Diagnosis of pneumonia in young children. Features of the course of pneumonia in children with rickets, exudative-catarrhal

Definition. Pneumonia is an acute inflammatory process of lung tissue caused by bacterial and/or viral infection.

The incidence of acute pneumonia ranges from 15-20 per 1000 children early age.

Etiology. Pathogens - gram-positive and gram-negative flora, viruses, fungi, mycoplasma, chlamydia, legionella, protozoa

Pathogenesis. Routes of penetration (aerogenic, lymphogenous, hematogenous) Penetration and reproduction of microbes occurs at the transition point of the terminal bronchi to the alveolar, with the involvement of the bronchial, interstitial and alveolar tissue. The inflammatory process in the alveolar wall complicates gas exchange between the blood and alveolar air. Hypoxia and hypercapnia develop. Shifts occur in the functions of the central nervous system and cardiovascular system, and metabolic disorders are noted.

Predisposing factors: anatomical and physiological features of the bronchopulmonary system, chronic foci of infection, repeated acute respiratory viral infections, hereditary predisposition, immaturity immune system, passive smoking, etc.

Classification. According to their form, they distinguish focal, focal-confluent, segmental, lobar and interstitial pneumonia. By severity - uncomplicated and complicated, by course - acute and protracted.

Main diagnostic (reference) criteria Acute pneumonia is: cough (initially dry, then wet), shortness of breath (> 60 per minute), participation of auxiliary muscles, local crepitus, moist rales of various sizes, areas of shortening of the pulmonary sound, infiltrative sounds on the radiograph, increased body temperature, intoxication phenomena. There may be pallor of the skin, cyanosis of the nasolabial triangle, dysfunction of the cardiovascular system, gastrointestinal tract.

In the blood test: leukocytosis, neutrophilia, with a band shift to the left, enlarged ESR, anemia.

Clinical course options. The most severe cases of staphylococcal pneumonia occur in young children and pneumonia against the background of: malnutrition, ECD, rickets.

The examination includes: blood, urine, stool tests for worm eggs, chest X-ray, ECG, CBS(in case of severe course), immunogram (in case of protracted course), electrolytes in sweat (in case of protracted course), virological examination.

Differential diagnosis with bronchitis, bronchiolitis, respiratory allergosis.

Treatment. Protective regime, proper nutrition, aeration, sanitation (of the nasal passages). Antibiotic therapy taking into account the etiological factor (ampicillin, ampiox, gentamicin, t-P cephalosporins), macrolides (if an “atypical pathogen” is suspected).

Expectorant therapy for wet cough (decoctions of elecampane, fennel, coltsfoot, oregano), bromhexine, mucaltin, lazolvan.

Physiotherapy: alkaline, salt-alkaline inhalations + massage (at normal body temperature), thermal, paraffin, ozokerite applications

Vitamins gr. C, B, A, E (according to indications).

Symptomatic therapy (according to indications)

Forecast - favorable.

Complicated pneumonia in young children. Clinic. Treatment.

Pneumonia may be complicated and uncomplicated. Main complications are: pulmonary (sypneumonia and metapneumonic pleurisy, pulmonary destruction, lung abscess, pneumothorax, pyopneumothorax) and extrapulmonary (infectious-toxic shock, disseminated intravascular coagulation syndrome, cardiovascular failure, respiratory distress syndrome of age-related hypothyroidism)

Of the many complications in practice, the most common in young children is toxic syndrome.

Clinic. At the onset of the disease (1st degree of toxicosis), general toxic manifestations come to the fore: lethargy, loss of appetite, agitation, fever. Then (stage II toxicosis) cardiovascular changes occur: tachycardia, deafness of tones, hemodynamic changes. The condition is severe. These two zones of toxicosis are observed in any moderate pneumonia and disappear against the background of efferent antibiotic therapy. At stage III of toxicosis, changes in the nervous system are noted - disturbances of consciousness, convulsions, more often drowsiness, stupor. IN in rare cases pneumonic toxicosis can be complicated by disseminated intravascular coagulation syndrome.

Others most frequent complications you show acute pneumonia" tmespum. Zjadelzhut:

synpneumsticgt and ph"tapneuplunic pleurisy.

Synpneumonic pleurisy occurs in the first days of the disease. The effusion is small, clinically - pain when breathing. Etiology - pneumococcal. X-ray - may not be detected, only with ultrasound.

Metapneumonic pleurisy appears at 7-! About the day from the onset of acute pneumonia. Etiology - pneumococcal. The exudate is always fibrous, and after fibrin loss it is serous, with low cytosis. Metapneumonic pleurisy is a typical immuno pathological process. Diagnosis is made by x-ray and objective examination

Currently destructive pneumonia occurs somewhat less frequently. Destructive processes in the area of pneumonic infiltrate are caused by necrosis of lung tissue under the influence of a microbial factor. The resulting cavity initially contains pus and detritus, and its emptying through the bronchus can lead to the formation of a bulla cavity. In the period preceding the formation of the cavity, there is a temperature reaction, significant leukocytosis with a neutrophil shift, and a complete lack of effect from antibiotic therapy. Abscesses are less common than bubbles.

