Pneumonia in Children

Pneumonia in
Infants and
Children
Presented by
:
Dr.Neeraj.Mel
ayil MEM
RESIDENT
INTRODUCTION AND
EPIDEMIOLOGY
 Infection of the lung and lower respiratory tract.
 Invasion and overgrowth of pathogens in the lower respiratory tract.
 Anatomic and mechanical barriers to infection include the nasal hairs

and turbinates, cilia, epiglottis, and cough reflex.
 Infectious agents may be inhaled or aspirated directly into the lungs,

invade respiratory epithelium and spread contiguously, or, less
commonly, reach the lungs hematogenously.
Viral inoculation is typically by droplet or fomite (e.g., influenza, respiratory
syncytial virus) Bacterial pneumonia follows colonization of the
nasopharynx.
Infection can result in

Injury or death of the respiratory epithelium , interstitial
inflammation, or alveolar injury.
The air space fills with exudative

debris, causing
•Atelectasis
•Impaired oxygenation
•Ventilation-perfusion mismatch.
CLINICAL FEATURES AND
ETIOLOGY
Cardinal symptoms of lower respiratory tract
infection include Cough
Fever
Tachypn
ea
Respirat
ory
distress.
However
, signs
and
sympto
ms vary
by age
and
AGE-SPECIFIC CAUSES OF
PNEUMONIA
Neonates 0 to 30 Days of Age
Risk for acquired perinatal bacterial pathogens.
Group B streptococci
Gram-negative enteric bacteria such as Klebsiella and
Escherichia coli Listeria monocytogenes.
Late-onset neonatal pneumonia may be

caused by Staphylococcus aureus
Streptococcus
pneumoniae
Streptococcus
pyogenes.
Infants and Children Between 30 Days and 2 Years of Age
Viral rather than

bacterial
Respiratory syncytial
virus Human
rhinovirus Influenza
Parainfluenza
Human
metapneumovirus
Adenovirus.
Bacterial cause of
community-acquired
pneumonia remains
S. pneumoniae
Children 2 to 5 Years of Age
Community-acquired pneumonia is caused by respiratory
viruses, notably Respiratory syncytial virus
Human rhinovirus
Human metapneumovirus
S. pneumoniae
H. influenzae type b
Mycoplasma
pneumoniae
Chlamydophila
pneumoniae
Children 5 to 13 Years of Age
M.pneumoniae is a more commonly
detected
Less common bacterial causes

include
S. aureus
Streptococ
cus
species (including group A
Streptococcus) Nontypeable H.
influenzae
Legionella
UNIQUE AND HIGH-RISK GROUPS
Younger children with cystic fibrosis are often infected with S. aureus in
the first years of life
Children with sickle cell disease - Encapsulated bacteria (e.g.,

pneumococcus, Salmonella, Klebsiella), which can cause acute chest
syndrome and sepsis.
Children with congenital or acquired immune deficiencies such as

human immunodeficiency virus infection, malignancy, and congenital
immunodeficiencies are at risk for opportunistic infections with agents
such as
Pneumocystis
jirovecii
Cytomegalovirus
Fungi.
PATHOGEN-SPECIFIC PATTERNS OF
DISEASE
Typical pneumonias - high fever, chills, pleuritic chest pain, and
productive cough
Atypical pneumonias classically present

with high fever, chills, pleuritic chest pain, and productive
cough
DIFFERENTIAL
DIAGNOSIS
DIAGNO
SIS
Relevant HISTORY
Meconium aspiration may cause chemical or bacterial pneumonia in the first

24 to 72 hours of life.
Childhood immunizations can provide protection from common pathogens

implicated in pneumonia (e.g., S. pneumoniae, B. pertussis, N. meningitidis,
H. influenzae type b, and measles).
PHYSICAL
EXAMINATION
Markers of respiratory distress include nasal flaring, tracheal tugging, and
intercostal indrawing.
Lower chest or “abdominal” indrawing or retractions and grunting may

suggest more severe pneumonia.
In infants, intermittent apnea, grunting, and an inability to feed are

surrogate markers of dyspnea.
LABORATORY
EVALUATION
Bacterial cultures of nasopharyngeal samples are generally not helpful,
because results are delayed, and oral and nasal flora correspond poorly with
the organisms causing disease in the lung
The routine collection of blood cultures is not recommended in

healthy children with mild community-acquired pneumonia because
rates of bacteremia are low
For toxic-appearing children, those with severe disease requiring

hospitalization and those with complicated pneumonia , blood culture is
recommended, preferably before antibiotic administration
IMAGIN
Guidelines on the use of routine chest radiography are inconsistent.
G
Consider chest radiographs only when the results are likely to alter
diagnosis, treatment, or outcome
Benefits of radiography include diagnosis or confirmation of

pneumonia and occasionally the discovery of a significant congenital
abnormality
Potential indications for chest radiography
1.Infants and children with a toxic appearance and respiratory findings
2.Age of 0 to 3 months with fever and respiratory symptoms, as part of a

full sepsis evaluation
3.Child <5 years old, with a temperature of >39°C (102.2°F) lasting 5 days
or more, WBC of
≥20,000/mm, and no clear source of infection
4.Suspicion of a complication, such as pleural effusion or pneumothorax
5.Pneumonia that is prolonged or unresponsive to treatment
6.Children with biphasic illness (typical symptoms of upper respiratory

tract infection followed by acute worsening of [respiratory] symptoms
and high fever)
7.Suspected foreign body aspiration
8.Suspected congenital lung malformation (e.g., sequestration or

congenital cystic adenomatous malformation) or chest mass
9.Follow-up of recurrent pneumonia involving the same lobe or

with lobar collapse
TREATME
NT
SUPPORTIVE AND SYMPTOMATIC TREATMENT
Cough suppressants are not effective and have been withdrawn from
the market in several countries for children <5 years of age.
Antibiotics are not indicated for viral pneumonia

DISPOSITION AND
FOLLOW-UP

Pneumonia in Children

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Pneumonia in

 Invasion and overgrowth of pathogens in the lower respiratory tract.

 Anatomic and mechanical barriers to infection include the nasal hairs

 Infectious agents may be inhaled or aspirated directly into the lungs,

Infection can result in

The air space ﬁlls with exudative

Late-onset neonatal pneumonia may be

Viral rather than

Less common bacterial causes

Children with sickle cell disease - Encapsulated bacteria (e.g.,

Children with congenital or acquired immune deﬁciencies such as

Atypical pneumonias classically present

Meconium aspiration may cause chemical or bacterial pneumonia in the ﬁrst

Childhood immunizations can provide protection from common pathogens

Lower chest or “abdominal” indrawing or retractions and grunting may

In infants, intermittent apnea, grunting, and an inability to feed are

The routine collection of blood cultures is not recommended in

For toxic-appearing children, those with severe disease requiring

Beneﬁts of radiography include diagnosis or conﬁrmation of

2.Age of 0 to 3 months with fever and respiratory symptoms, as part of a

4.Suspicion of a complication, such as pleural effusion or pneumothorax

5.Pneumonia that is prolonged or unresponsive to treatment

6.Children with biphasic illness (typical symptoms of upper respiratory

7.Suspected foreign body aspiration

8.Suspected congenital lung malformation (e.g., sequestration or

9.Follow-up of recurrent pneumonia involving the same lobe or

Antibiotics are not indicated for viral pneumonia

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