Pneumonia is an inflammation of the lung tissue, mainly of an infectious origin, in which the alveoli are affected. The course of this disease in children has a number of features.
This dangerous disease is often called pneumonia - under the influence of various factors, the pathological process develops in the lung tissue, causing a syndrome of respiratory disorders. In children, the disease is among the severe enough and requires treatment in a hospital.
Causes of pneumonia
Pneumonia is considered a polietiologic disease. The type of a specific pathogen may be associated with the state of the child's immunity, his living conditions and location (in the case of hospital pneumonia).
Among the microorganisms that can be the causative agents of this disease, one can distinguish:
- pneumococcus (detected in about a quarter of patients);
- mycoplasma (about 30%);
- chlamydia (about 30%).
In addition, staphylococcus (aureus and epidermal), fungi, mycobacterium tuberculosis, Haemophilus influenzae and a number of other pathogens, including viruses (influenza, parainfluenza, rubella, cytomegalovirus, etc.), can become the cause of the disease.
In particular, in the body of babies aged from six months to five years, who fell ill at home, doctors most often find pneumococcus and Haemophilus influenzae. In preschoolers and primary school children, especially in the summer-autumn period, pneumonia caused by mycoplasma prevails.
In the case of community-acquired pneumonia, its own (endogenous) bacterial flora from the nasopharynx is more often activated, but it is not excluded that the pathogen penetrates from the outside.
Factors that can contribute to the development of pneumonia include:
- ARVI;
- hypothermia of the body;
- ingestion of vomit into the child's respiratory tract when regurgitating either food or foreign bodies.
In addition, a lack of vitamins and insufficiently developed immunity can play a fatal role. The risk of pneumonia also increases in young patients with rickets, congenital heart disease, after birth trauma, serious stressful situations, against the background of cystic fibrosis.
Nosocomial (hospital) pneumonia is observed when a child is treated in a hospital for any other disease. Inflammation of the lungs in such cases is caused by pathogens that are resistant to antibiotics. Among the so-called "hospital" strains - Klebsiella, Proteus, Pseudomonas aeruginosa, staphylococci. Pneumonia caused by the patient's endogenous microorganisms is not excluded.
According to statistics, in recent years, the incidence of pneumonia in children under 3 years of age is about 20 cases per thousand, and in older children - about 6 cases per thousand.
Symptoms of pneumonia
The clinical picture depends on the type of pneumonia - according to the existing classification, this disease can be:
- one - or two-sided;
- focal;
- segmental (when inflammation spreads, covering the entire segment of the lung);
- drain (several segments are affected);
- lobar (inflammation is localized in the upper or lower lobe).
In addition, depending on the localization of inflammation, there are:
- bronchopneumonia;
- pleuropneumonia;
- exudative pleurisy (when fluid appears in the pleural cavity, the condition can complicate the course of the disease).
The clinic also depends on the age of the child. In older children, the symptoms are clearer and more characteristic, while in the smallest patients, after minimal manifestations, severe respiratory failure and oxygen starvation develop quite quickly.
Usually, the first manifestations of pneumonia are such general signs as tearfulness, difficulty in nasal breathing, loss of appetite, and drowsiness. Later, the temperature may suddenly rise, remaining at around 38 ° C for several days. By that time, increased respiration and heart rate also appear, the skin turns pale.
A cough with pneumonia can appear only on the fifth or sixth day, it can be different - deep or superficial, dry or wet, paroxysmal. When involved in the inflammatory process of the bronchi, sputum begins to appear.
Symptoms from other systems are likely to include:
- muscle pain;
- skin rashes;
- stool disorders (diarrhea);
- convulsions - in infants with a high temperature.
The clinical manifestations of staphylococcal pneumonia include a higher (up to 40 ° C) temperature, which does not go astray for several days (up to ten days). In this case, the disease is characterized by an acute onset and a rapid increase in the severity of symptoms.
Diagnostics
During the examination, the doctor can conclude about intoxication and respiratory failure, wheezing in the lungs and other important symptoms.
Pneumonia is often detected during auscultation of the lungs, taking into account the accompanying clinical manifestations and information obtained from interviewing the patient or his parents. When tapping the chest over the affected area, a shortening of the sound is often observed. However, the absence of this symptom cannot exclude pneumonia.
