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Symptoms of pneumonia in children - signs, diagnosis and treatment

The disease is most common during the off-season, when the frequency of acute respiratory infections increases. Pneumonia, as a rule, joins again. This is due to a local decrease in immunity.

Content

Pneumonia, what is it?

Pneumonia, what is it?

What is pneumonia in a child, how to understand? This term denotes a group of diseases that have 3 characteristic features:

  1. Inflammatory lesion of the lungs with the primary involvement of the respiratory departments (alveoli) in the pathological process, in which exudate accumulates.
  2. Presence of clinical syndrome of respiratory disorders (dyspnea, increased frequency of chest excursions, etc.);
  3. ). The presence of infiltrative signs on the X-ray (this criterion is the World Health Organization's most important ).

In this case, the causes and mechanisms of the development of pneumonia can be very different. They are not decisive in the diagnosis. Important presence of clinical and radiological inflammatory syndrome.

Causes and forms of pediatric pneumonia

Causes and forms of pediatric pneumonia

The causes of pneumonia are always associated with the presence of a microbial factor. More than 80-90% are bacteria, the rest are viruses and fungi. Among the virus particles, the most dangerous is influenza, adenovirus and parainfluenza.

The nature of the pathogen leaves an imprint on the choice of the etiologic (affecting the cause) remedy. Therefore, from the clinical point of view, there are 3 main forms of pneumonia:

1). Community-acquired - develops at home and has no connection with a medical institution.

2). Intrahospital or hospital- develops within 72 hours (3 days) of stay in the hospital or during the same time interval after discharge.

This form represents the greatest danger, because is associated with microorganisms that have developed resistance factors to pharmacological drugs. Therefore, microbiological monitoring is regularly carried out at the medical institution.

3). Intrauterine - the child becomes infected from the mother during pregnancy. Clinically, she debuts within 72 hours after childbirth.

For each of these groups, the most likely pathogens are characteristic. These data were obtained in a series of epidemiological studies. They need regular updating, because The microbial landscape after a few years can significantly change.

At the moment they look like this. чаще всего связаны с такими микроорганизмами, как: Community-acquired pneumonia is most often associated with microorganisms such as:

  • up to half a year is an intestinal rod and viruses;
  • up to 6 years - pneumococci (less often, hemophilic rod);
  • up to 15 years - pneumococcus.

In any age period, the causative agents may be pneumocysts, chlamydia, mycoplasmas and others (atypical variant of the disease).

The infection caused by them, proceeds with slightly expressed clinical manifestations, but rapid development of respiratory failure. Atypical pneumonia in a child of 3 years is most often associated with mycoplasmas.

отличается от домашних. The microbial spectrum of nosocomial pneumonia differs from domestic ones. Caused agents may be:

  • resistant staphylococcus aureus (golden);
  • pseudomonas (their role is especially great with various medical manipulations);
  • serrations;
  • Klebsiella;
  • conditionally pathogenic microflora in patients undergoing artificial ventilation.

A group of children is allocated, at whom the risk of developing pneumonia is increased. They have predisposing factors:

  • tobacco smoke, if parents or other people from the environment are smoking;
  • ingestion of milk in the respiratory tract (in toddlers);
  • chronic foci in the body (tonsillitis, laryngitis, etc.);
  • supercooling;
  • hypoxia experienced in labor (in infants);
  • immunodeficiency states.

The first signs of pneumonia in a child

Signs of pneumonia in the child Signs of pneumonia in a child are characterized by an increase in body temperature. This is a nonspecific reaction to the presence of an infectious agent in the body. Usually it rises to high values, but sometimes it is subfebrile.

Inflammation of the pleura leads to painful breathing. It is often accompanied by a grunting sound, which appears at the beginning of exhalation. It can be mistaken for a sign of bronchial obstruction (for example, as in bronchial asthma).

It often reveals the involvement of the auxiliary muscles in the respiration. But this sign is nonspecific, tk. can be observed in other diseases.

