Pneumonia at children – sharp infectious process in a pulmonary parenchyma with involvement in an inflammation of all structurally functional units of respiratory department of lungs. Pneumonia at children proceeds with symptoms of intoxication, cough, respiratory insufficiency. The diagnosis of pneumonia at children is made on the basis of a characteristic auskultativny, clinical laboratory and radiological picture. Treatment of pneumonia demands purpose of antibiotic treatment, bronchial spasmolytics from children, febrifugal, expectorant, antihistamines; in a permission stage – physical therapy, LFK, massage.
Pneumonia at children
Pneumonia at children - sharp infectious damages of lungs, followed by existence of infiltrative changes on roentgenograms and symptoms of damage of the lower airways. Prevalence of pneumonia makes 5-20 cases on 1000 children of early age and 5–6 cases on 1000 children 3 years are aged more senior. Incidence of pneumonia among children annually increases in the period of a seasonal flu epidemic. Among various defeats of a respiratory path at children the share of pneumonia makes 1-1,5%. Despite achievements of diagnostics and pharmacotherapy, indicators of incidence, complications and pneumonia mortality among children remain steadily high. All this does studying of pneumonia at children by topical issue of pediatrics and children's pulmonology.
Classification of pneumonia at children
In the classification used in clinical practice infection conditions, X-ray morphological features of various forms of pneumonia at children, weight, duration, a disease etiology etc. are considered.
Under the terms, in which there was an infection of the child, allocate extra hospital (house), intrahospital (hospital) and congenital (pre-natal) pneumonia at children. Extra hospital pneumonia develops in house conditions, out of medical institution, mainly, as a SARS complication. The pneumonia which arose 72 hours later after hospitalization of the child and within 72 hours after his extract is considered intrahospital. Hospital pneumonia at children has the heaviest a current and an outcome as at intrahospital flora resistance to the majority of antibiotics quite often develops. The separate group is made by the congenital pneumonia developing at children with an immunodeficiency in the first 72 hours after the birth and neonatal pneumonia at children of the first month of life.
Taking into account X-ray morphological features children can have a pneumonia:
- Focal (focal and drain) – with the centers of infiltration with a diameter of 0,5-1 cm located in one or several segments of a lung, sometimes – bilateralno. The inflammation of pulmonary fabric has catarrhal character with education in a gleam of alveoluses of serous exudate. At a focal and drain form there is a merge of certain sites of infiltration to formation of the big center which is quite often occupying the whole share.
- Segmentary – with involvement in an inflammation of the whole segment of a lung and its atelektazy. Segmentary defeat often proceeds in the form of long pneumonia at children from the outcome in pulmonary fibrosis or the deforming bronchitis.
- Krupozna – with the giperergichesky inflammation passing stages of inflow, a red opecheneniye, a gray opecheneniye and permission. Inflammatory process has lobarny or sublobarny localization with involvement of a pleura (pleuropneumonia).
- Interstitsialna – with infiltration and proliferation of interstitsialny (connecting) tissue of lungs of focal or diffusion character. Interstitsialny pneumonia at children usually is caused by pnevmotsist, viruses, mushrooms.
On weight of a current distinguish the uncomplicated and complicated pneumonia forms at children. In the latter case development of respiratory insufficiency, hypostasis of lungs, pleurisy, destruction of a pulmonary parenchyma (abscess, lung gangrene), the ekstrapulmonalny septic centers, cardiovascular violations etc. is possible.
Children can have a sharp course of pneumonia or long. The acute pneumonia is allowed in terms of 4-6 weeks; at long pneumonia kliniko-radiological signs of an inflammation remain more than 1,5 months. On an etiology are allocated the virus, bacterial, fungal, parasitic, mikoplazmenny, chlamydial, mixed pneumonia forms at children.
