Difference between revisions of "Pneumonia (peds)"

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(Diagnosis)
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*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)
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**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)
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***Age 0-3mo (as part of sepsis work up)
***<5yr w/ temp >102.2, WBC >20K and no clear source of infection
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***<5yr with temp >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
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***Pneumonia that is prolonged or not responsive to abx
*Consider rapid assays for RSV, influenza
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*Consider rapid assays for RSV, [[influenza]]
 
*Blood/nasal culture are low yield
 
*Blood/nasal culture are low yield
  

Revision as of 23:41, 12 July 2016

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

Diagnosis

  • 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 temp >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • Pneumonia that is prolonged or not responsive to abx
  • 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%

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