Principles Treatments for toxicosis include normalization of peripheral circulation, detoxification therapy, treatment of heart failure, prevention and treatment of DIC syndrome, and symptomatic therapy.

Principles of treatment for SPP - pleural puncture, then prescribing antibiotic therapy. With adequate antibiotic therapy, the volume of effusion decreases. If the volume increases and with repeated puncture the cytosis increases, then the antibiotic should be changed. With MGGD - Anti-inflammatory drugs (indomethacin, steroid hormones) should be added to the main treatment of acute pneumonia, because the process is immunopathological in nature, + exercise therapy.

Principles of treatment of destructive pneumonia: regime, nutrition (sometimes through a tube), treatment respiratory failure(from elevated aeration to oxygen therapy) Antibacterial therapy (2 antibiotics are required; one of them intravenously in high doses), the use of anitbiotics both in aerosols and in the abscess cavity, pleural cavity Des intoxication therapy. Stimulation therapy (fresh frozen plasma, antistaphylococcal γ-globulin and plasma), vitamin therapy (A, C, E, B), biological products (lacto- and bifidumbacterin, bificod, bactisubtil). A patient with staphylococcal destruction is observed by a pediatrician and a surgeon.

- spicy infectious process in the pulmonary parenchyma with the involvement of all structural and functional units of the respiratory part of the lungs in inflammation. Pneumonia in children occurs with signs of intoxication, cough, and respiratory failure. The diagnosis of pneumonia in children is made on the basis of characteristic auscultatory, clinical, laboratory and x-ray patterns. Treatment of pneumonia in children requires antibiotic therapy, bronchodilators, antipyretics, expectorants, antihistamines; in the stage of resolution - physiotherapy, exercise therapy, massage.

General information

Pneumonia in children is an acute infectious lesion of the lungs, accompanied by the presence of infiltrative changes on radiographs and symptoms of damage to the lower respiratory tract. The prevalence of pneumonia is 5-20 cases per 1000 young children and 5-6 cases per 1000 children over 3 years of age. The incidence of pneumonia among children increases annually during the seasonal influenza epidemic. Among various lesions of the respiratory tract in children, the proportion of pneumonia is 1-1.5%. Despite advances in diagnostics and pharmacotherapy, rates of morbidity, complications and mortality from pneumonia among children remain consistently high. Studying pneumonia in children does all this topical issue pediatrics and pediatric pulmonology.

Reasons

The etiology of pneumonia in children depends on the age and conditions of infection of the child. Pneumonia of newborns is usually associated with intrauterine or nosocomial infection. Congenital pneumonia in children is often caused by herpes simplex virus types 1 and 2, chickenpox, cytomegalovirus, and chlamydia. Among nosocomial pathogens, the leading role belongs to group B streptococci, Staphylococcus aureus, Escherichia coli, and Klebsiella. In premature and full-term newborns, the etiological role of viruses is great - influenza, RSV, parainfluenza, measles, etc.

In children of the first year of life, the predominant pathogen is community-acquired pneumonia pneumococcus (up to 70-80% of cases), less often - Haemophilus influenzae, Moraxella, etc. Traditional pathogens for children up to school age serve as hemophilus influenzae, coli, Proteus, Klebsiella, Enterobacter, Pseudomonas aeruginosa, Staphylococcus aureus. In school-age children, along with typical pneumonia, the number of atypical pneumonias caused by mycoplasma and chlamydial infections is increasing. Factors predisposing to the development of pneumonia in children are prematurity, malnutrition, immunodeficiency, stress, cold, chronic foci of infection (dental caries, sinusitis, tonsillitis).

The infection penetrates into the lungs mainly through the aerogenic route. Intrauterine infection combined with aspiration amniotic fluid lead to intrauterine pneumonia. The development of aspiration pneumonia in young children can occur due to microaspiration of nasopharyngeal secretions, habitual aspiration of food during regurgitation, gastroesophageal reflux, vomiting, and dysphagia. Hematogenous spread of pathogens from extrapulmonary foci of infection is possible. Infection with hospital flora often occurs when a child undergoes tracheal aspiration and bronchoalveolar lavage, inhalation, bronchoscopy, and mechanical ventilation.

"Conductor" bacterial infection Typically, viruses appear that infect the mucous membrane of the respiratory tract, disrupt the barrier function of the epithelium and mucociliary clearance, increase mucus production, reduce local immunological defense and facilitate the penetration of pathogens into the terminal bronchioles. There, intensive proliferation of microorganisms occurs and inflammation develops, which involves adjacent areas of the pulmonary parenchyma. When you cough, infected sputum is thrown into the large bronchi, from where it enters other respiratory bronchioles, causing the formation of new inflammatory foci.

