Inflammation of the lungs is medically called pneumonia. It is an infection of one or both lungs at the same time, which is mainly caused by bacteria, viruses or fungi.

Nowadays, pneumonia is still a dangerous and serious disease. According to statistics, 5% of patients cannot tolerate this disease. In the Russian Federation, pneumonia is in 6th place in the ranking of deadly diseases. Pneumonia is especially dangerous for children. Symptoms in children appear much more subtle than in adults, so the disease always begins to be eliminated later than necessary, and this complicates treatment. This suggests that the treatment of this disease should be taken seriously, starting from the first stage.

The occurrence of the disease

There are cases when pneumonia is transmitted by viral droplets. This occurs when the patient sneezes. Its secretions contain microorganisms and bacteria that contribute to the occurrence of an inflammatory process in the body of an absolutely healthy person. In other cases, pneumonia occurs due to the increased activity of bacteria that are constantly present in a person’s throat and nose. If the body's immune defense is reduced, it is not able to resist these viruses, so they begin to multiply at high speed and, when they enter the lungs, cause inflammation.

Signs of illness

Symptoms of pneumonia often resemble those of the flu or a cold. If the pneumonia is bacterial, symptoms may appear gradually or acutely. These include: fever, heavy sweating, chest pain, trembling, cough with phlegm, cyanotic (change in skin color) nails and lips, rapid breathing, rapid pulse.

If the pneumonia is viral, symptoms such as dry cough, fever, weakness, muscle pain, headache, severe shortness of breath and fatigue are typical.

If pneumonia is caused by mycoplasmas, the symptoms are much less pronounced, but are very similar to the signs of viral and bacterial pneumonia. One of the main symptoms is chest pain, which occurs when the patient tries to take a deep breath. Basically, such pain occurs at the location of the main focus of inflammation. Such a sign should definitely raise suspicion of pneumonia. The symptoms in children are slightly different and do not appear that way.

Cough is not an important symptom, since the infection may be located far from the respiratory tract.

Recently, asymptomatic pneumonia has become increasingly common. In this case, the person’s temperature does not rise, there is no cough, and, therefore, sputum does not come out. This type of pneumonia is dangerous due to serious complications, since its treatment begins with a significant delay, since a person does not immediately notice that he has pneumonia. Symptoms in children are generally practically not observed.

Symptoms in children

Often, young patients do not experience the characteristic symptoms of pneumonia. The most noticeable signs are lethargy, fever and loss of appetite. But attentive parents may suspect pneumonia in their child if they notice some changes.

Temperature

Signs of pneumonia in children are rarely noticeable. But if a child’s body temperature is between 37.5 and 38 degrees, is not brought down by any antipyretics, and there is sweating, weakness and no appetite, this may be the first reason to suspect pneumonia in the baby.

Breath

The baby's breathing increases significantly. A baby up to 2 months takes 60 breaths per minute, up to 1 year - 50 breaths, after 1 year - 40 breaths. Very often, the child independently tries to lie on one side. According to statistics, right-sided pneumonia occurs most often in a child. In this case, the baby increasingly tries to lie on the left, less painful side.

The breathing rhythm may also be disturbed, and changes in the frequency and depth of breathing may be observed. In infants, shortness of breath is manifested by nodding the head in time with breathing, and the child sometimes stretches out his lips or puffs out his cheeks.

Atypical pneumonia

In this case, the signs of pneumonia in children appear a little differently. If pneumonia is caused by chlamydia or mycoplasma, the disease initially resembles a cold. A runny nose, sore throat and dry cough occur. But there is shortness of breath and a persistently high temperature, which should alert parents.

Character of the cough

A sore throat initially causes a slight cough, but over time the dry cough becomes painful. You may also notice an increase in coughing while your baby is feeding or when she cries. Then the cough becomes wet.

Baby's behavior

Pneumonia can also be suspected based on the child's behavior. Symptoms in children are generally similar. The baby becomes lethargic, whiny, and capricious. He doesn't sleep well and refuses to eat. In some cases, pneumonia can cause a child to vomit or have diarrhea. In infants, this is manifested by refusal of the breast and regurgitation of food.

Pneumonia without fever

With this type of pneumonia, the same symptoms are observed as with the normal course of the disease. Weakness and shortness of breath appear, sweating increases, a cough occurs, but there is no temperature reaction. Under what circumstances does this type of pneumonia occur? Symptoms without fever usually occur if the immune system is underactive. This situation is also scary because the severity of the patient’s condition can only be determined with additional diagnostics.

Pneumonia without fever most often occurs as a result of underbaked bronchitis, which then gradually develops into pneumonia. This is due to the fact that the body is already saturated with a number of anti-inflammatory drugs, and cannot adequately respond to a newly flared infection.

Causes of pneumonia

In children, this disease most often develops as a result of a viral infection, for example, respiratory or adenoviral. Pneumonia can also be caused by the common flu.

In addition, pneumonia is caused by bacteria. The main causative agents of pneumonia in a child are considered to be streptococcus pneumoniae, Haemophilus influenzae, and staphylococci.

The lungs can be infected by inhaling bacteria and viruses that are constantly present in the child’s throat or nose. These viruses and bacteria can also be spread through respiratory droplets, such as through sneezing or coughing.

Risk factors

Four main factors can contribute to the occurrence of pneumonia:

1. The baby’s weakened immune system, which is observed due to improper or insufficient nutrition. Very often this concerns infants who do not receive breast milk as the main type of feeding. In this case, invisible pneumonia may develop. Symptoms without fever often appear precisely because of this factor.

2. Pre-existing diseases. They can be otitis media, bronchitis, as well as frequent acute respiratory viral infections.

3. Ecological environment. Similar risk factors may include:

Polluted indoor air;

Overcrowded dwellings;

Smoky indoor air, etc.

4. Freezing. Very often, pneumonia in children occurs due to hypothermia. Most of all this concerns freezing feet.

Bilateral pneumonia

Bilateral pneumonia most often occurs in children, the elderly, or in patients whose health has been weakened by chronic illnesses. The disease most often develops during staphylococcal pneumonia, but also bilateral inflammation can occur due to the patient being immobile. Bilateral pneumonia usually begins in people who have had a viral infection. Symptoms of this disease include high body temperature and shortness of breath, wet cough, headache and confusion.

Therapy

It should be remembered that pneumonia is a disease that cannot be treated independently under any circumstances! To eliminate pneumonia, you will need the professionalism of a doctor, his experience, as well as the ability to competently use modern antibacterial agents. Many patients who do not know how to treat pneumonia often rely on advertising products. This is absolutely not allowed! It must be remembered that such drugs do not affect the outcome of the disease, but only alleviate the symptoms.

It is very rare that pneumonia goes away on its own without treatment. But in most cases, pneumonia leads to phenomena that can not only disrupt the patient’s ability to work, but also put his life at risk. It should also be taken into account that in our time there are modern effective and extremely safe antibiotics. This allows the doctor to prescribe successful treatment to the patient at home, but on the condition that the patient is provided with appropriate care. But if this is pneumonia in children, treatment is carried out only in a hospital under the constant supervision of an experienced specialist until complete recovery. This is due to the fact that childhood pneumonia is more difficult to treat, and it is also difficult to calculate the symptoms of the disease.

How to treat?

If pneumonia is mild, outpatient treatment (at home) is quite acceptable. But at the same time, the patient must unquestioningly follow the doctor’s instructions in order to avoid complications, since the acute form of the disease can very quickly develop into a chronic form if not treated correctly.

First of all, bed rest must be ensured throughout the entire period of intoxication and fever. As for medications, the main role is given to antibacterial drugs. The important point is that, taking into account the individual characteristics of the patient, the doctor prescribes exactly the antibiotic that is low-toxic and most active. The method and dose of introducing the medicine into the body is also determined by the doctor, since he knows best how to treat pneumonia in a particular patient. For example, if pneumonia is mild, the patient is prescribed a drug for oral use. If the form of the disease is severe, the drug is administered intravenously or intramuscularly.

Besides medications

In combination with medications, other means can be used, for example, mustard wraps, electrophoresis, ultraviolet irradiation, breathing exercises, etc. In addition, medical practice allows the use of phytotherapeutic agents. For example, an infusion of medicinal marshmallow root helps with a severe cough.

Diet plays an important role. The menu must contain fats, proteins and carbohydrates in sufficient quantities. The patient should also drink plenty of fluids - up to 3 liters per day. The most beneficial are vegetable, fruit and berry juices, as well as vitamin teas and cranberry juice.

It should be borne in mind that when taking antibiotics, intestinal function is impaired, so the patient should eat foods such as prunes, kefir, boiled beets, and rhubarb compote.

Consequences of pneumonia in children

We can say that timely treatment of pneumonia in children does not leave any consequences. But there are situations when the disease begins to be treated when it has already progressed. Under such circumstances, stopping the process is much more difficult, so various kinds of complications may arise. For example, pleurisy, pulmonary edema or abscess of lung tissue.

Also, the inflammatory process in the lungs can affect neighboring organs. This threatens the appearance of myocarditis (inflammation of the heart), and in the most severe cases can lead to meningitis.

It should be remembered that timely consultation with a doctor provides the patient with adequate therapy. If a child or adult is properly cared for, pneumonia will not lead to serious complications. This suggests that if there is even the slightest suspicion of this disease, you should not delay going to the doctor. This will help not only cure the patient faster and more painlessly, but also save his life.

Pneumonia (pneumonia) is a disease that affects people of all ages. Not everyone knows about the dangers of pneumonia. Although many will name the symptoms of the disease, they will say that it can be treated with antibiotics, and after the disease the body will take a long time to recover.

To be convinced of the danger of pneumonia, you must first understand what it is.

What is pneumonia?

This disease is caused by fungi, bacteria or viruses. Normally, every person has pathogenic microorganisms living on the mucous membrane of the pharynx, nose, and lungs. But as soon as the body’s immunity decreases, pathogenic microbes begin to multiply at tremendous speed, causing pneumonia. Inflammation can begin directly in the lungs or get there gradually, starting its “journey” from the throat or nose. In such cases, doctors explain that “the infection has gone down.”

The whole lung or part of it can become inflamed.

Symptoms of this disease are as follows: pain in the side, worsening with a deep breath or cough, very high body temperature, dry or wet cough, shortness of breath, chills. To make a correct diagnosis, you will need an X-ray examination of the lungs, blood and sputum tests. These studies will help to establish the nature of the disease and begin adequate therapy.

When treating pneumonia, doctors usually prescribe antibacterial drugs. Depending on the severity of the disease, the patient may be admitted to a hospital where injections are given several times a day. With the right antibiotic, the patient’s condition improves within 5-6 days from the start of treatment. If there is no improvement, doctors usually prescribe the patient another drug. Next, it is important to liquefy and remove the formed phlegm from the lungs. For this purpose, the patient may be prescribed inhalations and massage. In parallel, the patient is prescribed antiviral and immunomodulatory drugs. Full recovery usually occurs after 3-4 weeks.

Pneumonia is a very serious disease, from which, despite a wide range of modern antibiotics, people continue to die. We can't even talk about self-medication. This is fraught with serious consequences.

The danger of pneumonia for children

For a child’s body, pneumonia is a very serious test, even if the child received medical help on time. Most often, children of preschool age are susceptible to the disease. Doctors believe that by the age of 6 years, a child’s immunity develops. During this period, they are very vulnerable to various types of infections, including streptococcal infections, which in most cases causes pneumonia in babies.

In addition to the above symptoms of pneumonia, children often experience blue discoloration of the nasolabial triangle (cyanosis). This is a very serious indicator, indicating that against the background of the disease, not everything is in order with the child’s cardiovascular system.

The danger of pneumonia also lies in the fact that during the disease the lungs cannot continue to function fully: the baby’s breathing becomes shallow, and he has a feeling of lack of air. Therefore, sick children sleep very poorly, eat very poorly, and show constant anxiety.

The following factors aggravate the situation:

1. Late seeking of medical help.
2. The presence of concomitant chronic diseases in the baby.
3. Incorrect treatment of a child.

