Pneumonia is an acute inflammation, predominantly of an infectious origin, affecting all structural elements of the lungs. The process proceeds with such manifestations as severe cough, intoxication, deterioration of respiratory function. It is accompanied by infiltrative changes in the lung tissue. The incidence in children of the youngest age is about 20 cases per thousand people, in children over three years old – 5-6 cases per thousand people. In the structure of all pathologies of the respiratory system in pediatric pulmonary practice, pneumonia accounts for 1-1.5%. The percentage of complications and deaths of this disease is quite high, despite the achievements of modern pediatrics and the pharmaceutical industry.
Classification
The classification is carried out according to radiological, etiological signs. They also share different types of pathology, depending on how and where the infection occurred, the severity and duration of the course of the disease, the presence of complications.
On the basis of the conditions in which the infection was transmitted to the child, hospital, out-of- hospital and congenital forms of pneumonia are distinguished . Inflammation of the lungs that occurs outside the hospital is most often a complication of ARVI. Nosocomial pneumonia is diagnosed if the pathology manifests itself after three days of the child’s stay in the clinic, as well as in cases where the manifestation of the disease occurred on the third day after discharge from the hospital (or earlier).
Congenital forms are diagnosed if infection occurs even before birth, and symptoms begin to unfold in the first three days of a child’s life.
Pneumonia can occur with or without complications. Depending on how long the pathology lasts, acute and protracted forms of the disease are distinguished. By origin, pneumonia can be bacterial, viral, parasitic, fungal, or have a mixed etiology.
Pneumonia is also classified:
- focal – characterized by the presence in the lungs of small foci of infiltration, localized in one (sometimes more) segment, accumulation of exudate in the alveoli, can be both unilateral and bilateral;
- segmental – the pathological process extends to the whole segment, while the affected lobe of the lung falls off, such pneumonia often has a protracted course;
- interstitial – occur with damage to the connective tissue of the lungs;
- croupous – a severe form that affects one or more lobes of the lung, pleural tissues are involved in the process.
Causes of the disease
The etiology of pneumonia depends on the age and conditions of infection. Newborn babies most often become infected while still in the womb or suffer from hospital-acquired pneumonia. The causes of congenital inflammation in infants are most often viral infections (herpes viruses type 1 and 2, varicella zoster , cytomegalovirus, influenza and parainfluenza viruses, measles, respiratory syncytial virus) or chlamydia. Hospital-acquired pneumonia at the age of one month and earlier, as a rule, is provoked by streptococcus (group B), Staphylococcus aureus, Friedlander’s bacillus or E. coli.
In the first year of life, pneumococcal infection becomes the cause of community-acquired pneumonia in 80% of cases. After one year of age and up to 7 years, pneumonia begins due to the penetration of such pathogens:
- Pfeiffer’s wand ;
- Friedlander’s wand ;
- Pseudomonas aeruginosa;
- colibacillus;
- Staphylococcus aureus;
- enterobacter ;
- Proteus.
Children over seven years old today are often diagnosed with atypical pneumonia, provoked by mycoplasmas or chlamydia.
The provoking factors of childhood pneumonia are:
- prematurity;
- hypotrophy;
- immunodeficiency states;
- hypothermia;
- stress;
- rickets;
- severe congenital heart disease;
- the presence of chronic infectious foci.
Most often, the penetration of infection into a child’s body occurs by inhalation of pathogenic microorganisms, for example, through contact with infectious patients. Aspiration pneumonia may develop due to aspiration of the contents of the nasopharynx, stomach, food particles during regurgitation . Nosocomial microorganisms can enter the body during various medical procedures (inhalation, artificial ventilation of the lungs, bronchoscopy, and others). Sometimes infectious agents enter the lung tissue from distant foci with blood flow.
Symptoms in children
Typical symptoms of pneumonia in children are:
- a significant increase in temperature (up to 38 degrees and above);
- febrile symptoms;
- severe weakness;
- sleep disorders;
- lack of appetite;
- vomiting (often observed in infants, it can also occur at an older age with a croupous form of the disease);
- cough (may be unproductive or accompanied by the discharge of a large amount of phlegm);
- dyspnea;
- cyanosis in the area of the nasolabial triangle;
- respiratory failure (characteristic of severe inflammation that spreads to large volumes of lung tissue).