The organization of the focus of inflammation is facilitated by bronchial obstruction and the formation of areas of hypoventilation of lung tissue. Due to impaired microcirculation, inflammatory infiltration and interstitial edema, gas perfusion is disrupted, hypoxemia, respiratory acidosis and hypercapnia develop, which is clinically expressed by signs of respiratory failure.

Classification

In used in clinical practice classification takes into account the conditions of infection, x-ray morphological signs various forms pneumonia in children, severity, duration, etiology of the disease, etc.

According to the conditions in which the child was infected, community-acquired (home), hospital-acquired (hospital) and congenital (intrauterine) pneumonia in children are distinguished. Community-acquired pneumonia develops at home, outside of a medical institution, mainly as a complication of acute respiratory viral infection. Nosocomial pneumonia is considered to be pneumonia that occurs 72 hours after the child’s hospitalization and within 72 hours after his discharge. Hospital-acquired pneumonia in children has the most severe course and outcome, since nosocomial flora often develops resistance to most antibiotics. A separate group consists of congenital pneumonia that develops in children with immunodeficiency in the first 72 hours after birth and neonatal pneumonia in children in the first month of life.

Taking into account X-ray morphological signs, pneumonia in children can be:

Focal(focal-confluent) - with foci of infiltration with a diameter of 0.5-1 cm, located in one or several segments of the lung, sometimes bilaterally. Inflammation of the lung tissue is catarrhal in nature with the formation of serous exudate in the lumen of the alveoli. In the focal-confluent form, fusion occurs individual areas infiltration with the formation of a large focus, often occupying an entire lobe.
Segmental– with the involvement of an entire segment of the lung in inflammation and its atelectasis. Segmental damage often occurs in the form of prolonged pneumonia in children, resulting in pulmonary fibrosis or deforming bronchitis.
Krupoznaya– with hyperergic inflammation, passing through the stages of flushing, red hepatization, gray hepatization and resolution. The inflammatory process has a lobar or sublobar localization involving the pleura (pleuropneumonia).
Interstitial– with infiltration and proliferation of interstitial (connective) lung tissue of a focal or diffuse nature. Interstitial pneumonia in children is usually caused by pneumocystis, viruses, and fungi.

Based on the severity of the course, uncomplicated and complicated forms of pneumonia in children are distinguished. In the latter case, the development of respiratory failure, pulmonary edema, pleurisy, destruction of the pulmonary parenchyma (abscess, lung gangrene), extrapulmonary septic foci, cardiovascular disorders etc.

Among the complications of pneumonia that occur in children are infectious toxic shock, abscesses of lung tissue, pleurisy, pleural empyema, pneumothorax, cardiovascular failure, respiratory distress syndrome, multiple organ failure, DIC syndrome.

Diagnostics

The basis clinical diagnostics pneumonia in children consists of general symptoms, auscultatory changes in the lungs and radiological data. A physical examination of the child reveals a shortening of the percussion sound, weakening of breathing, and fine bubbling or crepitating rales. The “gold standard” for detecting pneumonia in children remains chest radiography, which makes it possible to detect infiltrative or interstitial inflammatory changes.

Etiological diagnosis includes virological and bacteriological research mucus from the nose and throat, sputum culture; ELISA and PCR methods for detecting intracellular pathogens.

Hemogram reflects changes inflammatory in nature(neutrophilic leukocytosis, increased ESR). Children with severe pneumonia should be tested biochemical parameters blood (liver enzymes, electrolytes, creatinine and urea, CBS), pulse oximetry.

The mere mention of pneumonia usually causes serious concern among parents of infants—and with good reason. Children in their first year of life suffer from this disease ten times more often than schoolchildren. The “peak” incidence occurs between 3 and 9 months of age. Unfortunately, it is for infants that pneumonia poses a particular danger: the characteristics of their body are such that when improper treatment the inflammatory process quickly spreads, the functioning of other systems (urinary, nervous, digestive) may be disrupted, and the already limited respiratory capabilities of the lungs are significantly reduced.

Bronchial tree That’s why it’s called that because it looks like a real tree, only upside down. Its "trunk" is trachea , which is divided into two powerful branches - the right and left main ones bronchi , which then, already in the depths of the lungs, are crushed into ever thinner branches, only they are surrounded not by leaves, but by clusters of tiny bubbles called alveoli . The total number of alveoli reaches hundreds of millions. Gas exchange occurs in the alveoli: oxygen from them enters the blood, which, in turn, releases it to the alveoli carbon dioxide. The fetus's lungs are in an unexpanded state. When the baby is born and takes his first breath, the alveoli fill with air and the lungs expand. By the time the child is born, the bronchial tree has already been formed: the lungs, like in adults, are divided into shares, and those, in turn, - on segments. The right lung has 3 lobes: upper, middle and lower, and the left lung has only two: upper and lower, but the volume of the lungs is approximately equal. Air passes better into the upper segments of the lungs, while the posterior lower segments are supplied with air less well. The main bronchi and large vessels entering and leaving the lungs form the so-called lung roots .