Each of these factors increases the risk of illness for a child several times. At the initial stage, the disease is very similar to a common viral infection, so doctors do not prescribe antibiotics right away. If antiviral treatment does not have an effect within 3 days (the high temperature continues and the cough does not stop), this is a reason to contact the doctor again. This picture of the disease means its bacterial nature. At this stage, taking antibiotics is mandatory. Not all mothers know this. Many continue to treat the child according to the original regimen prescribed by the doctor, wasting precious time. Within a few days, the child may develop acute respiratory failure, sometimes resulting in death. This is the danger of pneumonia.

Another dangerous consequence of untreated pneumonia in children is neurotoxicosis. It is characterized first by increased activity of the child, his excitement, frequent crying, and whims. This state gradually gives way to the opposite: the child is apathetic, does not eat, is drowsy, and muscle tone is reduced. At the third stage, the temperature rises, the child develops convulsions, and pulmonary failure develops (even to the point of respiratory arrest).

To reduce the risk of your baby developing pneumonia, a mother just needs to follow a few simple rules:

1. Try to breastfeed your baby until at least 1 year of age.
2. Do not refuse to vaccinate your baby.
3. Provide your child's diet with foods rich in zinc.
4. Temper your child and spend a lot of time walking in the fresh air.
5. Observe basic rules of home hygiene: ventilate the premises more often and carry out wet cleaning.

Consequences of pneumonia in adults

Pneumonia is no less dangerous for adults. The most common consequences:

1. Lung abscess.
2. Lung fibrosis.
3. Bronchial asthma.
4. Heart failure.
5. Respiratory failure.

The first two diseases are especially dangerous.

A lung abscess is decomposition (rotting) of the lung tissue in the part where there was inflammation. There can be only one source. Sometimes there are several of them. During the formation of an abscess, the patient develops a high temperature, weakness, lack of appetite, difficulty breathing, severe chest pain, and cough. At the next stage, the formed abscess is opened, sputum in large quantities (up to 1 liter per day) comes out through the respiratory tract. With proper treatment, the lung tissue becomes scarred over several years and complete recovery occurs.

Lung fibrosis is a patient’s condition in which connective tissue begins to form in place of damaged lung tissue. The lungs cannot work at full capacity, breathing becomes difficult, and chest pain appears. The disease progresses very quickly and therefore requires immediate attention to a medical facility. It is impossible to completely get rid of pulmonary fibrosis. Treatment is usually aimed at relieving symptoms and preventing further development of the disease. In extreme cases, the patient is indicated for a lung transplant.

How to avoid the negative consequences of pneumonia?

The mortality rate from pneumonia in our country, despite the sufficient level of development of medicine, remains quite high.

To recover quickly and avoid negative consequences, you need to be very attentive to your health.

In Russia, it is customary to go to the doctor when there are already very serious problems. This is wrong. In the case of pneumonia, this can be fatal. You should seek medical help as soon as the first symptoms of the disease appear and the temperature is not yet so high. You should not neglect the tests prescribed by the doctor. Their results will help the doctor immediately create an effective treatment plan.

A mother, caring for the health of her baby, should know that at the slightest suspicion of any disease, she should show the child to the doctor. Statistics show that the highest childhood mortality from pneumonia occurs among children under the age of 1 year. In the case of childhood pneumonia, hospitalization should not be neglected.

Both adults and children can protect themselves from pneumonia through physical exercise, proper nutrition rich in vitamins and microelements, hardening, frequent exposure to fresh air and close attention to their health.

Pneumonia in a child - symptoms, treatment, causes

Pneumonia or pneumonia is one of the most common acute infectious and inflammatory diseases in humans. Moreover, the concept of pneumonia does not include various allergic and vascular diseases of the lungs, bronchitis, as well as dysfunction of the lungs caused by chemical or physical factors (trauma, chemical burns).

Pneumonia occurs especially often in children, the symptoms and signs of which are reliably determined only on the basis of X-ray data and a general blood test. Pneumonia among all pulmonary pathologies in young children is almost 80%. Even with the introduction of progressive technologies in medicine - the discovery of antibiotics, improved diagnostic and treatment methods - this disease is still one of the ten most common causes of death. According to statistical data in various regions of our country, the incidence of pneumonia in children is 0.4-1.7%.

When and why can pneumonia occur in a child?

The lungs perform several important functions in the human body. The main function of the lungs is gas exchange between the alveoli and the capillaries that envelop them. Simply put, oxygen from the air in the alveoli is transported into the blood, and carbon dioxide from the blood enters the alveoli. They also regulate body temperature, regulate blood clotting, are one of the filters in the body, promote cleansing, the removal of toxins, breakdown products that occur during various injuries, and infectious inflammatory processes.

And in the event of food poisoning, burns, fractures, surgical interventions, or any serious injury or illness, a general decrease in immunity occurs, and it is more difficult for the lungs to cope with the load of filtering toxins. That is why very often a child develops pneumonia after suffering or against the background of injuries or poisoning.

Most often, the causative agent of the disease is pathogenic bacteria - pneumococci, streptococci and staphylococci, and recently cases of the development of pneumonia from pathogens such as pathogenic fungi, legionella (usually after staying in airports with artificial ventilation), mycoplasma, chlamydia, which are not They are rarely mixed or associated.

Pneumonia in a child, as an independent disease that occurs after serious, severe, prolonged hypothermia, is extremely rare, since parents try to prevent such situations. As a rule, in most children, pneumonia does not occur as a primary disease, but as a complication after ARVI or influenza, less often than other diseases. Why is this happening?

Many of us believe that acute viral respiratory diseases have become more aggressive and dangerous due to their complications in recent decades. This may be due to the fact that both viruses and infections have become more resistant to antibiotics and antiviral drugs, which is why they are so severe in children and cause complications.

One of the factors in the increase in the incidence of pneumonia in children in recent years has been the general poor health of the younger generation - how many children today are born with congenital pathologies, developmental defects, and lesions of the central nervous system. A particularly severe course of pneumonia occurs in premature or newborn babies, when the disease develops against the background of an intrauterine infection with an insufficiently formed, immature respiratory system.

In congenital pneumonia, the causative agents are often herpes simplex virus, cytomegalovirus, mycoplasma, and when infected during childbirth - chlamydia, group B streptococci, opportunistic fungi, Escherichia coli, Klebsiella, anaerobic flora; when infected with hospital infections, pneumonia begins on the 6th day or 2 weeks after birth.

Naturally, pneumonia most often occurs in cold times, when the body already undergoes a seasonal adjustment from heat to cold and vice versa, overloads occur for the immune system, at this time there is a lack of natural vitamins in foods, temperature changes, damp, frosty, windy weather contribute to hypothermia of children and their infection.

In addition, if a child suffers from any chronic diseases - tonsillitis, adenoids in children, sinusitis, dystrophy, rickets (see rickets in an infant), cardiovascular disease, any severe chronic pathologies, such as congenital lesions of the central nervous system, developmental defects, immunodeficiency states - significantly increase the risk of developing pneumonia and aggravate its course.

The severity of the disease depends on:

• The extent of the process (focal, focal-confluent, segmental, lobar, interstitial pneumonia).
• The age of the child, the younger the baby, the narrower and thinner the airways, the less intense gas exchange in the child’s body and the more severe the course of pneumonia.
• Places where and for what reason pneumonia occurred:
  - community-acquired: most often have a milder course
  - hospital: more severe, since infection with bacteria resistant to antibiotics is possible
  - aspiration: when foreign objects, mixture or milk enter the respiratory tract.
• The most important role is played by the general health of the child, that is, his immunity.

Improper treatment of influenza and ARVI can lead to pneumonia in a child

When a child gets sick with a common cold, acute respiratory viral infection, or influenza, the inflammatory process is localized only in the nasopharynx, trachea and larynx. If the immune response is weak, and also if the pathogen is very active and aggressive, and the child is treated incorrectly, the process of bacterial reproduction descends from the upper respiratory tract to the bronchi, then bronchitis may occur. Further, inflammation can also affect lung tissue, causing pneumonia.

What happens in a child’s body during a viral disease? In most adults and children, various opportunistic microorganisms - streptococci, staphylococci - are always present in the nasopharynx, without causing harm to health, since local immunity inhibits their growth.

However, any acute respiratory disease leads to their active reproduction, and if the parents act correctly during the child’s illness, the immune system does not allow their intensive growth.

What should not be done during ARVI in a child to avoid complications:

• Antitussives should not be used. Coughing is a natural reflex that helps the body clear the trachea, bronchi and lungs of mucus, bacteria, and toxins. If, to treat a child, in order to reduce the intensity of a dry cough, you use antitussives that affect the cough center in the brain, such as Stoptusin, Bronholitin, Libexin, Paxeladin, then an accumulation of sputum and bacteria in the lower respiratory tract may occur, which ultimately leads to pneumonia.
• You cannot carry out any preventive antibiotic therapy for colds or viral infections (see antibiotics for colds). Antibiotics are powerless against the virus, but the immune system must cope with opportunistic bacteria, and their use is indicated only if complications arise as prescribed by a doctor.
• The same applies to the use of various nasal vasoconstrictors; their use promotes faster penetration of the virus into the lower respiratory tract, therefore Galazolin, Naphthyzin, Sanorin are not safe to use for a viral infection.
• Drinking plenty of fluids - one of the most effective methods of relieving intoxication, thinning mucus and quickly clearing the respiratory tract is drinking plenty of fluids, even if the child refuses to drink, parents should be very persistent. If you do not insist that the child drinks a sufficiently large amount of liquid, there will also be dry air in the room - this will help dry out the mucous membrane, which can lead to a longer course of the disease or a complication - bronchitis or pneumonia.
• Constant ventilation, the absence of carpets and carpets, daily wet cleaning of the room in which the child is located, humidification and purification of the air with a humidifier and air purifier will help to quickly cope with the virus and prevent pneumonia from developing. Because clean, cool, moist air helps to thin sputum, quickly eliminate toxins through sweat, cough, and wet breath, which allows the child to recover faster.

Acute bronchitis and bronchiolitis - differences from pneumonia

ARVI usually has the following symptoms:

• High temperature in the first 2-3 days of illness (see antipyretics for children)
• Headache, chills, intoxication, weakness
• Qatar of the upper respiratory tract, runny nose, cough, sneezing, sore throat (not always the case).

In case of acute bronchitis against the background of acute respiratory viral infection, the following symptoms may occur:

• Slight increase in body temperature, usually up to 38C.
• At first the cough is dry, then it becomes wet, there is no shortness of breath, unlike pneumonia.
• Breathing becomes harsh, various scattered wheezes appear on both sides, which change or disappear after coughing.
• The radiograph shows an increase in the pulmonary pattern, and the structure of the roots of the lungs decreases.
• There are no local changes in the lungs.

Bronchiolitis occurs most often in children under one year of age:

• The difference between bronchiolitis and pneumonia can only be determined by X-ray examination, based on the absence of local changes in the lungs. According to the clinical picture, acute symptoms of intoxication and an increase in respiratory failure, the appearance of shortness of breath - are very reminiscent of pneumonia.
• With bronchiolitis, the child’s breathing is weakened, shortness of breath with the participation of auxiliary muscles, the nasolabial triangle becomes bluish, general cyanosis and severe pulmonary heart failure are possible. When listening, a boxy sound and a mass of scattered fine-bubble rales are detected.

Signs of pneumonia in a child

When the infectious agent is highly active, or when the body’s immune response to it is weak, when even the most effective preventive treatment measures do not stop the inflammatory process and the child’s condition worsens, parents can guess from some symptoms that the child needs more serious treatment and urgent examination by a doctor. At the same time, under no circumstances should you start treatment with any traditional method. If it really is pneumonia, not only will this not help, but the condition may worsen and time will be lost for adequate examination and treatment.

Symptoms of pneumonia in a child 2 - 3 years old and older

How can attentive parents determine if they have a cold or viral illness that they should urgently call a doctor and suspect pneumonia in their child? Symptoms that require x-ray diagnostics:

• After an acute respiratory infection or flu, there is no improvement in the condition for 3-5 days, or after a slight improvement, a jump in temperature and increased intoxication and cough reappear.
• Lack of appetite, lethargy of the child, sleep disturbances, and moodiness persist for a week after the onset of the illness.
• The main symptom of the disease remains a severe cough.
• The body temperature is not high, but the child has shortness of breath. At the same time, the number of breaths per minute in a child increases, the norm of breaths per minute in children aged 1-3 years is 25-30 breaths, in children 4-6 years old - the norm is 25 breaths per minute, if the child is in a relaxed, calm state. With pneumonia, the number of breaths becomes greater than these numbers.
• With other symptoms of a viral infection - cough, fever, runny nose, pronounced pallor of the skin is observed.
• If the temperature is high for more than 4 days and antipyretics such as Paracetamol, Efferalgan, Panadol, Tylenol are not effective.

