pneumonia paediatrics undergraduate

1. PNEUMONIA
SITI MARIAM BINTI MOHD HAMZAH
Is an infection of the lower respiratory tract that involves the airways and
parenchyma with consolidation of the alveolar spaces.

2. LOBAR PNEUMONIA
BRONCHOPNEUMONIA
INTERSTITIAL PNEUMONIA
Pneumonia may be classified anatomically as

3. The pathogens causing pneumonia may vary according to the child’s age:
Age group Pathogens
Newborn - Organisms from the mother’s genital tract particularly
group B streptococcus, but could be also gram –ve
enterococci
Infants and young children - Respiratory viruses (RSV are most common)
- Bacterial infections include Streptococcus pneumoniae or
H. influenza, Bordetella pertussis and Chlamydia
trachomatis.
- Staphylococcus aureus, infrequent but serious caused.
Children over 5 years - Mycoplasma pneumoniae, streptococcus pneumoniae and
Chlamydia pneumoniae
*at all ages Mycobacterium tuberculosis should be considered.

4. Bacteria invasion of
lung parenchyma
Inflammatory
immune response
Filling of bronchi /
alveolar sacs with
exudates
CONSOLIDATION
Decrease diameter
airways passageWHEEZING

5. CLINICAL MANIFESTATIONS

6. IMPORTANT POINT TO ASSESS-RR
• WHO respiratory rate thresholds for identifying children with pneumonia :
Children younger than 2 months >= 60 breaths/min
Children aged 2-11 months >= 50 breaths/min
Children aged 12-59 months >= 40 breaths/min

7. CLINICAL MANIFESTATIONS
• Age is a determinant in the clinical manifestations of pneumonia
Neonates - Fever or hypoxia only, with subtle or absent physical
examinations findings
Young infant - Apnea may be the first signs
Older infants and children - fever, chills, tachypnea, cough, malaise, pleuritic chest
pain, retractions, and nasal flaring, because of difficulty
in breathing or SOB
Viral pneumonia Bacterial pneumonia
- Associated more often with cough, wheezing, or
stridor
- Mucosal congestion and upper airway inflammation
- Higher fever, chills, cough, dyspnea, and auscultatory
findings on lung consolidation
- Localised chest, abdominal or neck pain; feature of
pleural irritation

8. INVESTIGATIONS
• Complete blood count & differential count
– in WBC count,
• often normal or mildly elevated with predominance of lymphocytes in case of viral
pneumonias, whereas with bacterial pneumonias the WBC count is elevated >20,000 /mm3
with a predominance of neutrophils
• Mild eosinophilia is characteristics of infant C. trachomatis pneumonia.
• Pulse oximetry assess oxygen saturation
• Blood/ sputum culture
– Nasopharyngeal aspirate
– Throat swab
– Bronchoalveolar lavage
– Lung aspirates
In addition
- Mantoux test ( M. tuberculosis)
- Serology test
- Urinary antigen (Legionella pneumophila)

9. INVESTIGATIONS
• Chest radiography
– To localize disease and adequately visualize retrocardiac infiltrates
Bacterial pneumonia Shows lobar consolidation, or a round
pneumonia, with pleural effusion in 10% or
30% of cases
Viral pneumonia Shows diffuse, streaky infiltrates of
bronchopneumonia and hyperinflation
Atypical pneumonia (M. pneumoniae
and C. pneumoniae)
Shows increased interstitial markings or
bronchopneumonia

10. TREATMENT & MANAGEMENT
• Therapy for pneumonia includes supportive and specific treatments and
depends on the degree of illness, complications, and knowledge of the
infectious agent likely causing the pneumonia
• Children with hypoxemia, inability to maintain adequate hydration, or moderate
to severe respiratory distress should be hospitalized
• Hospitalization should be considered in infants under 6 months with suspected
bacterial pneumonia, those in whom there is a concern for a pathogen with
increased virulence, or when concern exists about a family’s ability to care for the
child and to assess symptom progression.

11. WHO REVISED RECOMMENDATION (published
on 2014)
Children with fast breathing pneumonia with no chest
indrawing or general danger sign
oral amoxicillin: at least 40mg/kg/dose twice daily
(80mg/kg/day) for 5 days.
In areas with low HIV prevalence, give amoxicillin for 3 days.
Children with fast-breathing pneumonia who fail on first-line
treatment with amoxicillin should
have the option of referral to a facility where there is appropriate
second-line treatment.
Children age 2–59 months with chest indrawing pneumonia oral amoxicillin: at least 40mg/kg/dose twice daily for 5 days.
Children aged 2–59 months with severe pneumonia
*Not able to drink, persistent vomiting, convulsions, lethargic or
unconscious, stridor in a calm child or severe malnutrition
parenteral ampicillin (or penicillin) and gentamicin as a first-
line treatment.
• Ampicillin: 50 mg/kg, or benzyl penicillin: 50 000 units per
kg IM/IV every 6 hours for at least 5 days
• Gentamicin: 7.5 mg/kg IM/IV once a day for at least 5 days
*Ceftriaxone should be used as a second-line treatment in
children with severe pneumonia having
failed on the first-line treatment.

12. for HIV-infected and -exposed infants and for children
under 5 years of age with chest indrawing pneumonia or
severe pneumonia
– Ampicillin (or penicillin when ampicillin is not
available) plus gentamicin or ceftriaxone are
recommended as a first-line antibiotic regimen
– For who do not respond to treatment with
ampicillin or penicillin plus gentamicin, ceftriaxone
alone is recommended for use as second-line
treatment.

13. • Oseltamivir or zanamivir should be used if influenza is identified
or suspected, ideally within 48 hours of symptom onset.
• Oseltamivir is recommended by the CDC and American Academy of Pediatrics (AAP)
for the treatment of influenza in persons aged 2 weeks and older, and for the
prevention of influenza in persons aged 3 months and older.
• Zanamivir is recommended for the treatment of influenza in persons aged 7 years and
older, and for the prevention of influenza in persons aged 5 years and older.

15. THANK YOU