The alveoli are maintained in a straightened, working condition with the help of a special surfactant - surfactant , which in the right quantity is formed in the lungs of the fetus only in the third trimester of pregnancy. In children born much older ahead of schedule have difficulty breathing; Typically, the reason for this is that due to a lack of surfactant, the alveoli of the lungs are not yet ready to function.

There are different types of pneumonia

Pneumonia (from the Greek pneumon - lungs) is an acute infectious inflammatory disease lung tissue. As a rule, the disease develops gradually. Appear first general symptoms ailments: pallor, restlessness, poor sleep, regurgitation, sometimes bowel dysfunction, loss of appetite. In addition, there are signs of a respiratory tract infection: difficulty in nasal breathing, sneezing, and a dry cough that bothers the child. The patient may develop a fever. However, the “insidiousness” of pneumonia is that it occurs at low (up to 38°C) or even normal body temperature. After some time, blueness (cyanosis) of the skin appears in the area of the nasolabial triangle, which intensifies with screaming and sucking. All these symptoms should alert parents: when they appear, the child should be immediately shown to a doctor.

With the further development of the disease, the child’s breathing becomes more frequent, and its rhythm may collapse. There is tension in the wings of the nose, which become as if motionless and pale. Foamy discharge may appear from the mouth (more often in children in the first three months of life). Next, “groaning” shortness of breath appears, and the wings of the nose swell. Stopping breathing (so-called apnea) appears, which is especially frequent and prolonged in children in the first months of life. The skin of a sick child takes on a grayish tint. The cardiovascular system is involved in the pathological process, the work is disrupted intestinal tract. Lethargy appears, a significant decrease in motor activity, and anxiety may persist.

Depending on the size of the inflammation, doctors distinguish the following types of this disease:

Fine-focal pneumonia It occurs most often in infants. The lesion is relatively small in size; inflammation in the lung tissue develops as a continuation of inflammation in the bronchus corresponding to this lesion.
For segmental pneumonia inflammation affects one or more lung segments.
At lobar pneumonia the inflammatory process involves significant parts of the lung tissue - one or several lobes. This form of the disease is more severe.
Interstitial pneumonia is quite rare. In this case, inflammation affects not so much the lung tissue as the septum from connective tissue around the bronchi, alveoli.

There are acute pneumonia (in this case, the disease lasts up to 6 weeks) and prolonged, which lasts more than 6 weeks.

Using a phonendoscope, the doctor receives a lot of information about the child’s heartbeat and breathing. The pediatrician starts listening to the chest organs with the heart. At this point in the examination, it is important for the doctor that the child does not cry, since in this situation the heart sounds are significantly muffled. The heart is heard mainly on the anterior surface of the chest on the left. The doctor then listens to the respiratory system. In newborn children, breathing is often very quiet, its nuances are difficult to hear even with the help of a phonendoscope. Therefore, the pediatrician can resort to a trick - rub the baby’s heel (pressure on this place will obviously be unpleasant for the child), after which breathing becomes deeper and more sonorous. The baby's crying, which is always accompanied by deep breathing, usually helps the doctor.

Features of pneumonia in young children

Pneumonia usually begins in the first week of an acute respiratory infection. Although acute respiratory infections are more often of a viral nature, against their background the bacterial flora very quickly “raises its head”. The fact is that a viral infection disrupts protective barriers respiratory tract and lungs, thereby contributing to the emergence of foci of bacterial infection; It is bacteria (for example, pneumococci, streptococci) that cause pneumonia. There is also viral pneumonia, which can be caused by the influenza virus.

The development of pneumonia in children of the first year of life is promoted by a whole series factors.

First of all, this Features of the respiratory system of infants. Short and narrow airways, delicate and well supplied blood vessels mucous membrane facilitate the spread of the inflammatory process. Weak chest movements horizontal position ribs predispose to insufficient ventilation of the lungs, especially the posterior and lower sections. Stagnation of blood in the posterior sections of the lungs is also facilitated by the abundant blood supply to this section of the lungs and the supine position of children in the first months of life. Insufficient maturity of the lung tissue causes the development of atelectasis (collapse and airlessness of the lung tissue), in which microbes feel at ease, which also leads to inflammation.

Besides anatomical features, factors contributing to the development of pneumonia in infants include everything that in one way or another weakens the baby’s defenses: rickets, improper early mixed and artificial feeding, living conditions that do not take into account the hygienic needs of the baby, acute respiratory infections, gastrointestinal diseases etc.

