Pediatric pneumonia is a common disease in infancy and early childhood and is a common cause of death in infants and young children in the winter and spring in northern regions of China. Pneumonia is an inflammation of the lungs caused by pathogenic infections or inhalation of amniotic fluid and oils and allergic reactions, etc. The main clinical manifestations are fever, cough, shortness of breath, inspiratory difficulties and pulmonary bowel movements.
Common causes
Inflammation caused by pathogenic infection or inhalation of amniotic fluid and oil, allergic reaction, etc.
Common symptoms
Fever, cough, shortness of breath, dyspnea, and pulmonary fever
Etiology
Bacterial pneumonia.
Caused by Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus, and Pseudomonas aeruginosa.
Viral pneumonia.
Caused by adenovirus, influenza virus, whistling syncytial virus, measles virus.
Mycoplasma pneumonia.
Chlamydia pneumonia.
Fungal pneumonia.
Caused by Candida albicans, Aspergillus, Pneumocystis carinii, etc.
Clinical manifestations
1.General symptoms
There are fever, refusal to eat, irritability, wheezing and other symptoms, early body temperature of 38 ~ 39 ℃, can be as high as 40 ℃. In addition to respiratory symptoms, the child can be accompanied by depression, restlessness, loss of appetite, shivering, diarrhea and other systemic symptoms. Refusal to eat, choking, vomiting and difficulty in whistling are common in small infants.
2.Whistling system symptoms
(1) The cough starts with frequent irritating dry cough, followed by phlegm sound in the throat, and can be accompanied by vomiting and choking when the cough is intense.
(2) The symptoms and signs of the whistle tract are rapid increase in superficial whistling, nasal agitation, some children may have mild cyanosis around the mouth and nails. Pulmonary signs may not be obvious in the early stage, but small and medium-sized vesicular sounds can be heard later. In combination with pleural effusion, there may be solid percussion sounds and / or loss of inspiratory sounds.
3.Signs and symptoms of other systems
(1) Circulatory system symptoms are often associated with cardiac insufficiency in infants with pneumonia. If the child’s heart rate increases to 160-200 beats/min, liver enlarges or significantly enlarges within a short period of time, pale face, perioral cyanosis, edema of the extremities, and low urine, congestive heart failure should be considered.
(2) Neurological symptoms ① irritability, drowsiness, staring, strabismus, eye upturning. (2) Drowsiness, even coma and convulsions. (3) Bulbar conjunctival edema. ④Pupillary changes, dull or absent response to light. ⑤ Irregular rhythm of whistling. ⑥Dilated fontanelle with signs of meningeal irritation. Brain crest fluid is normal except for increased pressure, which is called toxic encephalopathy.
(3) Digestive system symptoms pneumonia children with decreased appetite, vomiting, diarrhea, abdominal distension, serious vomit is coffee-colored or blood in the stool, loss of intestinal sounds, may appear toxic intestinal paralysis and toxic hepatitis.
Examination
1.Blood routine examination
In bacterial pneumonia, the white blood cell count is usually increased, and the proportion of neutrophils is increased. In severe Staphylococcus aureus pneumonia and H. influenzae pneumonia, the total white blood cell count is sometimes reduced instead. In viral pneumonia, the white blood cell count is often normal or decreased, and the lymphocyte ratio is normal or increased.
2.C-reactive protein test
C-reactive protein values rise in bacterial infections, sepsis, etc. The rise is directly proportional to the severity of the infection, but usually not in viral and mycoplasma infections, but not entirely so.
3.Pathogenic examination
Pathogenic tests include direct smear microscopy and bacterial isolation and identification. Specimens can be sputum, pharyngeal swabs, pleural effusion, alveolar lavage fluid, etc. Isolation of the pathogen is the most reliable method. Bacterial or viral antigen detection, nucleic acid detection and antibody detection can also be done.
4.X-ray
In the early stage, increased lung texture can be seen, and later on, dotted infiltrates of different sizes in the middle and lower fields of both lungs can be seen, or fused into lamellar shadows, often complicated by emphysema and pulmonary atelectasis.
Diagnosis
The diagnosis can be made on the basis of clinical manifestations and imaging examinations. However, etiologic testing is still needed to clarify the cause, guide treatment and estimate prognosis.
Differential diagnosis
Pediatric pneumonia must be differentiated from tuberculosis, bronchial foreign bodies, and idiopathic pulmonary ferritin-containing hyperplasia.
Treatment
A combination of therapies should be used to improve ventilation, effectively control inflammation, and avoid complications.
1.General treatment
Keep the air circulation in the ward, maintain the room temperature at 20℃ and humidity at about 60%, supply easily digestible food, turn and pat the back frequently.
2.Give antibiotics
Select antibiotics according to the following principles: ① Clinical and laboratory information for possible pathogens. ② Select the pathogen-sensitive antibiotics. ③The severity of the disease. If it is mycoplasma pneumonia, macrolides can be used. Viral pneumonia can be used antiviral drugs such as ribavirin or acyclic guanosine.
3.Symptomatic treatment
If there is hypoxic performance, oxygen can be administered. If the sputum is sticky and not easy to cough up, nebulization therapy can be used.
Prevention
Prevention of upper whistle infection, pay attention to strengthening exercise, you can choose the appropriate exercise methods according to age. When outdoor activities, pay attention to the appropriate increase in clothing. Do not take your child to public places when there is an epidemic of respiratory viruses. Do not come into contact with children when someone in the family has a cold.