainage with tube in empyema, fibrinolytic
therapy: urokinase, streptokinase.
• Indications for hospitalization: age <6month,
persistent fever, worse signs, severe
respiratory distress, toxic appearance, no
response to antibiotic.

14. Complications
• Pleural effusion
• Empyema
• Pneumothorax
• Pericarditis
• Sepsis
• Meningitis
• Arthritis
• Respiratory failure
• Lung abcess.

15. PREVENTION OF PNEUMONIA
• Immunization against H. influenzae type b.
• Influenza vaccine.
• Heptavalent pneumococcal conjugate
vaccine.
• Health education of the community.
• Messages for mothers to recognize the
signs of pneumonia.

16. Case Presentation On
Pneumonia

17. Name : Aditya
Sex : male
Age : 1 year
Father’s Name : Ajay kumar
Informant : Mother
Address :VPO-Bagh ,Teh -Ladbadhol
Distt.-Mandi
IPD No. : 5833
Date of Admission : 31/12/17
Date of Discharge : 5/01/18

18. Chief Complaints :
Cough since 4 days.
Fever since 4 days
Difficult Noisy breathing since 2 day
Not taking feeds since 2 days
Vomiting 2 episodes at morning
H/O Present illness : According to pt.’s mother he was quite
asymptomatic 4days back then next day he suddenly developed
cough with fever . On enquiry She told that cough was dry in
nature, fever was continous, high grade in nature and was not
associated with chills and rigor.Mother gave him medications for
it.but baby did not get relief. On further enquiry she told that
cough became associated with noisy breathing after 2 days.He
was having breathlessness so he refused to feed.Baby vomitted
two times this morning. Mother told that vomitting material
contains food particles. With all these complaints mother brought
the baby to the hospital & got admitted in the IPD of Balrog
deptt.

19. H/O Past illnesss : H/O Recurent infection
Antenatal History : No H/o Infection,Irradiation
& any teratogenic toxic drug
intake
Natal History : NVD
Cry : Immediate cry
Postnatal History : No H/O feeding difficulty
No H/O neonatal jaundice.

20. Developmental history : All the milestones
attained at normal time
Immunization history :properly done As per
national immunization schdule.
Personal history :
Appetite : decreased
Thirst : Normal
Urine : once/day
Stool : Not passed since 24 hours
Family History:
Father : Healthy
Mother : Healthy

21. Socioeconomic history :
• House : Pakka, well ventilated
• Surroundings : Clean
• Source of water : Tap water
• Status : middle class
General Physical Examination :
General appearance : ill looking
• Built : Normal
• Nutrition : well nourished
• Height : 72cm
• Wt : 9 kg
• Head : B/L symmetrical
• Eyes : N
• Nose : N

22. • Oral cavity : Normal hygiene
• Teeth : N
• Tongue : coated
• Throat : N
• Lips : dry
• Neck : No swelling
• Lymphadenopathy : Absent
• Skin : Warm and dry
• Hairs : N
• Nails : N
• Spine : N
• Extremities : N
Vitals :
HR:130/min, Temp:100⁰ F, RR:50/min

23. Systemic examination :
Respiratory system
Inspection:
• Breathing :Bronchial
• Intercostal recession :Present
• Scar mark :Absent
Palpation:
• Temp :Raised
• Tenderness :Absent
Percussion:
• Dullness over Rt side in lower zone

24. Auscultation:
• Breathing sound :Bronchial
• Air entry :Diminished in right
side
• Added sounds :B/L Crepitations
present
• Vocal resonance :increased right side
Other System : Clinically NAD
Differtial Diagnosis:
• Bronchial asthma
• Bronchitis
• Tuberculosis

25. Positive Findings :
• High grade fever
• B/L Crepts
• Difficulty in breathing
• Refusal to feed
Provisional Diagnosis: Acute Pneumonia

26. Treatment Given :
1st day
Keep baby warm
• Free flow warm and humidified oxygen @4-5 lt/min for 3hrs
After that RR came in normal range then 02 discontinued and then following
treatment cont. for 7 days
• Give plenty of fluids
• Inj. Cefoprox 375mg I.V. BD
• Inj. Netspan 25 mg I.V. BD
• Syp. Brozedex LS kid 4 ml BD
• Syp. Crocin / marimol 6 ml 8 hourly
• novin nasal drops 2 drops B/N BD (for 3 days)
• Solvin cold AF 1ml tid

27. Ayurvedic approach
• Keep the baby warm
• Home made decoction of tulsi, adrakh, loung , elaychi.
• Balchaturbhadra churna 250 mg
Tankan bhasma 125 mg
Godanti bhasma 125 mg
Sfatika bhasma 60 mg
Shankha bhasma 60 mg
1×3 ē Madhu
• Adliv drop : 1 ml BD

28. THANKS