How to recognize pneumonia

The success of treating pneumonia largely depends on correct diagnosis. However, diagnosing an infant is not always easy, especially in initial stage, which practically coincides with the onset of an acute respiratory infection. And at this initial stage of the disease, timely consultation with a doctor is very important. Meanwhile, it happens that parents attribute the child’s illness to some banal reasons (for example, teething) and begin home-grown treatment for a non-existent disease, sometimes “blurring” the picture real disease and making diagnosis even more difficult. Let us repeat the common truths once again: do not give medications to an infant without consulting a doctor. This applies to antipyretic drugs, cough suppressants, and especially antibiotics.

Not only a thorough examination, palpation and listening, but also additional research methods - chest x-ray, general blood test - helps the doctor make a correct diagnosis. The fact is that, taken separately, inspection and additional examinations do not guarantee the correct diagnosis. Only comprehensive assessment the condition of a sick baby based on all of the above methods makes it possible to accurately determine the cause of his illness.

Treatment of pneumonia

If the disease is not severe, it is better to treat the child at home. In case of a severe form of the disease, the baby will have to be admitted to a hospital, the conditions of which will allow the necessary medical procedures: infusion, respiratory therapy (inhalation of an oxygen-air mixture, drugs), in critical situations - artificial ventilation. Fortunately, in most cases, with timely recognition of the disease and timely treatment, the outcome is favorable.

Today medicine has a fairly powerful arsenal medicines to help fight pneumonia. The basis of treatment is antibacterial drugs. Modern therapy also widely uses interferon drugs to increase antiviral immunity. Various phlegm thinners, expectorants and antiallergic agents are also used. However, let us remind you that only a doctor can prescribe these drugs, especially to young children.

What can parents do for speedy recovery child? If treatment occurs at home, it is necessary to regularly ventilate the room, change the position of the child’s body, and pick the baby up more often to avoid stagnation in the lungs.

It should be remembered that the symptoms of pneumonia disappear faster than the inflammatory process in the lungs itself. Therefore, incomplete treatment can lead to relapses, exacerbations of the disease, and in some cases, to the transition of an acute inflammatory process to a chronic one, to the formation of chronic bronchopulmonary diseases.

Prevention of pneumonia

The key to a child’s health is breastfeeding, prevention of rickets, restorative massage and gymnastics, hardening ( air baths and wiping). During epidemics respiratory infections It is especially important to limit the baby’s contact with strangers, even with relatives. It is advisable for adults who live in the same apartment with a child to get a flu shot. If the mother becomes ill with a respiratory viral infection, it is necessary to continue breastfeeding, because the baby will receive antiviral antibodies with milk. The only condition for this is the use of a protective mask. Even a mother taking antibiotics is not a contraindication for breastfeeding; the drugs that are safest for the baby are simply selected.

Congenital pneumonia

Due to a number of circumstances (acute and chronic infectious and non-communicable diseases, insufficient obturator function of the mother’s cervix, a long anhydrous interval during childbirth, etc.) some children are born with inflammatory changes in the lungs. Sometimes they develop pneumonia soon after birth. Especially often congenital infection observed in premature babies, since one of the main reasons premature birth is infection of amniotic fluid and the fetus.

The disease is usually severe. Therefore, nursing of sick babies is carried out exclusively in neonatal pathology departments or intensive care units. Despite the fact that neonatal pneumonia is a serious disease, modern medical technology allow us to successfully resist this disease. Among them is a massive antibacterial therapy, immunotherapy, helium-neon laser irradiation of the projection area of pneumonia foci, etc. After discharge from the hospital, the child must receive medications that normalize the intestinal flora (bifidumbacterin, primodophilus) and multivitamins. In this situation, breastfeeding is also a remedy.

If a child has suffered congenital pneumonia, this does not mean that pneumonia will inevitably haunt him throughout his life. However, the probability frequent illnesses respiratory system in such children is higher.

For prevention congenital pneumonia Before conception or already during pregnancy, a woman needs to treat all chronic foci of infection. A balanced diet and healthy image life of the expectant mother.

Albert Antonov
Honored Scientist of the Russian Federation,
Professor, Doctor of Medical Sciences, Head of the Intensive Care Unit,
neonatal intensive care
and nursing of low birth weight babies Scientific Center of Agipology of the Russian Academy of Medical Sciences

Discussion

16.10.2006 19:32:52

Comment on the article "Pneumonia in children of the first year of life"

Pneumonia in infants. Symptoms of pneumonia in a child. Treatment of pneumonia, possible complications. I looked at it ten more times on the computer and diagnosed it as left-sided pneumonia. in April she herself was in bed with inflammation, the eldest brought from...

Discussion

I had no symptoms, only some weakness, a hundred doctors listened and no one heard, only the x-ray showed bilateral hilar ((
They gave injections

You definitely need to do an x-ray examination. It could easily be pneumonia! And at your appointment, describe all your symptoms very specifically to the doctor. Indeed, yesterday there might have been an acute respiratory infection, and today there was pneumonia... Most likely (if the diagnosis is confirmed) antibiotics will be prescribed.
I myself suffered from pneumonia in mature age. I did inhalations with eucalyptus essential oil for 7 days! I drank mukaltin and galavit. A very serious illness, it may even be a consequence of the flu, which you once did not recover from.