Symptoms of pneumonia in infants, children under one year old

The mother can notice the onset of the disease by changes in the baby’s behavior. If a child constantly wants to sleep, becomes lethargic, apathetic, or vice versa, is capricious a lot, cries, refuses to eat, and the temperature may rise slightly, the mother should immediately consult a pediatrician.

Body temperature

In the first year of life, pneumonia in a child, the symptom of which is considered to be a high, unbroken temperature, is distinguished by the fact that at this age it is not high, does not reach 37.5 or even 37.1-37.3. However, temperature is not an indicator of the severity of the condition.

The first symptoms of pneumonia in an infant

This is causeless anxiety, lethargy, loss of appetite, the baby refuses to breastfeed, sleep becomes restless, short, loose stools appear, there may be vomiting or regurgitation, runny nose and paroxysmal cough, which intensifies while the baby is crying or feeding.

Baby's breathing

Chest pain when breathing and coughing.
Sputum - with a wet cough, purulent or mucopurulent sputum (yellow or green) is released.
Shortness of breath or an increase in the number of respiratory movements in young children is a clear sign of pneumonia in a child. Shortness of breath in infants may be accompanied by nodding of the head in time with breathing, and the baby also puffs out his cheeks and stretches out his lips, sometimes foamy discharge appears from the mouth and nose. A symptom of pneumonia is considered to be exceeding the normal number of breaths per minute:

• In children under 2 months, the norm is up to 50 breaths per minute; over 60 is considered a high frequency.
• In children from 2 months to a year, the norm is 25-40 breaths, if 50 or more, then this is exceeding the norm.
• In children older than one year, the number of breaths exceeding 40 is considered shortness of breath.

The relief of the skin changes when breathing. Attentive parents may also notice retraction of the skin when breathing, usually on one side of the diseased lung. To notice this, you should undress the baby and observe the skin between the ribs; it retracts when breathing.

With extensive lesions, one side of the lung may lag behind during deep breathing. Sometimes you can notice periodic stops in breathing, disturbances in the rhythm, depth, frequency of breathing, and the child’s desire to lie on one side.

Cyanosis of the nasolabial triangle

This is the most important symptom of pneumonia, when blue skin appears between the baby’s lips and nose. This sign is especially pronounced when the baby is breastfeeding. With severe respiratory failure, slight blue discoloration may appear not only on the face, but also on the body.

Chlamydial, mycoplasma pneumonia in a child

Among pneumonias, the causative agents of which are not common bacteria, but various atypical representatives, mycoplasma and chlamydial pneumonia are distinguished. In children, the symptoms of such pneumonia are somewhat different from the course of ordinary pneumonia. Sometimes they are characterized by a hidden, sluggish course. Signs of atypical pneumonia in a child may be as follows:

• The onset of the disease is characterized by a sharp rise in body temperature to 39.5 C, then a persistent low-grade fever forms -37.2-37.5 or even normalization of temperature occurs.
• It is also possible that the disease begins with the usual signs of ARVI - sneezing, sore throat, severe runny nose.
• Persistent dry debilitating cough, shortness of breath may not be constant. This cough usually occurs with acute bronchitis, not pneumonia, which complicates the diagnosis.
• When listening, the doctor is most often presented with scant data: rare wheezing of various sizes, pulmonary percussion sound. Therefore, it is difficult for a doctor to determine atypical pneumonia based on the nature of wheezing, since there are no traditional signs, which greatly complicates the diagnosis.
• There may be no significant changes in the blood test for SARS. But usually there is an increased ESR, neutrophilic leukocytosis, combination with anemia, leukopenia, eosinophilia.
• A chest x-ray reveals a pronounced increase in the pulmonary pattern and heterogeneous focal infiltration of the pulmonary fields.
• Both chlamydia and mycoplasma have the ability to exist for a long time in the epithelial cells of the bronchi and lungs, so most often pneumonia is of a protracted, recurrent nature.
• Treatment of atypical pneumonia in a child is carried out with macrolides (azithromycin, josamycin, clarithromycin), since the pathogens are most sensitive to them (to tetracyclines and fluoroquinolones, too, but they are contraindicated for children).

Indications for hospitalization

The decision about where to treat a child with pneumonia - in a hospital or at home - is made by the doctor, and he takes into account several factors:

• The severity of the condition and the presence of complications - respiratory failure, pleurisy, acute disturbances of consciousness, heart failure, drop in blood pressure, lung abscess, pleural empyema, infectious-toxic shock, sepsis.
• Damage to several lobes of the lung. Treatment of focal pneumonia in a child at home is quite possible, but for lobar pneumonia, it is better to treat it in a hospital setting.
• Social indications are poor living conditions, inability to carry out care and doctor’s orders.
• Age of the child - if an infant falls ill, this is grounds for hospitalization, since pneumonia in an infant poses a serious threat to life. If pneumonia develops in a child under 3 years of age, treatment depends on the severity of the condition and most often doctors insist on hospitalization. Older children can be treated at home, provided that the pneumonia is not severe.
• General health - in the presence of chronic diseases, weakened general health of the child, regardless of age, the doctor may insist on hospitalization.

Treatment of pneumonia in a child

How to treat pneumonia in children? Antibiotics are the mainstay of treatment for pneumonia. At a time when doctors did not have antibiotics in their arsenal for bronchitis and pneumonia, pneumonia was a very common cause of death in adults and children, so in no case should you refuse to use them; no folk remedies are effective for pneumonia. Parents are required to strictly follow all the doctor’s recommendations, provide proper care for the child, adhere to the drinking regime, nutrition:

• Taking antibiotics must be carried out strictly on time, if the drug is prescribed 2 times a day, this means that there should be a break of 12 hours between doses, if 3 times a day, then a break of 8 hours (see 11 rules on how to take antibiotics correctly) . Antibiotics are prescribed - penicillins, cephalosporins for 7 days, macrolides (azithromycin, josamycin, clarithromycin) - 5 days. The effectiveness of the drug is assessed within 72 hours - improvement in appetite, decrease in temperature, shortness of breath.
• Antipyretics are used if the temperature is above 39C, in infants above 38C. At first, antipyretics are not prescribed with antibiotics, since it is difficult to assess the effectiveness of therapy. It should be remembered that during high temperatures the body produces the maximum amount of antibodies against the pathogen, so if a child can tolerate a temperature of 38C, it is better not to knock it down. This way the body can quickly cope with the microbe that caused pneumonia in the baby. If a child has had at least one episode of febrile convulsions, the temperature should be brought down already at 37.5C.
• Feeding a child with pneumonia - lack of appetite in children during illness is considered natural and the child’s refusal to eat is explained by the increased load on the liver when fighting the infection, so you cannot force feed the child. If possible, you should prepare light food for the patient, exclude any ready-made chemical foods, fried and fatty, try to feed the child simple, easily digestible food - porridge, soups with a weak broth, steamed cutlets from lean meat, boiled potatoes, various vegetables and fruits.
• Oral hydration - in water, natural freshly squeezed diluted juices - carrot, apple, weakly brewed tea with raspberries, rosehip infusion, water-electrolyte solutions are added (Rehydron, etc.).
• Ventilation, daily wet cleaning, and the use of air humidifiers alleviate the baby’s condition, and the love and care of parents works wonders.
• No general tonic (synthetic vitamins), antihistamines, or immunomodulators are used, since they often lead to side effects and do not improve the course and outcome of pneumonia.

Taking antibiotics for pneumonia in a child (uncomplicated) usually does not exceed 7 days (macrolides 5 days), and if you follow bed rest, follow all the doctor’s recommendations, in the absence of complications, the child will quickly recover, but within a month there will still be residual effects in the form cough, slight weakness. With atypical pneumonia, treatment may take longer.

When treated with antibiotics, the intestinal microflora in the body is disrupted, so the doctor prescribes probiotics - RioFlora Immuno, Acipol, Bifiform, Bifidumbacterin, Normobakt, Lactobacterin (see Linex analogues - a list of all probiotic preparations). To remove toxins after completion of therapy, the doctor may prescribe sorbents such as Polysorb, Enterosgel, Filtrum.

If the treatment is effective, the child can be transferred to a general regimen and walks from the 6-10th day of illness, and hardening can be resumed after 2-3 weeks. In case of mild pneumonia, heavy physical activity (sports) is allowed after 6 weeks, in case of complicated pneumonia after 12 weeks.

Signs of pneumonia in a child

Very often, childhood colds can be complicated by pneumonia. This is a very serious disease that is difficult to diagnose and treat. Pneumonia can be different, depending on which zone of inflammation is covered. Most often, children under three years of age suffer from complex forms of pneumonia; they have an atypical course because children cannot cough up sputum and do not say in which area they feel pain. In young children, pneumonia is almost unheard of, because children are restless and cry. It is very important to identify this disease in advance so that there are no serious complications.

Causes of pneumonia in children

Most often, pneumonia occurs due to microbes – pneumococci. In children under 3 years of age, pneumonia can be caused by staphylococcus, very rarely chlamydial or microplasma pathogens, and pneumonia in children also occurs due to several microbes.

Pneumonia is very rarely spontaneous in children; most often it is a consequence of a viral infection or a complication after the flu. This appears due to the fact that a cold reduces immunity in the respiratory tract and the immune system stops fighting. Due to the fact that viruses infect the mucous membranes in the respiratory tract, the microbes that are in the upper and lower respiratory tract are not completely destroyed, they begin to multiply more strongly, and form a microbial process and pneumonia.

Often, children who are overtired, hypothermic, or have frozen feet are at risk of contracting pneumonia. A cold becomes more complicated when the baby is surrounded by pneumococci and other microbes; both children and adults can carry them. Pneumonia also develops if microbes or other infectious foci - kidney or intestinal - have been introduced into the blood. When heat and humidity dominate the lung tissue, microbes multiply rapidly and pneumonia develops.

The danger of pneumonia for children

For infants, this is a deadly disease, when germs begin to invade the lungs, they begin to destroy tissue, and swelling and inflammation can occur. Thus, the permeability of the lungs to oxygen is disrupted, that is, the child begins to suffocate, while a metabolic disorder is noticeable, carbon dioxide is removed from the tissues, and they are no longer supplied with oxygen.

When inflammation occurs, a lot of toxins begin to appear, because of this, intoxication occurs in the child’s body and the general state of health is disrupted, this further worsens the patient’s well-being. It is important to consider how much tissue in the lung is affected; this determines how severe the disease is.

Types of pneumonia in children

1. Focal pneumonia occurs when a small area of ​​the lung becomes inflamed.

2. Segmental pneumonia occurs when only a certain segment of the lung becomes inflamed; this lesion is more extensive than the previous one.

3. Lobar pneumonia is considered a very severe form because breathing is impaired due to the fact that a large section of lung tissue may fall out.

4. Total pneumonia is very dangerous for a child, it affects the entire lung, it comes in two types - one-sided and two-sided. This is a serious disease.

Pneumonia is characterized by the fact that metabolism is disrupted, because inflammation of the lung begins to affect all systems of the body. At the same time, microbes release toxins and can damage nerve tissue, while consciousness is depressed and the person feels overexcited. Hypoxia can also occur, because of this, blood circulation increases, while a person feels a strong load on the cardiovascular system, because of this he loses a lot of weight and develops neurasthenia. It is very important to recognize the symptoms of pneumonia in time and start treatment on time; if it is not treated in time, it can have serious and disastrous consequences for the child.

How does pneumonia manifest itself in different types of children?

Pneumonia depends on the area of ​​inflammation; if it is large and active, then the disease will be severe. Most often, pneumonia in children is well treated.

Bronchopneumonia or focal pneumonia is a complication of acute respiratory viral infection; it can begin with a common cold, runny nose, cough and drowsiness, then the infection goes down very deep. The virus begins to infect the bronchi, then the lung tissue, microbes join it and the disease worsens.

