Pneumonia in Babies and Children

Pneumonia is a disease of parenchymal tissue inflammation in the lungs. This disease is a severe infection that often occurs in infants and children. In Europe and North America the incidence reaches 34-40 cases per 1000 children per year.

When confirming diagnosis of pneumonia, a doctor must decide it based on the complete anamnesis (interview with the patient) and a physical examination. Sometimes he needs to do a chest x-ray and laboratory tests. In children, age is an important factor in diagnosis. Pneumonia in neonates (newborn babies) aged less than three weeks is usually transmitted from the mother at birth. Common causes are Escherichia coli, Streptococcus group B, and Listeria monocytogenes. At the age of 3 weeks to 3 months the main cause of bacterial pneumonia is Streptococcus pneumoniae and viruses. Common causes of pneumonia at age 4 months to 5 years is a kind of virus named respiratory syncytial virus (RSV).

Signs and Symptoms

Signs and symptoms that led to the diagnosis of pneumonia in children are fever, cyanosis (bluish, especially on the lips), and more from one of the symptoms of respiratory distress, they are: rapid breathing (tachypnea), cough, nose flaring, and retracted chest wall . Moreover, there is an additional voice in breathing. If the child is able to communicate/talk, he/she will complain of shortness of breath.

At the time of examination your doctor will ask you some important things, namely the age of the child, immunization status (had been immunized or not), a history of lodging in the hospital, the estimated source of infection, the drug that has been used. This is very important to confirm the diagnosis and determine the appropriate therapy.

Pneumonia should be suspected in children less than 2 years if there is any sign of tachypnea. Based on WHO criterion, it is called a tachypnea if breathing is more than 60 times per minute in infants less than 2 months, more than 50 times per minute in infants 2-12 months, more than 40 times per minute at 1-5 year olds, and more than 30 times per minute in children over 5 years. The calculation must be performed precisely in one minute.

Additional Examination

In most children, laboratory tests to determine the cause are not really necessary. Examination is required if there are severe symptoms, a hospitalised patient, or if there is a complication with other diseases.

Chest X-ray is not a routine examination. Indications of this examination are dubious physical examination, a long term pneumonia (not healed), unresponsive to antibiotic treatment, and possible complications such as pleural effusion (fluid in the pleural cavity, layers that wraps the lungs).

Therapy

Therapy selection decisions will be based on the age of the child, clinical findings, and epidemiological factors. The use of antibiotics is essential in management of bacterial pneumonia. In certain circumstances there will be required a hospitalization.

Infants less than 3 weeks with signs of respiratory distress should be referred to the hospital, with the assumption that the cause is bacterial, unless it was proved the existence of other causes. Blood cultures, urine and cerebrospinal fluid (brain fluid) should be done. Therapy using ampicillin and gentamycin should be started immediately.

Infants aged 3 weeks to 3 months suspected bacterial pneumonia are also require special attention, especially if there is fever, tachypnea, or looking very weak (toxic). This situation may also require hospitalization. Initial therapy begins with cefuroxime or cefotaxime. Other examinations needed are blood culture, urinalysis, and cerebrospinal fluid test; complete blood examination with leukocytes count; and examination of the chest image. After stabilized, treatment can be replaced with oral antibiotics for 10 days.

In patients aged 4 months to 5 years of hospitalization is required if there are signs of hypoxia, or respiration more than 70 times per minute. Other indication of reference are hard/shortness of breath, snoring breath, feeding difficulty, and less supervision of the family. Virus is the major cause of pneumonia in this age group. Another common cause is bacterial pneumonia. Thus, the empirical antibiotic treatment in this age group can also be done. In this group of age, diseases is usually preceded by coughing and colds. Empirical therapy is usually performed using amoxicillin and initial therapy with a single dose of ceftriaxone. Hospitalized patients treated with cefuroxime or cefotaxime. If the child is stable and has no more fever, it can be followed by oral therapy and can be discharged.

In older children (5 years and above), the significant cause of pneumonia is streptococcus. The must be referred to the hospital if there are signs of hypoxia, cyanosis (bluish), respiration more than 50 times per minute, difficult breathing (shortness of breath), and less supervision from the family. The therapy will be cefuroxime or cefotaxime. If stabilized, it can be replaced with oral therapy and can be discharged.

Prevention

Immunization of infants has been shown to reduce the risk of outbreak of pneumonia. Vaccination associated to this disease are Measles, HiB (Haemophillus influenza B), influenza and varicella (chicken pox).

This disease is an air-borne disease, which is transmitted through the air. Wearing masks while catching a common cold or flu will reduce the possibility of transmission of this disease. Separating a sick child in other room, will also reduce the risk of transmission.