Pediatric medicine. Child health, illnesses and treatment, clinic, hospital, doctor, vaccinations. My daughter had pneumonia...at 2.8 years old (it all started with a mild fever, runny nose, slight cough, then a temperature of 36.6 all day, and...

Discussion

My daughter had pneumonia...at 2.8 years old (it all started with a mild fever, a runny nose, a slight cough, then a temperature of 36.6 all day, and the next...the temperature was 39-40, the doctor said to do an X-ray!!! X-rays indicate inflammation .... T.39 and I went to get an X-ray... and an aunt in the clinic yelled at a 2.8-year-old child that she couldn’t stand still and raise her hands up and not breathe :))) There was no cough as such. ...Our local doctor said that my daughter was cutting her teeth :))) it turned out that I had to go to my place of registration in my area and called a doctor there... she told me about inflammation... and we were treated for teeth :) )))...

If the snot and cough do not go away with the a/b (and you seem to be on the 4th day of treatment), see an ENT specialist again, maybe you need to change the a/b, call for blood from the children. shelves are required to come and take them for free; if the pediatrician refuses, go to the manager, but in general it is enough for the pediatrician to write an application

How to determine pneumonia? When I cough, sir right side it hurts in the lung area. Is this already a reason for concern? Run to the doctor? I cough a lot, t-37.1. Pneumonia in children - dangerous disease, which most people know as pneumonia.

Discussion

2 years ago I got sick, I thought it was a common cold or a virus, as usual I was treated with whatever I knew, but 2 weeks passed from the onset of the disease and the cough at night began to be especially severe, and one night I couldn’t sleep at all, I coughed so much that I was turning inside out + by the morning I was coughing so bad, that I spat out something like a clot the size of blood... a little, but then I went nuts and was so scared, I thought I was dying, I ran straight to the doctor, she listened to me and sent me for an x-ray, they suspected pneumonia, during the examination she stuck me with a thermometer, I still remember, I laughed, I said I don’t have t, but it turned out to be 37.2... so I think you should get an x-ray for treatment, better soon), do it for your own good, Be healthy...

01/27/2011 22:31:09, zebrrrra

Only a doctor and x-ray can determine it.
It often happens that pneumonia cannot be heard, but is visible on an x-ray. Extremely rare - heard but not seen.

Hilar pneumonia... Hello everyone. The child is almost 4 years old. In February she was very high temperature, cough. They did an X-ray of the chest. A diagnosis was made: hilar pneumonia. We took two courses of antibiotics. Then we took immunosuppressants and vitamins. Now...

Discussion

Don't be alarmed, wait for your doctor's consultation. Judging by the fact that you describe there are many versions. We will only intimidate, since all radiological changes after antibiotics (if it was pneumonia, of course) should have regressed within a month (go away or at least decreased). Be patient. Best option- this is the remaining pneumofibrosis - compaction of the lung tissue after an infection.

Are the images described by a radiologist?

Pneumonia in children: symptoms, prevention and treatment. Pneumonia in children is a dangerous disease that most people know as pneumonia. Leading world experts in the field of pediatrics, epidemiology and vaccinology gathered at the annual... Larvae extract helps with pneumonia, tuberculosis and adhesions wax moth, still available in dragee. This is a natural product from the apiary. If there are remnants of inflammation, it will remove, if there are adhesions, then they will resolve. If you can’t find it, you can use honey with aloe.

And then, the antibiotic course has already ended, but there is still enough antibiotic in the blood. Therefore, control tests are not taken immediately, but after 2-3 weeks. Maybe we just need to wait?

It seems to me that in your case you need to choose rehabilitation therapy, and everything will pass.

It can hurt, then adhesions (moorings) form, i.e. there was inflammation of the pleura (local). Physiotherapy is effective, but you just need to be sure that the inflammatory process is over. Mustard plasters and other warming procedures can be dangerous: A) if there is still inflammation B) they can increase the formation of connective tissue (adhesions). Pulmonology is not necessary, a sane therapist will do, plus I wouldn’t be afraid to take another x-ray. About exercise therapy A very common misconception is that the balloon needs to be inflated. You have to inhale from it :) That is. the task is to hold your breath for as long as possible at maximum inhalation, and the resistance when inhaling should be dosed. And deep exhalation (when inflating the balloon) can be very unhelpful in this situation, because... By increasing the volume of the pleural cavity by decreasing the volume of the lung (exhalation), the formed moorings are constantly injured and, thus, the formation of connective tissue is stimulated purely mechanically. Len, however, pneumonia is my crouton after all. Would you like me to bring you a breathing machine? I can only meet in the center.

Discussion

Hello!, my daughter has one-sided pneumonia, she is a month old, she has been in intensive care for 6 days but the shortness of breath does not go away, how long does it take for this shortness of breath to go away?

