Pediatric pneumonia is a common disease in infancy and early childhood, and is a common cause of infant and child mortality in the winter and spring in the northern regions of China. Pneumonia is an inflammation of the lungs caused by pathogenic infection or inhalation of amniotic fluid and oils and allergic reactions, etc. The main clinical manifestations are fever, cough, shortness of breath, dyspnea, and pulmonary fetching.
I. Etiology
1, bacterial pneumonia: caused by Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus, Pseudomonas aeruginosa.
2, viral pneumonia
Caused by adenovirus, influenza virus, respiratory syncytial virus, measles virus.
3.Mycoplasma pneumonia
4.Chlamydia pneumonia
5, fungal pneumonia: caused by Candida albicans, Aspergillus, Pneumocystis carinii, etc.
Second, the clinical manifestations
1.General symptoms
There are fever, refusal to eat, irritability, wheezing and other symptoms, early body temperature of 38 ~ 39 ℃, or up to 40 ℃. In addition to respiratory symptoms, the child may be accompanied by depression, restlessness, loss of appetite, shivering, diarrhea and other systemic symptoms. Refusal of food, choking, vomiting and difficulty in breathing are common in small infants.
2. Respiratory symptoms
The cough starts with frequent irritating dry cough, followed by phlegm sound in the throat, and may be accompanied by vomiting and choking when the cough is intense.
The respiratory symptoms and signs include rapid superficial breathing, nasal agitation, and mild cyanosis around the mouth and nails in some children. 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 breath sounds.
3. Signs and symptoms of other systems
Circulatory system symptoms are often associated with cardiac insufficiency in infants with pneumonia. If the child’s heart rate is lethargic, even coma, convulsions. Bulbar conjunctival edema. Pupillary changes, dull or absent response to light. Irregular respiratory rhythm. The fontanelle is swollen and there are signs of meningeal irritation. Cerebrospinal fluid is normal except for increased pressure, which is called toxic encephalopathy.
Digestive system symptoms pneumonia children with decreased appetite, vomiting, diarrhea, abdominal distension, serious vomit is coffee-colored or blood in the stool, intestinal sounds disappeared, may appear toxic intestinal paralysis and toxic hepatitis.
Three, examination
1.Blood test
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, sometimes the total white blood cell count is 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.Chest X-ray examination
In the early stage of chest X-ray, the lung texture may be enhanced, and later on, there may be dotted infiltrates of different sizes in the middle and lower fields of both lungs, or fused into lamellar shadows, often complicated by emphysema and pulmonary atelectasis.
Diagnosis
The diagnosis can be made based on clinical manifestations and imaging examinations. However, it is still necessary to rely on etiological tests to clarify the cause, guide the treatment and estimate the prognosis.
Differential diagnosis: Pediatric pneumonia must be differentiated from tuberculosis, bronchial foreign bodies, and idiopathic pulmonary ferritin-containing hyperplasia.
V. Treatment
Comprehensive therapy should be adopted 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: clinical and laboratory information for possible pathogens. Select the pathogen-sensitive antibiotics. The severity of the disease. In case of mycoplasma pneumonia, macrolides can be used. Viral pneumonia can choose 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
To prevent upper respiratory tract infection, pay attention to strengthening exercise, and choose appropriate exercise methods according to your age. When outdoor activities, pay attention to the appropriate increase in clothing. Do not take children to public places when there is an epidemic of respiratory viruses. When someone in the family has a cold, do not come into contact with children.