According to some experts, in the smallest patients, pneumonia is "easier to see than hear." The fact is that even in the absence of changes during listening, such signs of pneumonia as shortness of breath, retraction of the auxiliary muscles, cyanosis of the nasolabial triangle, and refusal of food become obvious.
If pneumonia is suspected, an X-ray examination is immediately carried out, which can not only confirm the diagnosis, but also give an idea of the localization and level of spread of the inflammatory process in the lungs.
Clinical analysis is also quite informative. With pneumonia, it shows:
- an increase in the number of leukocytes;
- an increase in the number of stab leukocytes;
- an increased level of ESR indicating inflammation.
However, pneumonia can also occur against the background of the absence of such characteristic changes in the blood.
Based on the results of bacteriological analysis of mucus from the nose and throat, as well as sputum (if possible), the specific type of pathogen is determined, as well as its sensitivity to antibiotics.
If there is a suspicion of the viral nature of the disease, a virological method is used, in order to diagnose chlamydial and mycoplasma infections - ELISA and PCR.
According to indications (with a severe course of the disease and the risk of complications), patients are given an ECG and other studies.
Treatment
With a confirmed diagnosis, young children are admitted to the hospital, as well as older patients with signs of respiratory failure. Doctors urge parents not to abandon the hospital, as the course of the disease is unpredictable. With pneumonia, the severity of the condition can increase very quickly.
The issue of emergency hospitalization of a child with pneumonia is decided taking into account a number of other factors, in particular:
- the presence of developmental abnormalities and congenital diseases;
- the presence of concomitant diseases;
- possible hypotrophy;
- immunodeficiency states;
- socially unprotected family, etc.
Doctors allow the treatment of children over the age of three at home only if they are fully confident in the careful implementation of all appointments.
The main component of therapy for patients with pneumonia is drugs designed for the causative agent of the disease. The effectiveness of treatment can usually be judged after 1-2 days, according to objective data, the results of laboratory tests, as well as repeated X-ray images.
In the case when the patient's condition does not improve, the question is raised about changing the treatment regimen, or drugs are combined with drugs of another group.
Antibiotics from three main groups are commonly used to treat pneumonia in children:
- ampicillin, amoxiclav (semi-synthetic penicillins);
- azithromycin, erythromycin (macrolides);
- cephalosporins of II and III generations.
Patients with severe illness are also prescribed aminoglycosides, imipinems.
Legionella pneumonia is treated primarily with rifampicin. In the treatment of fungal pneumonia, drugs such as amphotericin B, fluconazole, etc. are prescribed.
Fluoroquinolones in the treatment of pediatric patients are used only in extreme cases when it comes to vital indications.
As long as the temperature remains high, patients need strict bed rest.
Intravenous detoxification is used in the most severe cases, as well as in complications that develop against the background of pneumonia.
In order to prevent the destruction of lung tissue in the first three days, patients with an extensive inflammatory process are sometimes prescribed drugs gordox, contrikal and other antiproteases.
Other medicines used for pneumonia in children include:
- antipyretic (with the threat of seizures developing against a background of high fever in babies);
- non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen) - with persistent fever;
- short courses of corticosteroids - with complications such as pleurisy;
- ACC, bromhexine, mucobene and other mucolytics and expectorants - in case of persistent cough with thick, difficult to separate phlegm; mucolytics are prescribed.
Adequate drinking, inhalation with warm alkaline mineral water or 2% baking soda solution contribute to the liquefaction of sputum.
Physiotherapeutic methods of treatment, including inductothermy, microwave, electrophoresis, are also considered effective for pneumonia. Massage and physiotherapy exercises, connected immediately after the disappearance of the fever, can speed up the recovery process and reduce the risk of complications after pneumonia
Providing the required volume of fluid is important. With pneumonia, the child should drink as much as possible - water, fruit drinks, herbal teas, vegetable teas and compotes, depending on age. Babies under one year of age are recommended to drink a volume of liquid equal to 140 ml / kg of their weight per day (including breast milk or a mixture if the child is artificially or mixed feeding).
Recovery period
Comprehensive health measures are recommended for convalescent patients:
- regular walks in the fresh air;
- oxygen cocktails prepared with juices and herbs;
- a complete diet and vitamin therapy.
Children who have had pneumonia should be monitored by a local pediatrician over the next year, periodically donating blood and visiting an ENT doctor, allergist and pulmonologist.