Lower right-sided pneumonia in a child can simulate liver disease. This is due to the appearance of pain in the right hypochondrium . However, with pneumonia, there are no symptoms that occur when the digestive system is affected - vomiting and nausea (can be with severe intoxication), diarrhea, rumbling in the abdomen, etc.

The expressed intoxication at a pneumonia causes occurrence of the general or common signs:

  • a complete lack of appetite or a significant decrease;
  • the excitation of the child or indifference;
  • poor sleep;
  • increased tearfulness;
  • pallor of the skin;
  • convulsions that appear against the background of rising temperatures.

Symptoms of pneumonia in children

High fever is the first symptom of pneumonia in a child

Symptoms of pneumonia in children may have certain variations depending on the causative microorganism. This is the basis of clinical and epidemiological diagnosis, which allows you to select the most rational antibiotic without laboratory examination.

Distinctive signs of pneumococcal lung injury are:

  • high temperature rise (up to 40 ° C);
  • chills;
  • cough with rusty sputum;
  • pain in the chest;
  • frequent loss of consciousness;
  • can develop in children, starting at 6 months of age.

Streptococcal pneumonia:

  • children aged 2 to 7 are more likely to be affected;
  • suppurative complications (purulent pleurisy, abscess of the lung);
  • violation of the blockade of impulses from the atrium to the ventricles.

Hemophilus infection:

  • more often up to 5 years of age;
  • sharp beginning;
  • severe toxicosis;
  • a slight increase in leukocytes in the blood;
  • extensive process in the lungs with the development of hemorrhagic edema;
  • inefficiency of the prescribed penicillin.

Mycoplasma pneumonia:

  • more common in school children;
  • persistent cough;
  • a mild general condition, which causes late appeal to the pediatrician;
  • redness of the conjunctival membrane of the eyes ("red eyes");
  • normal level of leukocytes in the blood;
  • asymmetric infiltration of pulmonary fields.

Diagnosis and analysis

Diagnosis of pneumonia in childhood is based on the results of clinical, radiologic and laboratory tests. In the presence of suspicious diseases, pulmonary radiography is performed.

It allows you to determine the massive nature of the defeat of the respiratory system and identify possible complications. With a characteristic radiographic picture, an accurate diagnosis of pneumonia is established.

At the second stage , the causative agent is identified. For this purpose, various studies can be conducted:

  1. Sputum culture in the framework of bacteriological analysis.
  2. Sowing blood to exclude sepsis.
  3. Determination of immunoglobulins (antibodies) in the blood to atypical pathogens (serological analysis).
  4. Detection of DNA or RNA of the pathogen. The material for the study is scraping from the back of the pharynx, conjunctiva or sputum.

All children with fever are shown general clinical and biochemical blood analysis. With pneumonia, there will be the following changes:

  • increase in the level of leukocytes. However, in viral and mycoplasma infections, leukocytosis rarely exceeds 15 000 / μL. Maximum it happens with chlamydial lesion (30 000 / μL and more);
  • shift the formula to the left with the appearance of young forms and toxic granularity of leukocytes (the most typical sign for bacterial pneumonia);
  • increased ESR (20 mm / h and more);
  • decrease in hemoglobin due to its redistribution between organs and the microcirculation system;
  • increased levels of fibrinogen;
  • acidosis.

Basic principles of treatment of pneumonia in children

Treatment of pneumonia begins with the right regimen and diet. All sick children are recommended bed rest. Its expansion becomes possible after lowering the temperature and stabilizing it within the limits of normal values.

Treatment of pneumonia in children

The room in which the child is located should be ventilated. The fresh air deepens and thins the breath. This has a positive effect on the course of the disease.

Dietary nutrition means:

  • in the diet easily digestible food prevails;
  • products should be with a low allergenic index;
  • in the diet, the amount of protein food increases (meat, eggs, cottage cheese);
  • abundant drink (purified water, teas).

Antibiotics for pneumonia in children are the main treatment. are aimed at eliminating the causative agent that caused the disease. The sooner they are appointed, the sooner they will act, and the child's condition will be normalized.