Signs of pneumonia in children

1. A sharp deterioration in the baby’s health.

2. The appearance of a very dry or wet cough that is deep.

3. Shortness of breath may occur during breastfeeding, crying and physical activity, and even during sleep.

4. The pectoral cellular muscles begin to take part in breathing.

5. The temperature rises from 38 to 39 degrees, and practically does not go down.

6. If the baby has problems with immunity, there may not be a fever and, on the contrary, the body temperature decreases.

7. Body temperature during pneumonia lasts for several days, even after active treatment has begun.

8. When examined, the baby is pale; blue discoloration may appear around the mouth and nose.

9. The child is restless, eats poorly and sleeps a lot.

10. When listening to the bronchi, harsh breathing may be observed, this indicates inflammation of the upper respiratory tract.

11. Small wheezing can be heard above the lungs, they are moist, they do not disappear after the baby coughs.

12. Tachycardia may be observed in the heart, vomiting and nausea are noted, the stomach hurts, loose stools appear, and because of this, an intestinal infection also occurs.

13. With pneumonia, the liver becomes enlarged.

14. The child arrives in serious condition.

So, it is very important to diagnose lung disease in a child in time and begin timely treatment, this way you can get rid of complications and help the child cope with the disease. The disease can be diagnosed using an x-ray; the image shows darkened areas of the lung, this indicates inflammation and hardening of the tissue. A general blood test shows an increased number of leukocytes, which also indicates an inflammatory process.

How is right upper lobe pneumonia manifested and treated?

As the name of the disease suggests, right upper lobe pneumonia develops in the upper part of the right lung. This disease is difficult. The victim is overcome by shortness of breath, fever with a possible transition to a state of delirium.

Pneumonia affects the right lung much more often than the left. This is due to the anatomical structure of the body: the right bronchus is shorter and wider, so it is easier for infections to spread through it.

Pneumonia is another name for pneumonia. The disease was very dangerous until the discovery of penicillin. At this time, the disease is well treated, especially if diagnosed at the beginning of its development. But about 5 percent of those infected still die to this day. Therefore, pneumonia must be taken seriously.

How does upper lobe pneumonia manifest?

Diseases of an infectious-inflammatory nature are difficult to distinguish from each other, so the sick person does not always understand whether he just has a cold or whether a more serious illness is already beginning to develop.

With right-sided pneumonia, the inflammatory process develops in the right lung. Accordingly, the left side affects the left.

Pneumococcus and Klebsiella bacteria are to blame for the development of the disease. The human body into which they enter, for example, by airborne droplets, does not immediately react to their presence. Pathogens linger for some time on the mucous membranes, for example, the nose or larynx. The disease has not yet begun to overcome a person, but his immune system understands that foreign organisms have appeared, and it is time to prepare to fight them.

If for some reason the immune system weakens, bacteria move from the mucous membranes to the lungs. Here they actively reproduce. The cause of decreased immunity may be hypothermia, a cold, or repeated contact with a sick person.

Upper lobe pneumonia differs from others in the severe course of the disease. The patient's health deteriorates very sharply. He feels a prolonged fever. Possible delirium. The whole body is poisoned, the health of other systems is disrupted.

Elderly people and those who have problems with the immune system are most susceptible to this disease.

Symptoms of the disease resemble fever:

• the patient is constantly shivering;
• he experiences muscle aches;
• he is plagued by severe headaches.

Upper lobe pneumonia appears suddenly. If in the evening the patient experienced some discomfort, it was so insignificant that he did not in any way connect it with a possible illness. And in the morning there are difficulties with breathing: it becomes shallow. A person is even afraid to take a deep breath, as it causes pain. A painful cough begins, dry and exhausting.

The resulting temperature does not go down, and if it is possible to do this, it is only for a short time. The following symptoms gradually appear:

• digestive problems, nausea;
• the whites of the eyes turn yellow due to the destruction of red blood cells;
• rashes appear on the lips;
• at rest, shortness of breath does not stop.

Sometimes a condition similar to that of meningitis occurs. Sometimes the patient is haunted by hallucinations.

Diagnosis and treatment of right-sided pneumonia

The presence of pneumonia is determined using radiography.

At the appointment, the doctor examines the patient and interviews him. The specialist must listen to wheezing in the lungs, because this method remains the best in identifying pathology to this day. Even with modern technology, an experienced doctor will be able to correctly hear and understand the nature of the noise in the respiratory organs.

An x-ray shows how much of the lung is affected by inflammation. This is a very objective method. It is also good because in the absence of an experienced doctor it will always help to make a correct diagnosis.

Other diagnostic methods are laboratory blood tests and bacterial culture of sputum. Changes in leukocytes, ESR, etc. are determined from the blood. And sputum shows the type of pathogen. But this analysis is ready only a few days after the biomaterial is collected. Doctors do not wait for the result, but prescribe treatment immediately, using a standard regimen. And after receiving data from the laboratory, additional drugs are prescribed.

Right-sided pneumonia of the upper lobe is fraught with dangerous complications if left untreated. It happens that pathology leads to disability of the patient and even death.

Treatment of the disease is carried out using antibacterial therapy. Penicillins, ampicillins and much more are used depending on the type of pathogen. The patient takes them strictly as prescribed by the doctor. The entire treatment process is controlled by radiographs and laboratory tests.

It happens that the patient is admitted to the hospital in serious condition. In this case, treatment begins with normalizing the patient's condition. This may include ventilation of the lungs using artificial means, adjusting the balance of water and salts, restoring blood pressure and other measures.

The doctor may prescribe antipyretic, antiallergic, anti-inflammatory, and painkillers.

Without fail, the patient takes medications that help strengthen or correct immunity.

All medications can be supplemented with therapeutic massage, physiotherapeutic procedures, and physical therapy.

Pneumonia is a serious disease, so all treatment procedures are prescribed only by a doctor. Often the patient needs appropriate care and special procedures. Therefore, upper lobe pneumonia is most often treated in a hospital setting.

Upper lobe right-sided pneumonia in children

This disease most often develops in those children who have recently suffered from influenza, colds or inflammation of the mucous membranes of the respiratory system. The main cause of the disease is weakened immunity.

Children's right-sided pneumonia is a focal disease. Develops after diseases of the bronchial system. Several foci of varying degrees of inflammation develop in the upper lobe of the right lung. Bacteria cannot penetrate into one large area, but affect various foci. Subsequently, they can merge into one big one. This complicates further treatment.

The symptoms of this disease in a child are similar to milder ailments. This is a cough, fever, excessive sweating. The doctor may listen for persistent wheezing and gurgling sounds in the child's lungs. The baby does not have enough air, so he experiences difficulty breathing: it becomes intermittent and harsh. Children's health cannot be risked. Harmful bacteria have a detrimental effect on the child’s immunity. Delay in treatment is unacceptable.

Treatment for a sick child is prescribed depending on the stage of the disease. Antibacterial therapy is considered the most effective.

Right-sided inflammation in a child requires hospital treatment, as proper care and constant monitoring of the patient’s condition are necessary due to the action of antibiotics.

With properly organized treatment, improvement in the child’s condition occurs on the 6th day. At the end of the treatment course, an x-ray is required, as this is the best way to diagnose pneumonia.

Upper lobe pneumonia on the right side is not so common in children. Prevention of this disease is possible in the form of vaccinations. They are carried out with special vaccines, pneumococcal and influenza. But not all children are shown them. There are risk groups that should not do this.

Pneumonia can have consequences both in the early period of the disease and against the background of general improvement. Pneumonia in newborns is especially dangerous: the consequences of this process often lead to the death of the baby. The consequences of intrauterine pneumonia are no less terrible if adequate conservative treatment has not been carried out. The most common toxic consequence in children is pneumonia. It is usually formed by pneumonia in a child with manifestations of intestinal toxicosis or neurotoxicosis.

Clinical manifestations of intestinal toxicosis in the form of consequences of pneumonia usually begin at an early stage of the disease. All symptoms completely disappear by the time of complete recovery.

There are three stages of toxicosis and three degrees of internal toxicosis:

Toxicosis:
Stage I- with increased functions of all organs and systems; the child is excited, restless; vomiting, liquid and frequent bowel movements, tachycardia are observed;
Stage II- decreased functioning of organs and systems; the child is inactive and indifferent; perhaps a disturbance of consciousness - stupor or stupor;
Stage III- loss of consciousness.

Internal toxicosis:
I degree- loss of body weight up to 5%; the child has moderate thirst, the mucous membranes are dry;
II degree- loss of body weight from 5 to 10%; dry skin and mucous membranes, decreased tissue elasticity, sunken fontanel, tachycardia, decreased blood pressure; frequent vomiting, stool 10 times a day or more;
III degree- loss of more than 10% body weight; mucous membranes are dry, facial features are pointed, skin without elasticity, shortness of breath, muffled heart sounds, lack of urination, intestines do not work.

The basic principles of treatment of the toxic effects of pneumonia in newborns are:

• Combating low oxygen levels in the blood and lung tissue;
• Therapy aimed at treating the consequences of toxicosis.

What are the consequences of pneumonia in newborns?

Acute pneumonia in newborns often results in severe and difficult-to-correct conditions. Treatment of toxicosis due to pneumonia in children is carried out in a hospital.

The main measures for treating toxicosis are:

1) normalization of peripheral circulatory disorders by performing a blockade in order to:

• elimination of centralization of blood circulation;
• reducing the inadequate activity of brain parts involved in the pathological process;

2) carrying out detoxification therapy for the purpose of:

• collecting toxins and removing them from the body;
• correction of disturbances in water-electrolyte metabolism and acid-base status;
• providing increased energy cellular metabolism with the required amount of fluid;
• changes (improvement) in the rheological properties of blood;

3) treatment of heart failure;
4) prevention and therapy of disseminated intravascular coagulation;
5) symptomatic therapy.

Detoxification therapy for the consequences of pneumonia

Detoxification treatment of the consequences of pneumonia in children is intravenous therapy, which involves forced diuresis. The indicator for intravenous therapy is the comatose or stuporous state of the patient; persistent body hyperthermia, which does not respond to standard treatment methods; the patient has uncontrollable vomiting and intestinal dysfunction, which caused dehydration and electrolyte disturbances; destructive forms of pneumonia with severe infectious toxicosis; dyspeptic digestive disorders, in which standard diets are undesirable.

This therapy begins with intravenous drip infusions of glucose and saline solutions. When calculating the amount of sodium required per day, it should be taken into account that a 5% albumin solution contains 154 mmol/l sodium and 0.5 mmol/l potassium, a 5% plasma solution contains 142 mmol/l sodium, 5 mmol/l potassium.

The volume of fluid is calculated in any case depending on the state of the child’s cardiovascular system, the presence of signs of dehydration (degree of internal toxicosis), and the presence or absence of pathological symptoms (diarrhea, fever). Physiological fluid requirements can be determined using the Aberdeen nomogram.

Consequences of pneumonia in children with delayed diuresis

In most cases, the consequences of pneumonia in children manifest themselves in the form of urinary retention. Diuresis is controlled with the help of diuretics (Lasix or furosemide) at a dose of 1-3 mg per 1 kg of child weight. The forced diuresis technique involves accurate hourly recording of diuresis, which is carried out by inserting a catheter into the bladder. Forced diuresis is carried out in three options:

• elimination of dehydration;
• normalization of water salt metabolism;
• eliminating symptoms of increased fluid levels in the child’s body.

The dehydration elimination regimen is indicated when carrying out detoxification therapy in children with pastosity, edema and low hematocrit. During the administration of protein preparations, diuresis per 1 hour (less than 2 hours) is taken into account. The amount of liquid for the next hour is equal to the diuresis of the previous one, that is, the number of drops of liquid poured into the vein per unit time is equal to the number of drops of urine excreted. It turns out that the regime for eliminating dehydration is ensured by compensation of physiological losses with a surplus. The liquid is infused: 10% glucose with the addition of potassium, sodium, calcium salts in accordance with physiological needs.

The mode of normalization of water salt metabolism is used in patients with toxicosis without peripheral circulatory disorders or heart failure. The volume of fluid per hour is calculated as the sum of: diuresis for the previous hour + absorption losses (1 ml per kg of weight) + the volume of pathological daily losses (20 ml / kg for vomiting and diarrhea + 10 ml / kg for each degree of elevated temperature).