The pneumonia reasons at children
The pneumonia etiology at children depends on age and conditions of infection of the child. Pneumonia of newborns is usually connected with pre-natal or intrahospital infection. Congenital pneumonia at children often is caused by a virus of simple herpes of types 1 and 2 of types, chicken pox, a cytomegalovirus, a hlamidiya. Among intra hospital pathogens the leading role belongs to group B streptococci, golden staphylococcus, colibacillus, a klebsiyella. At the premature and full-term newborns the etiologichesky role of viruses – flu, RSV, paraflu, measles, etc. is big.
At children of the first year of life the pneumococcus acts as the prevailing causative agent of extra hospital pneumonia (to 70-80% of cases), is more rare - a hemophilic stick, a moraksella, etc. As traditional pathogens for children of preschool age serve the hemophilic stick, colibacillus, proteas, a klebsiyell, an enterobakter, a sinegnoyny stick, golden staphylococcus. At children of school age, along with typical pneumonia, the number of the atypical pneumonia caused by a mikoplazmenny and chlamydial infection increases. As the factors contributing to development of pneumonia in children serve prematurity, a hypotrophy, an immunodeficiency, a stress, cooling, the chronic centers of an infection (caries of teeth, antritis, tonsillitis).
The infection gets into lungs in mainly aerogenic way. A pre-natal infection in combination with aspiration of amniotic waters lead to developing of pre-natal pneumonia. Development of aspiration pneumonia in children of early age can happen owing to microaspiration of a secret of a nasopharynx habitual to aspiration of food at vomiting, a gastroezofagealny reflux, vomiting, a dysphagy. Perhaps hematogenic distribution of pathogens from the extra pulmonary centers of an infection. Infection with hospital flora quite often happens when carrying out to the child of trakhealny aspiration and a bronkhoalveolyarny unleavened wheat cake, inhalation, a bronkhoskopiya, IVL.
As "conductor" of a bacterial infection the viruses affecting mucous a respiratory path, breaking the barrier functions of an epithelium and mukotsiliarny clearances increasing production of slime, reducing local immunological protection and facilitating penetration of activators into terminal bronchioles usually act. There is an intensive reproduction of microorganisms and development of an inflammation in which adjacent sites of a pulmonary parenchyma are involved. At cough the infected phlegm is thrown in large bronchial tubes from where gets into other respiratory bronchioles, causing formation of the new inflammatory centers.
The organization of the center of an inflammation is promoted by bronchial obstruction and formation of sites of hypoventilation of pulmonary fabric. Owing to violation of microcirculation, inflammatory infiltration and interstitsialny hypostasis perfusion of gases is broken, the gipoksemiya, respiratory acidosis and a giperkapniya develops that is clinically expressed by signs of respiratory insufficiency.
Pneumonia symptoms at children
The clinic of focal pneumonia at children usually develops for the 5-7th day of a SARS. The all-infectious symptomatology is characterized by febrilny body temperature (> 38 °C), symptoms of intoxication (slackness, a sleep disorder, pallor of integuments, disorder of appetite; at babies - vomiting and vomiting). Respiratory symptoms of pneumonia at the child include cough (damp or dry), short wind, perioralny cyanosis; sometimes - participation in breath of auxiliary muscles, retraction of mezhreberiya. A current focal and drain pneumonia at children always heavier; quite often with respiratory insufficiency, a toxic syndrome, development of pleurisy or destruction of pulmonary fabric.
Segmentary pneumonia at children proceeds with fever, intoxication and respiratory insufficiency of various degree of expressiveness. Process of restoration can be dragged out up to 2-3 months. Further on the place of an inflammation it can be formed segmentary or bronkhoektaza.
The clinic of krupozny pneumonia at children differs in the rough beginning, high fever with oznoba, pain at cough and breath in a thorax, an expectoration of the "rusty" phlegm expressed by respiratory insufficiency. Quite often at pneumonia at children the abdominal syndrome with vomiting, belly-aches with symptoms of irritation of a peritoneum develops.
