Pneumonia (peds): Difference between revisions
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== Background ==
==Background==
*Most common site of infection in neonates
*Most common site of infection in neonates


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**[[Gram-negative bacilli]]
**[[Gram-negative bacilli]]
**[[Listeria monocytogenes]]
**[[Listeria monocytogenes]]
*1mo-3mo
*1-3 months
**[[Streptococcus pneumoniae]]  
**[[Streptococcus pneumoniae]]  
**[[Chlamydia trachomatis]]     
**[[Chlamydia trachomatis]]     
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**[[Bordetella pertussis]]   
**[[Bordetella pertussis]]   
**[[Staphylococcus aureus]]
**[[Staphylococcus aureus]]
*3mo-5yr
*3 months-5 years
**[[S. pneumoniae]]   
**[[S. pneumoniae]]   
**[[S. aureus]]   
**[[S. aureus]]   
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**[[C. trachomatis]]   
**[[C. trachomatis]]   
**[[Mycoplasma pneumoniae]]   
**[[Mycoplasma pneumoniae]]   
*5–18 y
*5–18 years
**[[M. pneumoniae]]   
**[[M. pneumoniae]]   
**[[S. pneumoniae]]   
**[[S. pneumoniae]]   
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{{Pediatric fever DDX}}
{{Pediatric fever DDX}}


== Diagnosis ==
==Evaluation==
*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 bact (but lobar infiltrate more often bacterial)
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
**Consider for:
**Consider for:
***Age 0-3mo (part of w/u for sepsis)
***Age 0-3mo (as part of sepsis workup)
***<5yr w/ temp >102.2, WBC >20K and no clear source of infection
***<5yr with temperature >102.2, WBC >20K and no clear source of infection
***Ambiguous clinical findings
***Ambiguous clinical findings
***PNA that is prolonged or not responsive to abx
***Pneumonia that is prolonged or not responsive to antibiotics
*Consider rapid assays for RSV, influenza
*Consider rapid assays for [[RSV]], [[influenza]]
*Blood/nasal culture are low yield
*Blood/nasal culture are low yield
**in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion <ref> Prevalence, risk factors, and outcomes of bacteremic pneumonia in children.  Pediatrics. 2019 Jun 19. </ref>
**consider for sicker ones, those with effusions


== Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{{Pediatric pneumonia treatment}}
{{Pediatric pneumonia treatment}}


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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==
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<references/>
<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:ID]]
[[Category:ID]]
[[Category:Pulmonology]]

Revision as of 19:57, 6 October 2019

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 workup)
      • <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
    • in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion [1]
    • consider for sicker ones, those with effusions

Treatment[2]

Newborn

1-3 Month

>3mo - 18 years

Disposition

All Children less than 2 months should be hospitalized[10]

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. ↑ Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19.
  2. ↑ Sanford Guide to Antimicrobial Therapy 2014
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
  4. ↑ Sanford Guide to Antimicrobial Therapy 2014
  5. ↑ Sanford Guide to Antimicrobial Therapy 2014
  6. ↑ Sanford Guide to Antimicrobial Therapy 2014
  7. ↑ Sanford Guide to Antimicrobial Therapy 2014
  8. ↑ Sanford Guide to Antimicrobial Therapy 2014
  9. ↑ Sanford Guide to Antimicrobial Therapy 2014
  10. ↑ AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011
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