The regime for eliminating excess fluid is carried out for patients in whom toxicosis is combined with severe peripheral circulatory disorders, but without heart failure.

Forced diuresis should be carried out only in the intensive care unit, by well-instructed personnel and round-the-clock laboratory and functional monitoring for the following indicators: relative density of urine, hematocrit, plasma and erythrocyte electrolytes, blood glucose and urine sugar, residual nitrogen, acid-base state of the blood, central venous pressure, electrocardiogram.

If continuous intravenous therapy must last more than a day, then central veins (subclavian or femoral) are catheterized to carry it out. Monitoring of diuresis is carried out by recording the urine drained by an indwelling catheter. Blood plasma transfusions and blood purification using an artificial kidney apparatus are also used for detoxification purposes.

Differentiated therapy (carried out simultaneously with general treatment):

1. For pulmonary capillary hypertension, a blockade is used, which reduces venous return to the heart, blood flow into the pulmonary artery, pulmonary pressure (nitroglycerin), cardiac glycosides for myocardial insufficiency (digoxin in an age-related dose);
2. If intracellular pressure is low, plasma transfusion is prescribed.

With increased permeability of the alveolar-capillary membrane, the following is carried out:

A) normalization of hemodynamics of the pulmonary circulation (using aminophylline, nitroglycerin);
b) combating low blood oxygen levels;
V) prescription of hormonal drugs (initial dose of prednisolone - 1-2 mg/kg i.v.) and antihistamines (1 mg/kg i.m. three times a day);
G) correction of metabolic acidosis (cocarboxylase, and after normalization of ventilation - sodium bicarbonate intravenously depending on the acid-base state of the blood);
d) intravenous infusions of solutions of calcium gluconate and ascorbic acid.

In case of bloating and increased production of intestinal gases, an abdominal massage is performed, sorbitol is administered intravenously (1 ml per 1 kg of body weight in the form of a 10% solution in a 5% glucose solution or isotonic sodium chloride solution), 10% albumin solution, 20% vitamin solution B5 (0.5 -1 ml). For hypokalemia, potassium supplements are prescribed under the control of electrolytes. Cerucal (0.1 ml of 1% solution per year of life) or prozerin (0.1 ml of 0.05% solution per year of life), vitamins B1 (0.3-0.5 ml of 2.5% solution) are administered intramuscularly. ). In case of severe staphylococcal decay of the lungs and in the presence of flatulence, Trasylol or Contrical is added to therapy (1000 units per 1 kg IV drip). If these measures are ineffective, intravertebral anesthesia is performed. Systematic vomiting and regurgitation is an indication for gastric lavage to wash out mucus.

Prevention of intravascular coagulation with heparin is indicated for all children on mechanical ventilation and on full intravenous nutrition, with sepsis, and destructive pneumonia. For this purpose and for the prevention of thrombosis of regional vessels and catheter with total parenteral nutrition, heparin is prescribed at a dose of 0.2 units per 1 ml of any solution.

Consequences after pneumonia in the form of seizures

Children often experience consequences after pneumonia in the form of seizures. To relieve convulsive syndrome, special medical methods are used. For seizures, therapeutic measures are aimed at eliminating the main causes: low levels of oxygen in the blood, cerebral edema. Drugs that reduce brain excitability are used: seduxen (0.05-0.1 ml/kg 0.5% solution) or g-hydroxybutyric acid (GHB) intravenously or intramuscularly, phenobarbital
intravenously or intramuscularly (initial dose - 20 mg/kg the first day and then 3-4 mg/kg daily), magnesium sulfate intramuscularly (0.2 ml/kg 25% solution per injection). The anticonvulsant effect of GHB can be enhanced by simultaneous administration of droperidol (0.1 ml/kg 0.25% solution intramuscularly or intravenously, but the dose of GHB is reduced to 50 mg/kg per injection). If drug relief of seizures is ineffective, a spinal puncture is indicated (for therapeutic and diagnostic purposes).

Treatment of the consequences of pneumonia with surgical methods

In children, surgical treatment of the consequences of pneumonia is used only in cases of lung collapse. In case of staphylococcal decay of the lungs, it is necessary to use different routes of antibiotic administration: intravenous, intramuscular, aerosol, and, if indicated, locally - into the pleural cavity or abscess. For staphylococcal pneumonia, a clear positive effect will be created by anti-staphylococcal immunoglobulin at a dose of 20 AE/kg daily or every other day, 5-7 injections. Other immunoglobulins are administered. At the height of severe toxicosis, a number of clinics successfully use blood and plasma purification, which promotes the release of bacterial toxins and autotoxic substances arising during the course of the disease from the patient’s blood.

Due to the ability to suppress the enzymatic activity of microorganisms and increase their antibiotic sensitivity, protein breakdown inhibitors have found wide use in the treatment of purulent infections. For this purpose, Trasylol is used at a dose of 500-1000 inhibitory units or Contrical at a dose of 250-500 units per 1 kg of body weight intravenously twice a day for the first 5-6 days, then according to indications.

A patient with staphylococcal decay of the lungs is monitored jointly by a pediatrician and a pediatric surgeon. The tactics of surgeons boil down to the following: with simple inflammatory foci, in most cases, surgical assistance is not required; tense air cavities puncture and remove air. For abscesses with good physiological separation of sputum, treatment measures consist of creating a drainage position, performing breathing exercises, and prescribing alkaline aerosols with antibiotics 4-6 times a day. With progressive pneumonia with a large accumulation of fluid in the pleural cavity, in most cases, bronchoscopy with washing of the bronchial tree with proteolytic enzymes (chymotrypsin, Mucomist) is indicated. Hyperimmune antistaphylococcal gammaglobulin is prescribed intramuscularly 3 to 5 times depending on the severity of the disease.

With giant abscesses, there is a constant threat of its breakthrough and infection of the pleural cavity, and puncture only accelerates this process. In these cases, urgent surgical intervention (drainage) is recommended.

For all pulmonary-pleural complications of staphylococcal destruction of the lungs, emergency surgical care is required: pleural puncture (purulent inflammation of the pleura of the pleura), and drainage of the pleural cavity with active removal of pus or radical surgery - removal of the affected part of the lungs. Children with tension (“valvular”) pneumothorax (blockage of air in the pleural cavity and compression of lung tissue) require emergency assistance: an internal puncture of the anterior or posterior chest wall is made using a thick puncture needle, thereby converting a closed tension pneumothorax into an open one. This simple surgical action helps doctors save the life and health of a child. To do this, it is necessary to transfer him to the surgical department, where the pleural cavity is directly drained or a radical operation is performed.

A common disease that poses a real threat to life is pneumonia in children, in the treatment of which modern medicine has made great progress. Even 30-40 years ago, according to statistics, doctors were able to save only every 3-4 children with pneumonia.

Modern methods of therapy have reduced the mortality rate from this disease tenfold, but this does not make the disease less serious. Prognosis in the treatment of each child always depends not only on the correct diagnosis and treatment plan, but also on the timeliness of contacting a doctor.

Inflammation of the lungs, called pneumonia, is a common disease that occurs not only in children of all ages, but also in adults.

The concept of pneumonia does not include other lung diseases, for example, vascular or allergic lesions, bronchitis and various disorders in their functioning caused by physical or chemical factors.

This disease is common in children; as a rule, approximately 80% of all lung pathologies in children are pneumonia. The disease is an inflammation of the lung tissue, but unlike other lung diseases, such as bronchitis or tracheitis, with pneumonia, pathogens penetrate into the lower parts of the respiratory system.

The affected part of the lung cannot perform its functions, emit carbon dioxide and absorb oxygen. For this reason, the disease, especially acute pneumonia in children, is much more severe than other respiratory infections.

The main danger of childhood pneumonia is that without adequate treatment, the disease quickly progresses and can lead to pulmonary edema of varying severity, and even death.

In children with a weak immune system, the disease occurs in very severe forms. For this reason, pneumonia in infants is considered the most dangerous, since their immune system is not yet fully developed.

The state of the immune system plays a large role in the development of the disease, but it is important to correctly determine the cause of pneumonia, since only in this case its treatment will be successful.

Causes of pneumonia

For successful treatment of pneumonia in children, it is important to correctly diagnose the disease and identify the causative agent. The disease can be caused not only by viruses, but also by bacteria and fungi.

Often the cause is the microbe pneumococcus, as well as mycoplasma. Therefore, the nature of the occurrence of pneumonia may be different, but this particular point is important for organizing effective treatment, since the drugs to combat bacteria, viruses and fungi are completely different.

Pneumonia can have different origins:

1. Bacterial origin. The disease can occur not only against the background of another illness of the respiratory system, as a complication, but also independently. Antibiotics for pneumonia in children are used specifically for this form of the disease, since it requires careful and urgent antibiotic therapy.
2. Viral origin. This form of the disease is the most common (detected in approximately 60% of cases) and the mildest, but requires adequate treatment.
3. Fungal origin. This form of pneumonia is rare; in children, it usually occurs after inadequate treatment of respiratory diseases with antibiotics or their abuse.

Inflammation of the lungs can be unilateral, affecting one lung or part of it, or it can be bilateral, affecting both lungs at once. As a rule, with any etiology and form of the disease, the child’s temperature rises significantly.

Pneumonia itself is not a contagious disease and even with a viral or bacterial form it is very rarely transmitted from one child to another.

The only exception is atypical pneumonia, the cause of which was the activation of a certain type of mycoplasma. In this case, the disease in children is very severe, accompanied by high temperatures.

Special mycoplasmas of pneumonia, causing respiratory mycoplasmosis and pneumonia, are easily transmitted by airborne droplets, causing various forms of respiratory system diseases, the severity of which depends on the state of the child’s immune system.

The symptoms of this type of pneumonia are somewhat different:

• At the very beginning of the disease, the child’s temperature rises sharply, the values ​​of which reach 40°, but after that it decreases and becomes subfebrile with persistent values ​​of 37.2–37.5°. In some cases, complete normalization of indicators is observed.
• In some cases, the disease begins with the usual signs of an acute respiratory viral infection or a cold, such as a sore throat, frequent sneezing, and a severe runny nose.
• Then shortness of breath and a very strong dry cough appear, but acute bronchitis also has the same symptoms, this fact complicates the diagnosis. Children are often treated for bronchitis, which greatly complicates and aggravates the disease.
• By listening to a child's lungs, the doctor cannot detect pneumonia by ear. The wheezes are rare and varied in nature; there are practically no traditional signs when listening, which greatly complicates the diagnosis.
• When examining a blood test, as a rule, there are no pronounced changes, but an increase in ESR is detected, as well as neutrophilic leukocytosis, supplemented by leukopenia, anemia and eosinophilia.
• When performing an X-ray, the doctor sees in the images foci of heterogeneous infiltration of the lungs with an enhanced expression of the pulmonary pattern.
• Mycoplasmas, like chlamydia, which causes atypical pneumonia, can exist for a long time in the epithelial cells of the lungs and bronchi, and therefore the disease is usually protracted and, once it appears, can often recur.
• Treatment of atypical pneumonia in children should be done with macrolides, which include clarithromycin, josamycin and azithromycin, since pathogens are most sensitive to them.

Indications for hospitalization

Only a doctor can decide where and how to treat a child with pneumonia. Treatment can be carried out not only in a hospital setting, but also at home, however, if the doctor insists on hospitalization, this should not be prevented.

Children are subject to hospitalization:

• with a severe form of the disease;
• with pneumonia complicated by other diseases, for example, pleurisy, cardiac or respiratory failure, acute impairment of consciousness, lung abscess, drop in blood pressure, sepsis or infectious-toxic shock;
• who have damage to several lobes of the lung at once or a lobar variant of pneumonia;
• up to a year. In infants under one year of age, the disease is very severe and poses a real threat to life, so their treatment is carried out exclusively in a hospital setting, where doctors can provide them with emergency care in a timely manner. Children under 3 years of age also undergo inpatient treatment, regardless of the severity of the disease. Older children can undergo home treatment, provided that the disease is not complicated;
• who have chronic diseases or severely weakened immunity.

Treatment

In most cases, the basis of therapy for pneumonia is the use of antibiotics, and if the doctor prescribed them to the child, in no case should they be abandoned.