Interstitsialny pneumonia at children is characterized by prevalence of symptoms of the increasing respiratory insufficiency: short wind, cyanosis, painful cough with a poor phlegm, weakening of breath; quite often - symptoms of right ventricular heart failure.
Among the complications of pneumonia which are found at children - infectious and toxic shock, abscesses of pulmonary fabric, pleurisy, an empiyema of a pleura, pheumothorax, cardiovascular insufficiency, a respiratory distress syndrome, polyorgan insufficiency, the DVS-syndrome.
Diagnosis of pneumonia at children
The basis of clinical diagnosis of pneumonia at children is made by the general symptomatology, auskultativny changes in lungs and radiological data. At fizikalny inspection of the child shortening of a perkutorny sound, weakening of breath, melkopuzyrchaty or krepitiruyushchy rattles is defined. "The gold standard" of detection of pneumonia children have X-ray analysis of lungs allowing to find infiltrative or interstitsialny inflammatory changes.
Etiologichesky diagnostics includes virologic and bacteriological researches of slime from a nose and a pharynx, phlegms; IFA and PTsR-methods of identification of intracellular activators.
Gemogramma reflects changes of inflammatory character (neytrofilny , increase in SOE). Children with heavy pneumonia need to conduct a research of biochemical indicators of blood (hepatic enzymes, electrolytes, creatinine and urea, BRAIDS), a pulsoksimetriya.
Pneumonia at children needs to be distinguished from a SARS, an acute bronchitis, a bronkhiolit, tuberculosis, a mukovistsidoz. In typical cases diagnosis of pneumonia at children is carried out by the local pediatrician; in doubtful situations the child needs consultation of the children's pulmonologist or phthisiatrician, carrying out KT of lungs, fibrobronkhoskopiya, etc.
Treatment of pneumonia at children
The bases for hospitalization of the child who got sick with pneumonia are: age up to 3 years, involvement in an inflammation of two and more shares of lungs, heavy respiratory insufficiency, pleurisy, heavy encephalopathies, a hypotrophy, congenital heart diseases and vessels, chronic pathology of lungs (bronchial asthma, a bronchopulmonary dysplasia, etc.), kidneys (glomerulonefrit, pyelonephritis), a condition of an immunodeficiency. In the feverish period the bed rest, a balanced diet and drinking loading is shown to the child.
The main method of treatment of pneumonia at children is empirical, and then etiotropny antibacterial therapy for which beta lactams (amoxicillin + clavulanic acid, etc.), tsefalosporina (tsefuroksy, can be used), macroleads (, , ), ftorkhinolona (ciprofloxacin, ), imipenema (imipeny), etc. At inefficiency of therapy within 36-48 hours the starting antibiotic is replaced with medicine from other group.
Symptomatic and pathogenetic therapy of pneumonia at children includes purpose of medicines of febrifugal, mukolitichesky, bronkholitichesky, antihistaminic action. After subsiding of fever physiotreatment is shown: Microwave oven, induktotermiya, electrophoresis, inhalations, massage of a thorax, perkutorny massage, LFK.
The forecast and prevention of pneumonia at children
At timely recognition and treatment a pneumonia outcome at children favorable. The pneumonia caused by high-virulent flora, complicated has the adverse forecast it is purulent - destructive processes; proceeding against the background of a serious somatic illness, immunodeficiency. The long course of pneumonia at children of early age is fraught with formation of chronic bronchopulmonary diseases.
Prevention of pneumonia at children consists in the organization of good care of the child, his hardening, the prevention of a SARS, treatment of LOR-pathology, vaccination against flu, a pnevmokokkovy infection, a hemophilic infection. All children who had pneumonia are subject to the dispensary account at the pediatrician during 1 year with carrying out a control X-ray analysis of a thorax, OAK, survey of the child by the children's pulmonologist, the children's allergist-immunologist and the children's otolaryngologist.