Difference between revisions of "Pneumonia (peds)"

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*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
 
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
 
*Imaging
 
*Imaging
**CXR is not the gold standard!
+
**[[CXR]] is not the gold standard!
 
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
 
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
 
**Consider for:
 
**Consider for:
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''All Children less than 2 months should be hospitalized<ref>AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011</ref>''
 
''All Children less than 2 months should be hospitalized<ref>AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011</ref>''
 
===Consider Admission For===
 
===Consider Admission For===
*Age: 2-3 months old
+
*Age: <2-3 months old
 
*History of severe or relevant congenital disorders
 
*History of severe or relevant congenital disorders
 
*Immune suppression (HIV, SCD, malignancy)
 
*Immune suppression (HIV, SCD, malignancy)
 
*Toxic appearance/respiratory distress
 
*Toxic appearance/respiratory distress
 
*SpO2 <90-93%
 
*SpO2 <90-93%
 +
*Vomiting/dehydration
 +
*Unstable social environment
  
 
==See Also==
 
==See Also==

Revision as of 17:49, 19 April 2018

Background

  • Most common site of infection in neonates

Bugs by Age Group

Clinical Features

Fever and tachypnea are sensitive but not specific

  • Fever
  • Cough
    • Productive cough is rarely seen before late childhood

Differential Diagnosis

Pediatric fever

Evaluation

  • Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
  • Imaging
    • CXR is not the gold standard!
    • Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
    • Consider for:
      • Age 0-3mo (as part of sepsis work up)
      • <5yr with temperature >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • Pneumonia that is prolonged or not responsive to antibiotics
  • Consider rapid assays for RSV, influenza
  • Blood/nasal culture are low yield

Treatment[1]

Newborn

1-3 Month

>3mo - 18 years

Disposition

All Children less than 2 months should be hospitalized[2]

Consider Admission For

  • Age: <2-3 months old
  • History of severe or relevant congenital disorders
  • Immune suppression (HIV, SCD, malignancy)
  • Toxic appearance/respiratory distress
  • SpO2 <90-93%
  • Vomiting/dehydration
  • Unstable social environment

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014
  2. AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011