Pneumonia in a child: symptoms, signs, treatment
This dangerous disease is often called pneumonia - under the influence of various factors, the pathological process develops in the lung tissue, causing the syndrome of respiratory disorders. In children, the disease is among the most severe and requires treatment in a hospital.
Causes of pneumonia
Pneumonia is considered a polyetiologic disease. The type of specific pathogen may be associated with the state of the child's immunity, the conditions of his life and location (in the case of hospital pneumonia).
Among the microorganisms that can be the causative agents of this disease, we can distinguish:
- pneumococcus (detected in about a quarter of cases);
- mycoplasma (about 30%);
- chlamydia (about 30%).
In addition, staphylococcus (golden and epidermal), fungi, mycobacterium tuberculosis, hemophilus bacillus and a number of other pathogens, including viruses (influenza, parainfluenza, rubella, cytomegalovirus, etc.) can cause the disease.
In particular, in the body of babies from six months to five years of age who are sick at home, most often doctors find pneumococcus and hemophilic wand. At preschool children and pupils of elementary grades, especially in the summer-autumn period, pneumonia caused by mycoplasma prevails.
In the case of community-acquired pneumonia, the intrinsic (endogenous) bacterial flora from the nasopharynx is more often activated, but penetration of the pathogen from the outside is not excluded.
Factors that may contribute to the development of pneumonia include:
- vomit in the child's airway when regurgitating either food or foreign bodies.
In addition, a fatal role can play a lack of vitamins and insufficiently developed immunity. 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 in a hospital is treated for some other disease. Inflammation of the lungs in such cases is caused by pathogens resistant to the action of antibiotics.Among the so-called "hospital" strains - Klebsiella, Proteus, Pseudomonas aeruginosa, staphylococcus. It is not excluded pneumonia, caused by endogenous microorganisms of the patient.
According to statistics, in recent years, the incidence of pneumonia in children under 3 years 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 - in accordance with the existing classification, this disease can be:
- single or double sided;
- segmental (when inflammation spreads, covering the entire lung segment);
- drain (affected by several segments);
- lobar (inflammation is localized in the upper or lower lobe).
In addition, depending on the location of inflammation emit:
- exudative pleurisy (with the appearance of fluid in the pleural cavity, the condition may 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, whereas in the smallest patients, after minimal manifestations, severe respiratory insufficiency and oxygen starvation develop quickly enough.
Usually the first manifestations of pneumonia are such common symptoms as weeping, difficulty in nasal breathing, loss of appetite, drowsiness. Later, the temperature may suddenly rise, remaining at more than 38 ° C for several days. By the time there is also an increase in respiration and heart rate, the skin turns pale.
Cough with pneumonia can appear only on the fifth or sixth day, it can be different - deep or superficial, dry or wet, paroxysmal. With involvement in the inflammatory process of the bronchi, sputum begins to appear.
Among the symptoms of other systems are likely:
- muscle pain;
- skin rashes;
- stool disorders (diarrhea);
- convulsions - in infants with a high fever.
The clinical manifestations of staphylococcal pneumonia include a higher (up to 40 ° C) temperature, which does not stray 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.
During the examination, the doctor may 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 a survey of the patient or his parents. When the chest is tapped over the lesion, sound shortening is often observed. However, the absence of this feature cannot exclude pneumonia.
According to some experts, in the smallest patients, pneumonia is “easier to see than to hear.” The fact is that even in the absence of changes when listening, such signs of pneumonia as dyspnea, auxiliary muscle engaging, cyanosis of the nasolabial triangle, refusal of food become evident.
If you suspect pneumonia, an x-ray examination is immediately carried out, which not only can confirm the diagnosis, but also give an idea of the location and extent of the inflammatory process in the lungs.
Rather informative and clinical analysis. In pneumonia, it shows:
- increased white blood cell count;
- increase in the number of stab leukocytes;
- evidence of inflammation, elevated levels of ESR.
However, pneumonia can also occur in the absence of such characteristic changes in the blood.
The results of bacteriological analysis of mucus from the nose and throat, as well as sputum (if possible) determine the specific type of pathogen, as well as its sensitivity to antibiotics.
If a viral nature of the disease is suspected, a virological method is used, and for the diagnosis of chlamydial and mycoplasmal infections, ELISA and PCR are used.
According to the testimony (in case of severe illness and the risk of complications), ECG and other studies are performed on patients.
With a confirmed diagnosis, young children are hospitalized in the hospital, as well as older patients with signs of respiratory failure. Doctors persuade parents not to abandon the hospital, since the course of the disease is unpredictable. With pneumonia, the severity of the condition can increase very quickly.
The question of emergency hospitalization of a child with pneumonia is solved taking into account several other factors, in particular:
- developmental abnormalities and congenital diseases;
- the presence of concomitant diseases;
- possible hypotrophy;
- immunodeficiency states;
- socially unprotected family, etc.
Doctors allow treatment of children older than three years at home only if they are fully confident that all appointments are carefully carried out.
The main component of the treatment of 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 re-taken X-ray photographs.
In the case when the patient's condition does not improve, the question of changing the treatment regimen is raised, or the drugs are combined with drugs from another group.
Usually in the treatment of pneumonia in children, antibiotics are used from three main groups:
- ampicillin, amoxiclav (semi-synthetic penicillins);
- azithromycin, erythromycin (macrolides);
- cephalosporins II and III generations.
Aneglycoside, imipinem, is also prescribed to patients whose disease is severe.
Legionella inflammation of the lungs is treated mainly 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 fever remains high, patients need strict bed rest.
Intravenous detoxification is used in the most severe cases, as well as for complications that have developed against the background of pneumonia.
Patients with extensive inflammation in order to prevent the destruction of lung tissue in the first three days are sometimes prescribed drugs gordox, kontrykal and other antiproteases.
Among other medicines that are used for pneumonia in children:
- antipyretic (with the threat of seizures on the background of high temperature in children);
- nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen) - with persistent fever;
- short courses of corticosteroids - with complications in the form of pleurisy;
- ACC, Bromhexine, Mucobene and other mucolytics and expectorant drugs - in case of persistent cough with thick, difficult to separate sputum ;. mucolytics are prescribed.
Adequate drinking, inhalation with warm alkaline mineral water or 2% solution of baking soda contribute to the dilution of sputum.
Physiotherapeutic methods of treatment, including inductothermia, microwave, electrophoresis, are also considered effective in pneumonia. Massage and physical therapy, connected immediately after the disappearance of fever, can speed up the recovery process and reduce the risk of complications after pneumonia
An important role is played by ensuring the required volume of fluid. In pneumonia, the child should drink as much as possible - water, fruit drinks, herbal teas, vegetable decoctions and fruit drinks, depending on age. It is recommended for babies up to one year old to drink a volume of liquid equal to 140 ml / kg of their mass (including breast milk or formula, if the child is artificially or mixed-fed).
Convalescent patients are recommended comprehensive health measures:
- regular walks in the fresh air;
- oxygen cocktails made with juices and herbs;
- full diet and vitamin therapy.
Children who have had pneumonia should be monitored by a district pediatrician for the next year, periodically donating blood and visiting an ENT specialist, an allergist and a pulmonologist.
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