The choice of an antibacterial drug depends on the form of pneumonia. It is performed only by a doctor - self-treatment is unacceptable.

The main antibiotics approved for use in childhood are:

  • Amoxicillin, incl. protected form (Amoxiclav);
  • Ampicillin;
  • Oxacillin.

Alternative antibiotics (prescribed in the absence of basic or intolerance) are cephalosporins:

  • Cefuroxime;
  • Ceftriaxone;
  • Cefazolin.

Antibiotics reserve are used when the above listed are ineffective. . Their use is limited in pediatrics because of the increased risk of side effects . But in situations of pharmacological resistance of microorganisms - this is the only way to etiotropic treatment.

Representatives of these drugs are:

  • Vancomycin;
  • Carbopenem;
  • Ertapenem;
  • Linezolid;
  • Doxycycline (in children older than 18 years).

Simultaneous symptomatic therapy is performed.

It depends on the developed complications and the general condition of the child:

  1. Fever - antipyretic agents (non-steroids and paracetamol).
  2. Respiratory failure - oxygen therapy and artificial pulmonary ventilation (in severe cases).
  3. Pulmonary edema - careful consideration of the injected fluid to avoid hyperhydration and artificial ventilation.
  4. Disseminated blood clotting in the vessels - prednisolone and heparin (in the phase of increased blood clotting).
  5. Septic shock - adrenaline and prednisolone to increase blood pressure, evaluate the effectiveness of the antibiotics used, sufficient infusion therapy, artificial blood purification methods (in severe cases).
  6. Anemia - iron-containing drugs (but in the acute period of the disease they are contraindicated).

Forecast and consequences

The prognosis for pneumonia in children depends on the timeliness of the treatment started and the condition of the premorbid background (the presence of aggravating factors). If therapy is started within 1-2 days from the onset of the disease, then complete recovery without residual changes occurs.

If the first signs of the disease are missed, then complications may develop.

Complications after pneumonia The consequences of pneumonia can be different. Their severity depends on the causative agent. More often than not, the most serious consequences are caused by hemophilic rods, pneumococci, staphylococci, streptococci, Klebsiella and serrations. They contribute to the development of lung destruction.

The weighting of the infectious process can be associated with an unfavorable premorbid background:

  • prematurity of the child;
  • nutritional deficiency;
  • cystic fibrosis of the lungs ;
  • foreign body in the respiratory tract;
  • habitual ingress of food into the respiratory system.

Complications after pneumonia are classified into 3 types (depending on topography):

Легочные: 1. Pulmonary:

  • inflammation of the pleura;
  • abscess of the lung;
  • pulmonary edema;
  • pneumothorax - ingress of air into the pleural cavity at rupture of lung tissue with its subsequent compression.

Кардиологические: 2. Cardiological:

  • heart failure;
  • endocarditis;
  • myocarditis.

Системные: 3. System:

  • violation of blood clotting (DVS-syndrome);
  • septic shock, manifested by a critical drop in pressure and a violation of microcirculation in the organs;
  • sepsis - the presence of microorganisms in the blood and their distribution to various organs (extremely difficult condition).

The child after the transferred pneumonia can cough for a long time in the mornings. This is due to the still not completely finished restoration of the mucosa. Coughing is usually dry. To eliminate it, it is recommended to inhale salty sea air and general hardening of the body. Physical loads are resolved only 1.5 months after recovery with mild pneumonia, and 3 months after severe (with complications).

Prevention

Specific prophylaxis (vaccination) of pneumonia in childhood is conducted against the most dangerous and common pathogens. Thus, a vaccine against Hib infection (a hemophilic rod) was developed and introduced into practice.

This vaccine against pneumonia is recommended for children in the first year of life, because This microorganism most often causes the disease before the age of 5 years.

Nonspecific prevention implies the following rules:

  • suppression of supercooling;
  • rational and balanced nutrition of the child, not leading to weight loss or obesity;
  • refusal of parents to smoke;
  • general hardening;
  • timely treatment of catarrhal diseases (not self-medication, but therapy prescribed by a doctor).
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