Diagnostics
Diagnosis of pneumonia in children begins with a physical examination and analysis of the clinical picture. X-ray diagnostics in most cases allows you to make a final diagnosis: the changes in the lung tissues that occur under the influence of inflammation are clearly visible in the images.
Also, the doctor prescribes the following types of laboratory tests:
- general blood analysis;
- blood biochemistry;
- oximetry (determination of blood oxygen saturation);
- bacteriological culture of sputum;
- serological tests to identify certain pathogens (enzyme immunoassay, polymerase chain reaction);
- microscopy of sputum or nasopharyngeal secretions.
In difficult cases, the doctor may prescribe a computed tomography of the lungs, bronchoscopy.
Treatment methods
If the disease is easy enough, and the child does not suffer from any serious pathologies, then the treatment can be carried out at home. A child should be treated on an outpatient basis, strictly following the recommendations and prescriptions of the attending physician. Hospitalization is highly recommended in the following cases:
- age up to three years;
- chronic diseases of the bronchopulmonary system;
- severe respiratory failure;
- congenital defects and heart defects;
- immunodeficiency states;
- the spread of the inflammatory process to the pleural tissues;
- extensive damage to lung tissue by the inflammatory process;
- chronic kidney disease.
Both at home and in the hospital, for the period of persistence of febrile phenomena, a small patient should be provided with bed rest, abundant warm drink, high-calorie food that provides all the needs of a weakened body.
The main method of treating pneumonia in children is antibiotic therapy. It takes quite a long time to recognize the pathogen, and measures should be taken to suppress infectious agents quickly; at the initial stage of treatment, the doctor prescribes broad-spectrum drugs. After the pathogen has been identified and its resistance to antibacterial agents has been determined, other types of antibiotics may be prescribed. Replacement of the drug is also done if after 1-2 days there is no positive dynamics in the patient’s condition.
In addition to antibacterial drugs, medications are prescribed to reduce the severity of symptoms:
- antipyretic;
- mucolytics ;
- bronchodilators ;
- antihistamines .
When the febrile phenomena cease to appear, physiotherapeutic procedures (UHF, electrophoresis, aerosol therapy), physiotherapy exercises are prescribed for a speedy recovery.
Pneumonia in a child can be treated with folk remedies, but they must be agreed with the attending physician and considered as additional measures aimed at alleviating symptoms. Alternative medicine methods help to cure a child faster, but using them exclusively is dangerous to his health and life.
Prophylaxis
For the prevention of pneumonia in children, the following recommendations should be observed:
- the child’s nutrition should provide the developing body with all the necessary nutrients, vitamins and microelements;
- dress the child according to the weather;
- from an early age, it is necessary to take measures aimed at strengthening the baby’s immunity, hardening the body;
- it is necessary to timely and adequately treat all emerging respiratory diseases, otolaryngological pathologies;
- preventive vaccinations against pneumococcal infection, influenza, Haemophilus influenzae should be given.
A child who has had pneumonia should be regularly shown to a pediatrician, pulmonologist or otolaryngologist until complete rehabilitation for the purpose of a dispensary examination.
Possible complications
The course of pneumonia in a child can be complicated by the occurrence of the following dangerous conditions:
- inflammation of the pleural tissues;
- empyema of the pleura;
- suppuration of lung tissue;
- pneumothorax;
- severe respiratory failure;
- thrombohemorrhagic syndrome;
- multiple organ failure syndrome;
- insufficiency of heart function.
Pneumonia at an early age usually has a good prognosis if the child is otherwise healthy. If this disease develops against the background of serious immunodeficiency, severe pathologies, then the prospects are deteriorating. Predictions are unfavorable if the inflammatory process is complicated by destruction, suppuration in the lung tissues. The child must be treated strictly following the recommendations of the attending physician, since the consequences of a protracted course of pneumonia are often the development of chronic pathologies of the bronchopulmonary system.