02/17/2019 20:56:34, Sagova Toma

lay in 3 hospitals with croup in infectious department - St. Vladimir - I didn’t like it, my mother’s day stay, so I had to sleep on 3 chairs, on the third day they left with a signature, boxes without amenities for 3 children, Tushinskaya 7 - they were there a week ago, I didn’t like anything except inhalers, boxes for 1 or 2 children, lie with mothers, bathroom, toilet right there, everything else is just a disaster, everything you can’t do for money, you can’t go out, the food is worse than everywhere else, Morozovskaya - I liked it, so to speak, most of all, boxes for 1-2 children, mother and child, bath, toilet, pharmacy on site, you can run to sleep or to the buffet, store, transfers at any time. There is no sugar everywhere, but at 7 and St. Vl. I won’t go again, but to Moroz. We've already gone 2 times.

01.12.2003 19:31:10, L Irina

Pneumonia (lung inflammation) is infectious disease, which develops in the respiratory part of the respiratory system with the obligatory involvement of lung tissue in the inflammatory process and is characterized by the development of a specific symptom complex - intoxication, respiratory disorders, changes in the lungs detected during examination and on an x-ray.

Pneumonia may be independent disease, and may arise as a complication of any disease. Highest percentage incidence of pneumonia occurs in early childhood, decreasing two to three times in adolescents. During periods of influenza epidemics, the incidence increases.

With pneumonia, the pathogen enters the lowermost parts of the respiratory system. As a result, the affected part of the lung loses the ability to perform its functions: absorb oxygen and release carbon dioxide. Therefore, this disease is much more severe than other respiratory infections.

Risk factors

The following increase the risk of developing pneumonia: predisposing factors:

In young children

Prematurity;
Severe perinatal pathology (asphyxia, intrauterine hypoxia, birth trauma and others);
Vomiting and regurgitation syndrome;
Artificial feeding;
Hypotrophy;
Congenital heart defects, lung malformations;
Cystic fibrosis;
Hereditary immunodeficiencies, hypovitaminosis.

In school-age children

Chronic foci of infection in the ENT organs;
Recurrent and chronic bronchitis;
Smoking (both active and passive);
Cooling of the body, stress reactions.

There are several types of pneumonia

According to the conditions of infection: out-of-hospital (home), intra-hospital (hospital).

In newborns, pneumonia is divided into intrauterine (congenital) and acquired (postnatal).

By morphological feature : focal, segmental, focal-confluent, lobar (lobar), interstitial.

Downstream- acute, lingering.

Pneumonia in the background artificial ventilation lungs: early (first 72 hours of mechanical ventilation) and late (4 days or more on mechanical ventilation).

Pneumonia is also identified in people with immunodeficiency.

According to etiology:

pneumonia caused by Streptococcus pneumoniae; Haemophilus influenzae, staphylococci, pneumococci, clastridium and other pathogens.
There are also bacterial and virus-associated pneumonias.

Causes and pathogens of pneumonia in children

In most cases, the cause of pneumonia is an infection. Most often, acute pneumonia develops in a child suffering from acute respiratory viral infection in the first week of illness.

The development of severe pneumonia, as a rule, is caused by mixed flora - bacterial-bacterial (a combination of staphylococcus, Haemophilus influenzae or streptococci), viral-bacterial, viral-mycoplasma and others.

The peculiarity is that pneumonia is a typical infectious process. This means that various pathogens cause diseases that do not differ significantly in clinical signs.

The risk of developing pneumonia increases with the presence of predisposing factors.

The most common pathogens of pneumonia in children

Intrauterine pneumonia(first days of life). Bacteria - group B streptococci, less often Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Staphylococcus epidermidis; Viruses - cytomegalovirus, herpes. Others are mycoplasmas, urealiticum.

5 days - 1 month: bacteria - staphylococci, coliform bacteria, listeria. Viruses - cytomegalovirus, RS virus, herpes. Others are chlamydia trachomatis.

1 month - 6 months: bacteria - pneumococcus, Staphylococcus aureus, Haemophilus influenzae. Viruses - MS virus, parainfluenza, cytomegalovirus. Chlamyia trachomatis.

6 months - 5 years: bacteria - pneumococcus, Staphylococcus aureus, Haemophilus influenzae. Viruses - RS virus, adenovirus, influenza, herpes.

Over 5 years old: bacteria - pneumococcus, Haemophilus influenzae. Viruses - influenza A, B, picornaviruses. Mycoplasma, chlamydia.

The etiological spectrum of pneumonia depends on diagnostic quality criteria. According to many authors, among focal and infiltrative pneumonia, about 77-83% are caused by bacterial pathogens.

Clinical manifestations of pneumonia in children

Clinical symptoms various types pneumonia are similar, but there are still some features depending on age and the degree of damage to the lung tissue.

Focal pneumonia is the most common.