No folk remedies, homeopathy or even traditional methods of treating ARVI can help with pneumonia.

Parents, especially during outpatient treatment, must strictly comply with all doctor’s instructions and strictly follow all instructions in terms of taking medications, eating, drinking, resting and caring for a sick child. In a hospital, all necessary measures must be carried out by medical personnel.

Pneumonia needs to be treated correctly, which means you should follow some rules:

• Antibiotics prescribed by a doctor must be taken strictly according to the established schedule. If, as prescribed by a doctor, you need to take antibiotics 2 times a day, then an interval of 12 hours should be observed between doses. When prescribing three doses, the interval between them will be 8 hours, and this rule cannot be violated. It is important to observe the timing of taking medications. For example, cephalosporin and penicillin antibiotics are taken for no longer than 7 days, and macrolides should be used for 5 days.
• The effectiveness of treatment, expressed in improvement of the child’s general condition, improved appetite, decreased shortness of breath and decreased temperature, can be assessed only after 72 hours from the start of therapy.
• The use of antipyretic drugs will be justified only when the temperature in children over one year of age exceeds 39°, and in children under one year of age - 38°. High temperature is an indicator of the immune system’s fight against the disease, with maximum production of antibodies that destroy pathogens. For this reason, if the baby tolerates a high temperature normally, it is better not to bring it down, since in this case the treatment will be more effective. But, if the baby has had febrile convulsions at least once against the background of an increase in temperature, an antipyretic should be given only when the readings rise to 37.5°.
• Nutrition. Lack of appetite with pneumonia is a natural condition. There is no need to force your child to eat. During the treatment period, you should prepare light meals for your baby. The optimal diet would be liquid porridge, steamed cutlets made from lean meat, soups, boiled potatoes or mashed potatoes, as well as fresh fruits and vegetables rich in vitamins.
• It is also necessary to monitor your drinking regime. The child should drink plenty of pure still water, green tea with raspberries, and natural juices. If a child refuses to drink liquid in the required amount, you should give him small portions of special pharmaceutical solutions to restore the water-salt balance, for example, Regidron.
• In the child's room, it is necessary to carry out wet cleaning daily, and also monitor the air humidity; for this, you can use humidifiers or place a container of hot water in the room several times a day.
• It should also be remembered that immunomodulators and antihistamines should not be used in the treatment of pneumonia. They will not provide help, but can lead to side effects and worsen the child’s condition.
• The use of probiotics is necessary for pneumonia, since taking antibiotics causes disruption of the intestines. And to remove toxins formed from the activity of pathogens, the doctor usually prescribes sorbents.

If all instructions are followed, the sick child is transferred to the usual regimen and allowed to walk in the fresh air from about 6–10 days of therapy. For uncomplicated pneumonia, after recovery, the child is given exemption from physical activity for 1.5-2 months. If the disease is severe, sports will be allowed only after 12–14 weeks.

Prevention

It is necessary to pay special attention to preventive measures, especially after the child has suffered from an illness. It is important to prevent accumulation of sputum in the lungs, which is what causes the development of the disease.

Maintaining sufficient humidity in your baby's room will not only help ensure easy breathing, but will also be an excellent measure to prevent mucus from thickening and drying in the lungs.

Sports and high mobility of children are excellent preventive measures that help eliminate mucus from the lungs and respiratory tract and prevent the formation of its accumulations.

Drinking plenty of fluids not only helps keep your baby’s blood in good condition, but also helps thin the mucus in the airways and lungs, making it easier to eliminate naturally.

Pneumonia can be treated effectively only if all doctor's instructions are followed. But, of course, it is much easier to prevent it, and for this, any diseases of the respiratory system should be promptly and completely eliminated.

It must be remembered that pneumonia in most cases becomes a complication when colds or other diseases of the respiratory system are neglected, as well as when therapy is not carried out in a timely manner or treatment is stopped prematurely. Therefore, in order to avoid possible complications and the development of pneumonia, you should not self-medicate colds, but consult a doctor for any manifestations.

I like!

Pneumonia in a child is an acute infectious disease of a predominantly bacterial nature, characterized by focal damage to the respiratory parts of the lungs, respiratory disorders and intra-alveolar exudation, as well as infiltrative changes on radiographs of the lungs. The presence of radiological signs of infiltration of the pulmonary parenchyma is the “gold standard” for diagnosing pneumonia, allowing it to be distinguished from bronchitis and bronchiolitis.

ICD-10 code

• J12 Viral pneumonia, not elsewhere classified.
• J13 Pneumonia caused by Streptococcus pneumoniae.
• J14 Pneumonia caused by Haemophilus influenzae(Afanasyev-Pfeiffer wand).
• J15 Bacterial pneumonia, not elsewhere classified.
• J16 Pneumonia caused by other infectious agents, not elsewhere classified.
• J17 Pneumonia in diseases classified elsewhere.
• J18 Pneumonia without specifying the causative agent.

ICD-10 code

J10-J18 Flu and pneumonia

J12 Viral pneumonia, not elsewhere classified

J13 Pneumonia caused by Streptococcus pneumoniae

J14 Pneumonia caused by Haemophilus influenzae [Afanasyev-Pfeffer bacillus]

J15 Bacterial pneumonia, not elsewhere classified

J16 Pneumonia caused by other infectious agents not elsewhere classified

J17* Pneumonia in diseases classified elsewhere

J18 Pneumonia without specifying the pathogen

Epidemiology of pneumonia in children

Pneumonia is diagnosed in approximately 15-20 cases per 1000 children in the first year of life, in approximately 36-40 cases per 1000 children in preschool age, and in school and adolescence, the diagnosis of pneumonia is established in approximately 7-10 cases per 1000 children and adolescents .

The frequency of hospital-acquired pneumonia depends on the population and age of patients (accounts for up to 27% of cases of all nosocomial infections), it is maximum in young children, especially newborns and premature infants, as well as in children who have undergone surgery, trauma, burns, etc.

The mortality rate from pneumonia (including influenza) averages 13.1 per 100,000 population. Moreover, the highest mortality rate is observed in the first 4 years of life (it reaches 30.4 per 100,000 population), the lowest (0.8 per 100,000 population) is observed at the age of 10-14 years.

The mortality rate from hospital-acquired pneumonia, according to the US National Nosocomial Infections Surveillance System, at the turn of the last and present centuries was 33-37%. In the Russian Federation, the mortality rate of children from hospital-acquired pneumonia during this period has not been studied.

Causes of pneumonia in children

The most common causative agents of community-acquired pneumonia are Streptococcus pneumoniae (20-60%), Mycoplasma pneumoniae (5-50%), Chlamydia pneumoniae (5-15%), Chlamydia trachomatis (3-10%),

Haemophilus influenzae (3-10%), Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, etc. - 3-10%), Staphylococcus aureus (3-10%), Streptococcus pyogenes, Chlamydia psittaci, Coxiella bumeti, etc. However, it is necessary to take into account that the etiology of pneumonia in children and adolescents is very closely related to age.

In the first 6 months of a child’s life, the etiological role of pneumococcus and Haemophilus influenzae is insignificant, since antibodies to these pathogens are transmitted from the mother in utero. The leading role at this age is played by E. coli, K. pneumoniae and S. aureus. The etiological significance of each of them does not exceed 10-15%, but it is they that cause the most severe forms of the disease, complicated by the development of infectious toxic shock and lung destruction. Another group of pneumonia of this age is pneumonia caused by atypical pathogens, mainly C. trachomatis, which children become infected with from their mother intranatally, rarely in the first days of life. Infection with P. carinii is also possible, which is especially significant for premature infants.

From 6 months to 6-7 years, pneumonia is mainly caused by S. pneumoniae (60%). Acapsular hemophilus influenzae is often also sown. H. influenzae type b is detected less frequently (7-10%), it usually causes severe pneumonia, complicated by lung destruction and pleurisy.

Pneumonia caused by S. aureus and S. pyogenis is detected in 2-3% of cases, usually as complications of severe viral infections such as influenza, chicken pox, measles and herpes. Pneumonia caused by atypical pathogens in children of this age is mainly caused by M. pneumoniae and C. pneumoniae. It must be said that the role of M. pneumoniae has clearly increased in recent years. Mycoplasma infection is mainly diagnosed in the second or third year of life, and C. pneumoniae infection is diagnosed in children over 5 years of age.

Viruses in children of this age group can be either an independent cause of the disease or a participant in viral-bacterial associations. The most important is the respiratory syncytial (RS) virus, which occurs in approximately half of cases of viral and viral-bacterial disease. In a quarter of cases, parainfluenza viruses types 1 and 3 become the etiological factor. Influenza viruses A and B and adenoviruses play a small role. Rhinoviruses, enteroviruses, and coronaviruses are rarely detected. Pneumonia caused by measles, rubella and chickenpox viruses has also been described. As already mentioned, in addition to its independent etiological significance, respiratory viral infection in children of early and preschool age is an almost obligatory background for the development of bacterial inflammation.

The causes of pneumonia in children over 7 years of age and adolescents are practically no different from those in adults. Most often, pneumonia is caused by S. pneumoniae (35-40%) and M. pneumoniae (23-44%), less often - by C. pneumoniae (10-17%). H. influenzae type b, and pathogens such as Enterobacteriaceae (K. pneumoniae, E. coli, etc.) and S. aureus are practically not found.

Particularly worth mentioning is pneumonia in patients with immunodeficiency. In children with primary cellular immunodeficiencies, in HIV-infected patients and AIDS patients, pneumonia is most often caused by Pneumocysticus carinii and fungi of the genus Candida, as well as M. avium-intracellare and cytomegalovirus. In case of humoral immunodeficiency, S. pneumoniae, as well as staphylococci and enterobacteria are more often cultured; in case of neutropenia, gram-negative enterobacteria and fungi are cultured.

Causes of community-acquired pneumonia in patients with immunodeficiency

Pathogenesis of pneumonia in children

Of the features of the pathogenesis of pneumonia in young children, the most important is the low level of anti-infective protection. In addition, one can note the relative insufficiency of mucociliary clearance, especially with a respiratory viral infection, which, as a rule, begins pneumonia in a child. The tendency to edema of the mucous membrane of the respiratory tract and the formation of viscous sputum also contributes to impaired mucociliary clearance.

There are four main causes of pneumonia:

• aspiration of oropharyngeal secretions;
• inhalation of aerosol containing microorganisms;
• hematogenous spread of microorganisms from the extrapulmonary source of infection;
• direct spread of infection from neighboring affected organs.

In children, microaspiration of oropharyngeal secretions is of greatest importance. Aspiration of large amounts of contents from the upper respiratory tract and/or stomach is typical for newborns and children in the first months of life. Less commonly, aspiration occurs during feeding and/or vomiting and regurgitation. In children of early and preschool age, airway obstruction is most significant, especially in the case of the development of broncho-obstructive syndrome.

Factors predisposing to aspiration/microaspiration

• Encephalopathy of various origins (posthypoxic, with malformations of the brain and hereditary diseases, convulsive syndrome).
• Dysphagia (vomiting regurgitation syndrome, esophageal-tracheal fistulas, achalasia cardia, gastroesophageal reflux).
• Broncho-obstructive syndrome due to respiratory, including viral, infection.
• Mechanical violations of protective barriers (nasogastric tube, tracheal intubation, tracheostomy, esophagogastroduodenoscopy).
• Repeated vomiting with intestinal paresis, severe infectious and somatic diseases.

Symptoms of pneumonia in children

The classic symptoms of pneumonia in children are nonspecific - shortness of breath, cough (with or without sputum), fever, weakness, and symptoms of intoxication. Pneumonia should be suspected if a child develops cough and/or shortness of breath, especially when accompanied by fever. Corresponding percussion and auscultation changes in the lungs, namely shortening of the percussion sound, weakening or, conversely, the appearance of bronchial breathing, crepitus or fine rales are determined only in 50-77% of cases. It should be remembered that in early childhood, especially in children in the first months of life, these manifestations are typical for almost any acute respiratory infection, and physical changes in the lungs with pneumonia in most cases (with the exception of lobar pneumonia) are practically indistinguishable from changes with bronchitis.

According to WHO, symptoms of pneumonia in children are characterized by the following:

• febrile state with body temperature above 38 °C for 3 days or more;
• shortness of breath (with the number of respiratory movements more than 60 per minute for children under 3 months, more than 50 per minute - up to 1 year, more than 40 per minute - up to 5 years);
• retraction of the compliant areas of the chest.

