Pneumonia (peds): Difference between revisions

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*[[Fever]]
*[[Fever]]
*[[Cough]]
*[[Cough]]
**Productive cough is rarely seen before late childhood


==Differential Diagnosis==
==Differential Diagnosis==
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== Diagnosis ==
== Diagnosis ==
*Absence of tachypnea, resp distress, and rales/decr BS rules-out with 100% sp
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
**Productive cough is rarely seen before late childhood
*Imaging
*Imaging
**CXR is not the gold standard!
**CXR is not the gold standard!

Revision as of 19:18, 19 June 2015

Background

  • Most common site of infection in neonates
  • Fever and tachypnea are sensitive but not specific

Bugs by Age Group

Clinical Features

  • 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 bact (but lobar infiltrate more often bacterial)
    • Consider for:
      • Age 0-3mo (part of w/u for sepsis)
      • <5yr w/ temp >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • PNA 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[9]

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. 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. AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011