The course of pneumonia in young children

So, symptoms of pneumonia in infants and young children are characterized by: severe intoxication, signs of respiratory failure come to the fore (shortness of breath, cyanosis, participation of auxiliary muscles in the act of breathing), more typical late appearance physical changes in the lungs (shortening of percussion tone over lesions, weakened or hard breathing, wheezing).

For pneumonia in infants characteristic in initial period catarrhal changes - runny nose, sneezing, dry cough, impaired general condition, increased body temperature to subfebrile levels. Subsequently, the cough intensifies, the general condition worsens, children become lethargic, pale, maybe unstable chair, regurgitation, vomiting. These symptoms of pneumonia are most typical in children 1 year of age. Although in some babies the disease may begin among full health from the expressed sharp increase body temperature, general condition disturbances (lethargy, weakness, drowsiness, refusal to eat), shortness of breath, cough.

At pneumonia in newborns in addition to shortness of breath (increased breathing), cyanosis, wheezing in the lungs, special diagnostic value have a violation of the breathing rhythm, participation in the act of breathing of auxiliary muscles (retraction of the intercostal muscles, jugular fossa, flaring of the wings of the nose), chest rigidity. Newborns are characterized by hyperthermia (a significant increase in body temperature) and severe intoxication of the body.

During an objective examination, the doctor can identify signs of swelling of the lungs, such as a boxy tint on percussion tone, a narrowing of the boundaries of relative cardiac dullness. Auscultation (listening to the lungs with a stethoscope) at the onset of the disease weakened breathing is heard. Then local sonorous fine-bubbling and crepitating wheezing appears (in half of the patients they may appear in the first days of the disease.

The radiograph reveals swelling of the lungs, expansion of the roots of the lungs, increased pulmonary pattern, irregular shape focal shadows with not sharp contours.

The course of pneumonia in children of preschool and school age

The onset of the disease may be gradual, with slow progression clinical symptom by the end of the 1st - beginning of the 2nd week of the disease, or it can be sudden, in which a clear clinical picture appears already in the first 3 days. In children 2-4 years old, pneumonia most often occurs according to the second option. Symptoms of pneumonia in children 7 years of age increase, as a rule, gradually.

In the first (gradual) variant of development, signs of intoxication appear or increase in the child against the background of ARVI (fever, headache, lethargy, loss of appetite, deterioration in health), sleep is disturbed, tongue is coated, and heart rate increases. “Pulmonary” complaints are added: wet cough, shortness of breath, sometimes there may be pain in the side. Slight pallor is typical for patients with pneumonia skin with normal coloration of mucous membranes. Noteworthy is the perioral (around the mouth) cyanosis and the participation of auxiliary muscles.

An objective examination can reveal: shortening of the percussion tone over the lesions, weakened or harsh breathing, crepitating constant fine-bubble rales. Characteristic feature for pneumonia is the persistence of local symptoms.

In the second option (sudden violent onset), all of the above symptoms (pulmonary complaints, intoxication, respiratory failure, local changes over the lungs) appear in the first hours of the disease.

X-ray reveals focal shadows in one of the lungs

Segmental pneumonia

Focal pneumonias that occupy a segment or several segments are called segmental. Three variants of the course of segmental pneumonia have been described:

benign - a poor clinical picture, respiratory failure, intoxication, cough may be completely absent;

according to the type of lobar pneumonia with a sudden onset, fever, severe intoxication, and a cyclic course;

according to the type of focal pneumonia.

Diagnostics

To make a diagnosis, the following examination is performed:

general clinical analysis blood;
chest x-ray;
bacteriological cultures from various loci to determine the pathogen and its sensitivity to antibiotics.

Treatment of pneumonia in children

Treatment of pneumonia in children at home is possible, but only in cases of mild, uncomplicated forms, in the presence of favorable living conditions, with a sufficient level of general and sanitary culture of family members, and confidence in parents’ strict compliance with all doctor’s prescriptions. A pediatrician visits such a patient daily until there is a lasting improvement in the general condition.

Treatment of pneumonia is complex:

Regimen - bed during the entire febrile period, protective throughout the illness, careful care of the skin and mucous membranes, ventilation of the room;
Nutrition must be appropriate for the child’s age. During the acute period, food should be mechanically and chemically gentle. The amount of fluid during febrile periods is increased by 20%;
Antibacterial therapy is the main type of treatment aimed at the cause of the disease;
Vitamin therapy;
Symptomatic therapy - mucolytic, expectorant, antipyretic therapy;
Herbal medicine is a mixture containing plants with an expectorant (elecampane root, licorice, sage, thyme, etc.), disinfectant effect ( Icelandic moss, St. John's wort, birch leaves);
Stimulation protective forces the body during the recovery period - dibazol, pentoxyl, ginseng and others.
Prevention of dysbiosis - probiotics;
Physiotherapy;
Therapeutic exercise and gymnastics, including breathing.