Classification

Pneumonia in children is usually divided depending on the conditions of its occurrence into community-acquired (home) and hospital-acquired (hospital, nosocomial). The exception is pneumonia of newborns, which is divided into congenital and acquired (postnatal). Postnatal pneumonia, in turn, can also be community-acquired or hospital-acquired.

Community-acquired pneumonia (CAP) is understood as a disease that develops under normal living conditions of a child. Hospital-acquired pneumonia (HP) is a disease that developed after a child’s three-day stay in the hospital or during the first 3 days after his discharge.

It is customary to consider ventilator-associated hospital-acquired pneumonia (VAHP) and ventilator-non-associated hospital-acquired pneumonia (VnAHP). There are early VAHPs, developing in the first 3 days of artificial pulmonary ventilation (ALV), and late VAHPs, developing starting from the 4th day of mechanical ventilation.

Pneumonia may affect an entire lobe of the lung (lobar pneumonia), one or more segments (segmental or polysegmental pneumonia), alveoli or groups of alveoli (focal pneumonia), adjacent to the bronchi (bronchopneumonia), or interstitial tissue (interstitial pneumonia). These differences are revealed mainly by physical and radiological examination.

Based on the severity of the course, the degree of damage to the pulmonary parenchyma, the presence of intoxication and complications, mild and severe, uncomplicated and complicated pneumonia are distinguished.

Complications of pneumonia include infectious-toxic shock with the development of multiple organ failure, destruction of the pulmonary parenchyma (bullas, abscesses), involvement of the pleura in the infectious process with the development of pleurisy, empyema or pneumothorax, mediastinitis, etc.

Complications of pneumonia in children

Intrapulmonary destruction

Intrapulmonary destruction is suppuration with the formation of bullae or abscesses at the site of cellular infiltration in the lungs, caused by certain serotypes of pneumococcus, staphylococci, H. influenzae type b, hemolytic streptococcus, Klebsiella, Pseudomonas aeruginosa. Pulmonary suppuration is accompanied by fever and neutrophilic leukocytosis until emptying, which occurs either into the bronchus, accompanied by increased cough, or into the pleural cavity, causing pyopneumothorax.

Synpneumonic pleurisy

Synpneumonic pleurisy can be caused by any bacteria and viruses, starting with pneumococcus and ending with mycoplasma and adenovirus. Purulent exudate is characterized by a low pH (7.0-7.3), cytosis above 5000 leukocytes in 1 μl. In addition, the exudate can be fibrinous-purulent or hemorrhagic. With adequate antibacterial therapy, the exudate loses its purulent nature and pleurisy gradually resolves. However, complete recovery occurs after 3-4 weeks.

Metapneumonic pleurisy

Metapneumonic pleurisy usually develops in the stage of resolution of pneumococcal, less often - hemophilic pneumonia. The main role in its development belongs to immunological processes, in particular the formation of immune complexes in the pleural cavity against the background of the decay of microbial cells.

As already mentioned, metapneumonic pleurisy develops in the stage of resolution of pneumonia after 1-2 days of normal or subnormal temperature. The body temperature rises again to 39.5-40.0 °C, and the general condition is impaired. The febrile period lasts an average of 7 days, and antibacterial therapy has no effect on it. X-rays reveal pleurisy with fibrin flakes; in some children, echocardiography reveals pericaditis. In the analysis of peripheral blood, the number of leukocytes is normal or reduced, and the ESR is increased to 50-60 mm/h. Fibrin resorption occurs slowly, over 6-8 weeks, due to the low fibrinolytic activity of the blood.

Pyopneumothorax

Pyopneumothorax develops as a result of a rupture of an abscess or bulla into the pleural cavity. There is an increase in the amount of air in the pleural cavity and, as a result, a displacement of the mediastinum.

Pyopneumothorax usually develops unexpectedly: acute pain, breathing problems, and even respiratory failure occur. In case of tension valvular pyopneumothorax, urgent decompression is indicated.

Diagnosis of pneumonia in children

During the physical examination, special attention is paid to identifying the following signs:

• shortening (dullness) of percussion sound over the affected area of ​​the lung;
• local bronchial breathing, sonorous fine rales or inspiratory crepitus during auscultation;
• increased bronchophony and vocal tremor in older children.

In most cases, the severity of these symptoms depends on many factors, including the severity of the disease, the extent of the process, the age of the child, and the presence of concomitant diseases. It must be remembered that physical symptoms and cough may be absent in approximately 15-20% of patients.

Peripheral blood testing should be performed in all patients with suspected pneumonia. A leukocyte count of about 10-12x10 9 /l indicates a high probability of bacterial infection. Leukopenia less than 3x10 9 /l or leukocytosis more than 25x 10 9 /l are unfavorable prognostic signs.

Chest X-ray is the main method for diagnosing pneumonia. The main diagnostic sign is inflammatory infiltrate. In addition, the following criteria are assessed, which indicate the severity of the disease and help in choosing antibacterial therapy:

• lung infiltration and its prevalence;
• presence or absence of pleural effusion;
• the presence or absence of destruction of the pulmonary parenchyma.

Repeated radiography allows you to assess the dynamics of the process against the background of the treatment and the completeness of recovery.

Thus, clinical and radiological criteria for the diagnosis of community-acquired pneumonia are considered to be the presence of changes in the lungs of an infiltrative nature, identified by chest x-ray, in combination with at least two of the following clinical signs:

• acute febrile onset of the disease (T>38.0 °C);
• cough;
• auscultatory signs of pneumonia;
• leukocytosis > 10x10 9 / l and/or band shift > 10%. It is important to remember that a clinical and radiological diagnosis cannot be equated with an etiological diagnosis!

A biochemical blood test is a standard method for examining children with severe pneumonia who require hospitalization. The activity of liver enzymes, the level of creatinine and urea, and electrolytes in the blood are determined. In addition, the acid-base state of the blood is determined. In young children, pulse oximetry is performed.

Blood cultures are performed only in severe pneumonia and, if possible, before antibiotics are used to make an etiological diagnosis.

Microbiological examination of sputum in pediatrics is not widely used due to technical difficulties in collecting sputum in children under 7-10 years of age. It is performed mainly during bronchoscopy. Coughed sputum, aspirates from the nasopharynx, tracheostomy and endotracheal tube, and cultures of punctate pleural contents are taken as material for the study.

Serological research methods are also used to determine the etiology of the disease. An increase in titers of specific antibodies in paired sera taken during the acute period and during the recovery period may indicate mycoplasma, chlamydial or legionella infection. This method, however, does not affect treatment tactics and has only epidemiological significance.

Computed tomography has 2 times higher sensitivity in identifying foci of infiltration in the lower and upper lobes of the lungs. It is used in differential diagnosis.

Fiberoptic bronchoscopy and other invasive techniques are used to obtain material for microbiological research in patients with severe immune disorders and for differential diagnosis.

Differential diagnosis

The differential diagnosis of pneumonia in children is closely related to the age of the child, as it is determined by the characteristics of pulmonary pathology at different age periods.

In infancy, the need for differential diagnosis arises for diseases that are difficult to respond to standard treatment. In these cases, it should be remembered that, firstly, pneumonia can complicate another pathology, and secondly, clinical manifestations of respiratory failure can be caused by other conditions:

• aspiration;
• foreign body in the bronchi;
• previously undiagnosed tracheoesophageal fistula, gastroesophageal reflux;
• malformations of the lung (lobar emphysema, coloboma), heart and large vessels;
• cystic fibrosis and agantitrypsin deficiency.

In children 2-3 years of age and older, the following should be excluded:

• Kartagener's syndrome;
• pulmonary hemosiderosis;
• nonspecific alveolitis;
• selective immunodeficiency IgA.

The diagnostic search in patients of this age is based on endoscopic examination of the trachea and bronchi, scintigraphy and angiography of the lungs, tests for cystic fibrosis, determination of the concentration of agantitrypsin, etc. Finally, in all age groups it is necessary to exclude pulmonary tuberculosis.

In patients with severe immune defects, when shortness of breath and focal infiltrative changes in the lungs appear, it is necessary to exclude:

• progression of the underlying disease;
• involvement of the lungs in the main pathological process (for example, in systemic connective tissue diseases);
• consequences of the therapy (drug-induced lung injury, radiation pneumonitis).

Treatment of pneumonia in children

Treatment of pneumonia in children begins with determining the place where it will be carried out (for community-acquired pneumonia) and immediately prescribing antibacterial therapy to any patient with suspected pneumonia.

Indications for hospitalization for pneumonia in children are the severity of the disease, as well as the presence of risk factors for an unfavorable course of the disease (modifying risk factors). These include:

• the child’s age is less than 2 months, regardless of the severity and extent of the process;
• the age of the child is under 3 years with a lobar lesion of the lungs;
• damage to two or more lobes of the lungs (regardless of age);
• children with severe encephalopathy of any origin;
• children of the first year of life with intrauterine infection;
• children with malnutrition of II-III degree of any origin;
• children with congenital malformations, especially congenital defects of the heart and large vessels;
• children suffering from chronic diseases of the lungs (including bronchopulmonary dysplasia and bronchial asthma), cardiovascular system, kidneys, as well as oncohematological diseases;
• patients with immunodeficiency (long-term use of glucocorticoids, cytostatics);
• the impossibility of adequate care and fulfillment of all medical prescriptions at home (socially dysfunctional families, poor social conditions, religious views of parents, etc.);

The indication for hospitalization in the intensive care unit (ICU) or intensive care unit (ICU), regardless of modifying risk factors, is suspected pneumonia in the presence of the following symptoms:

• respiratory rates more than 80 per minute for children of the first year of life and more than 60 per minute for children over one year of age;
• retraction of the jugular fossa during breathing;
• moaning breathing, breathing rhythm disturbances (apnea, gasps);
• signs of acute cardiovascular failure;
• intractable or progressive hypothermia;
• disturbances of consciousness, seizures.

Indication for hospitalization in the surgical department or in the ICU/ICU with the possibility of providing adequate surgical care is the development of pulmonary complications (sypneumonic pleurisy, metapneumonic pleurisy, pleural empyema, lung destruction, etc.).

Antibacterial treatment of pneumonia in a child

The main method of treating pneumonia in children is antibacterial therapy, which is prescribed empirically until the results of a bacteriological study are obtained. As is known, the results of a bacteriological study become known 2-3 days or more after collecting the material. In addition, in the vast majority of cases of non-severe disease, children are not hospitalized and do not undergo bacteriological examination. This is why it is so important to know about the likely etiology of pneumonia in different age groups.

Indications for replacing the antibiotic/antibiotics are the lack of clinical effect within 36-72 hours, as well as the development of side effects.

Criteria for the lack of effect of antibacterial therapy:

• maintaining body temperature above 38 °C;
• deterioration of general condition;
• increasing changes in the lungs or pleural cavity;
• increasing dyspnea and hypoxemia.

If the prognosis is unfavorable, treatment is carried out according to the de-escalation principle, i.e. start with antibacterial drugs with the widest possible spectrum of action, followed by a transition to drugs with a narrower spectrum.

The peculiarities of the etiology of pneumonia in children in the first 6 months of life make inhibitor-protected amoxicillin () or a second-generation cephalosporin (cefuroxime or cefazolin) the drugs of choice even for mild pneumonia; for severe pneumonia, third-generation cephalosporins (ceftriaxone, cefotaxime) in monotherapy or in combination with aminoglycosides , or in combination amoxiclav + clavulanic acid with aminoglycosides.

In a child under 6 months with normal or subfebrile temperature, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, one can think about pneumonia caused by C. trachomatis. In these cases, it is advisable to immediately prescribe a macrolide antibiotic (azithromycin, roxithromycin or spiramycin) orally.

In premature infants, the possibility of pneumonia caused by P. carinii should be kept in mind. In this case, co-trimoxazole is prescribed along with antibiotics. If Pneumocystis etiology is confirmed, they switch to co-trimoxazole monotherapy for at least 3 weeks.

For pneumonia aggravated by the presence of modifying factors or with a high risk of an unfavorable outcome, the drugs of choice are the inhibitor-protected amoxicillin in combination with aminoglycosides or third- or fourth-generation cephalosporins (ceftriaxone, cefotaxime, cefepime) in monotherapy or in combination with aminoglycosides, depending on the severity of the disease , carbapenems (imipenem + cilastatin from the first month of life, meropenem from the second month of life). For staphylococcal etiology, linezolid or vancomycin is prescribed alone or in combination with aminoglycosides, depending on the severity of the disease.

Alternative drugs, especially in cases of development of destructive processes in the lungs, are linezolid, vancomycin, carbapenems.

The choice of antibacterial drugs in children during the first 6 months of life with pneumonia

At the age of 6-7 months to 6-7 years, when choosing initial antibiotic therapy, three groups of patients are distinguished:

• patients with non-severe pneumonia who do not have modifying factors or have modifying factors of a social nature;
• patients with severe pneumonia and patients with modifying factors that aggravate the prognosis of the disease;
• patients with severe pneumonia and a high risk of adverse outcome.

For patients in the first group, it is most advisable to prescribe oral antibacterial drugs (amoxicillin, amoxicillin + clavulanic acid or the second generation cephalosporin cefuroxime). But in some cases (lack of confidence in fulfilling prescriptions, the child’s condition is quite serious, when parents refuse hospitalization, etc.), a stepwise method of treatment is justified: in the first 2-3 days, antibiotics are administered parenterally, and then, when the condition improves or stabilizes, the same drug is prescribed orally. For this, amoxicillin + clavulanic acid is used, but it must be administered intravenously, which is difficult at home. Therefore, cefuroxime is more often prescribed.

In addition to ß-lactams, treatment can be carried out with macrolides. But, given the etiological significance of Haemophilus influenzae (up to 7-10%) in children of this age group, only azithromycin, to which H. influenzae is sensitive, is considered the drug of choice for initial empirical therapy. Other macrolides are an alternative if ß-lactam antibiotics are intolerant or if they are ineffective, for example, with pneumonia caused by atypical pathogens M. pneumoniae and C. pneumoniae, which is quite rare at this age. In addition, if the drugs of choice are ineffective, third generation cephalosporins are used.

Patients of the second group are shown parenteral administration of antibiotics or the use of a stepwise method. The drugs of choice, depending on the severity and extent of the process and the nature of the modifying factor, are amoxicillin + clavulanic acid, ceftreaxone, cefotaxime and cefuroxime. Alternative drugs if initial therapy is ineffective - third or fourth generation cephalosporins, carbapenems. Macrolides are rarely used in this group, since the overwhelming majority of pneumonia caused by atypical pathogens is not severe.

Patients with a high risk of an unfavorable outcome or with severe purulent-destructive complications are prescribed antibacterial drugs according to the de-escalation principle, which involves the use of linezolid alone or in combination with an aminoglycoside at the beginning of treatment, as well as a combination of a glycopeptide or fourth-generation cephalosporin with aminoglycosides. An alternative is to prescribe carbapenems.

The choice of antibacterial drugs for the treatment of pneumonia in children from 6-7 months to 6-7 years

Form of pneumonia	Drug of choice	Alternative therapy
Mild pneumonia	Amoxicillin. Amoxicillin + clavulanic acid. Cefuroxime. Azithromycin	II generation cephalosporins. Macrolides
Severe pneumonia and pneumonia in the presence of modifying factors	Amoxicillin + clavulanic acid. Cefuroxime or ceftriaxone. Cefotaxime	III or IV generation cephalosporins alone or in combination with an aminoglycoside. Carbapenems
Severe pneumonia with a high risk of poor outcome	Linezolid alone or in combination with an aminoglycoside. Vancomycin alone or in combination with an aminoglycoside. Cefepime alone or in combination with an aminoglycoside	Carbapenems

When choosing antibacterial drugs for pneumonia in children over 6-7 years of age and adolescents, two groups of patients are distinguished:

• with mild pneumonia;
• with severe pneumonia requiring hospitalization, or with pneumonia in a child or adolescent with modifying factors.

The antibiotics of choice for the first group are amoxicillin and amoxicillin + clavulanic acid or macrolides. Alternative drugs are cefuroxime or doxycycline, as well as macrolides if amoxicillin or amoxicillin + clavulanic acid was previously prescribed.

The antibiotics of choice for the second group are amoxicillin + clavulanic acid or second generation cephalosporins. Alternative drugs are third or fourth generation cephalosporins. Macrolides should be preferred in cases of intolerance to ß-lactam antibiotics and in pneumonia presumably caused by M. pneumoniae and C. pneumoniae.

The choice of antibacterial drugs for the treatment of pneumonia in children and adolescents (7-18 years old)

For pneumonia in patients with immunocompromised patients, empirical therapy begins with third or fourth generation cephalosporins, vancomycin or linezolid in combination with aminoglycosides. Then, as the pathogen is clarified, either continue the therapy started, for example, if pneumonia is caused by Enterobacteriaceae (K. pneumoniae, E. coli, etc.), S. aureus or Streptococcus pneumoniae, or prescribe co-trimoxazole (20 mg/kg according to trimethoprim ) when pneumocystis is detected, or fluconazole is prescribed for candidiasis and amphotericin B for other mycoses. If pneumonia is caused by viral agents, then antiviral drugs are prescribed.

The duration of the course of antibiotics depends on their effectiveness, the severity of the process, the complexity of pneumonia and the premorbid background. The usual duration is 2-3 days after obtaining a lasting effect, i.e. about 6-10 days. Complicated and severe pneumonia usually require a course of antibiotic therapy for at least 2-3 weeks. In patients with immunocompromised patients, the course of antibacterial drugs is at least 3 weeks, but may be longer.

The choice of antibacterial drugs for pneumonia in patients with immunocompromised patients

Character immunodeficiency	Etiology of pneumonia	Drugs for therapy
Primary cellular immunodeficiency	Pneumocysta carinii. Fungi of the genus Candida	Co-trimoxazole 20 mg/kg according to trimethoprim. Fluconazole 10-12 mg/kg or amphotericin B in increasing doses, starting from 150 units/kg and up to 500 or 1000 units/kg
Primary humoral immunodeficiency	Enterobacteria (K. pneumoniae, E. coli, etc.). Staphylococci (S. aureus, S. epidermidis, etc.). Pneumococci	Cephalosporins 111 or IV generation in monotherapy or in combination with aminoglycosides. Linezolid or vancomycin in monotherapy or in combination with aminoglycosides. Amoxicillin + clavulanic acid in monotherapy or in combination with aminoglycosides
Acquired immunodeficiency (HIV-infected, AIDS patients)	Pneumocystis. Cytomegaloviruses. Herpes viruses. Fungi of the genus Candida	Co-trimoxazole 20 mg/kg according to trimethoprim. Ganciclovir. Acyclovir. Fluconazole 10-12 mg/kg or amphotericin B in increasing doses, starting from 150 units/kg and up to 500 or 1000 units/kg
Neutropenia	Gram negative enterobacteria. Fungi of the genus Candida, Aspergillus, Fusarium	III or IV generation cephalosporins in monotherapy or in combination with aminoglycosides. Amphotericin B in increasing doses, starting from 150 units/kg and up to 500 or 1000 units/kg

Doses, routes and frequency of administration of antibacterial drugs for community-acquired pneumonia in children and adolescents

Preparation		Path introduction	Multiplicity introduction
Penicillin and its derivatives
[Amoxicillin	25-50 mg/kg body weight. For children over 12 years old, 0.25-0.5 g every 8 hours		3 times a day
Amoxicillin + clavulanic acid	20-40 mg/kg body weight (according to amoxicillin). For children over 12 years of age with non-severe pneumonia, 0.625 g every 8 hours or 1 g every 12 hours		2-3 times a day
Amoxicillin + clavulanic acid	30 mg/kg body weight (for amoxicillin). For children over 12 years old, 1.2 g every 8 or 6 hours		2-3 times a day
I and II generation cephalosporins
Cefazolin	60 mg/kg body weight. For children over 12 years old, 1-2 g every 8 hours		3 times a day
Cefuroxime	50-100 mg/kg body weight. For children over 12 years old, 0.75-1.5 g every 8 hours		3 times a day
Cefuroxime	20-30 mg/kg body weight.		2 times a day
III generation cephalosporins
Cefotaxime	50-100 mg/kg body weight. For children over 12 years old, 2 g every 8 hours		3 times a day
Ceftriaxone	50-75 mg/kg body weight. For children over 12 years old, 1-2 g 1 time per day		1 time per day
IV generation cephalosporins
	100-150 mg/kg body weight. For children over 12 years old, 1-2 g every 12 hours		3 times a day

Carbapenems
Imipenem	30-60 mg/kg body weight. For children over 12 years old, 0.5 g every 6 hours		4 times a day
Meropenem	30-60 mg/kg body weight. For children over 12 years old, 1 g every 8 hours		3 times a day
Glycopeptides
Vancomycin	40 mg/kg body weight. For children over 12 years old, 1 g every 12 hours		3-4 times a day
Oxazolidinones
Linezolid	10 mg/kg body weight		3 times a day
Aminoglycosides
Gentamicin	5 mg/kg body weight		2 times a day
Amikacin	15-30 mg/kg body weight		2 times a day
Netilmicin	5 mg/kg body weight		2 times a day
Macrolides
Erythromycin	40-50 mg/kg body weight. For children over 12 years old, 0.25-0.5 g every 6 hours		4 times a day
Spiramycin	15,000 IU/kg body weight. For children over 12 years old, 500,000 IU every 12 hours		2 times a day
Roxithromycin	5-8 mg/kg body weight. For children over 12 years old, 0.25-0.5 g every 12 hours		2 times a day
Azithromycin	10 mg/kg body weight on the first day, then 5 mg/kg body weight per day for 3-5 days. For children over 12 years old, 0.5 g 1 time per day, every day		1 time per day

Tetracyclines
Doxycycline	5 mg/kg body weight. For children over 12 years old, 0.5-1 g every 8-12 hours		2 times a day
Doxycycline	2.5 mg/kg body weight. For children over 12 years old, 0.25-0.5 g every 12 hours		2 times a day
Antibacterial drugs of different groups
Co-trimoxazole	20 mg/kg body weight (as trimethoprim)		4 times a day
Amphotericin B	Start with 100,000-150,000 units, gradually increasing by 50,000 units per 1 administration once every 3 days up to 500,000-1,000,000 units		1 time every 3-4 days
Fluconazole	6-12 mg/kg body weight	IV, inside	1 time per day

Evaluation of the effectiveness of treatment of pneumonia in children

The ineffectiveness of therapy and a high risk of unfavorable prognosis of the disease should be indicated if, within the next 24-48 hours, the following is noted:

• increase in respiratory failure, decrease in the PaO2/P1O2 ratio;
• a drop in systolic pressure, which indicates the development of infectious shock;
• an increase in the size of pneumonic infiltration by more than 50% compared to the original;
• other manifestations of multiple organ failure.

In these cases, after 24-48 hours, a transition to alternative drugs and increased functional support of organs and systems is indicated.

Stabilization of the condition during the first 24-48 hours from the start of treatment and some regression of radiological changes and homeostatic disorders on the 3-5th day of therapy indicate the success of the chosen tactics.

The transition to taking antibacterial drugs orally is indicated:

• with stable normalization of body temperature;
• with a decrease in shortness of breath and cough;
• with a decrease in leukocytosis and neutrophilia in the blood.
• It is usually possible in case of severe pneumonia on the 5-10th days of treatment.

Dynamic radiographic examination during the acute period of the disease is carried out only if there is progression of symptoms of lung damage or if signs of destruction and/or involvement of the pleura in the inflammatory process appear.

With clear positive dynamics of clinical manifestations confirmed by dynamic radiographs, there is no need for control radiography upon discharge. It is more advisable to carry it out on an outpatient basis no earlier than 4-5 weeks from the onset of the disease. Mandatory X-ray monitoring before discharge of the patient from the hospital is justified only in cases of complicated pneumonia.

In the absence of positive dynamics of the process within 3-5 (maximum 7) days of therapy, protracted course, torpidity to the therapy, it is necessary to expand the range of examination both in terms of identifying unusual pathogens (C. psittaci, P. aerugenoza, Leptospira, C. burneti), and in terms of identifying other lung diseases.