Features of pneumonia in young children. Diagnosis of acute pneumonia

Pneumonia in young children plunges parents into shock, because this is not an easy disease, it requires treatment, and in newborns it can even lead to death in a matter of hours. respiratory failure. In addition, pneumonia causes not only problems with the respiratory system, but also with other functional departments body. With pneumonia, the symptoms of pneumonia in children from 0 to 3 years old differ slightly from each other and this is due to maturity immune system.

Features of pneumonia in young children

They consist in the fact that in most cases the disease appears against the background viral infection: influenza, adenovirus, ARVI with a layer of bacterial flora.

The most common pathogens of the disease are:

1. Pneumococcus.
2. Streptococcus.
3. Haemophilus influenzae.
4. Atypical flora – chlamydia, mycoplasma, legionella.
5. Viruses.

At this point, the immune system has already been formed, surfactant is produced, so the disease does not occur often, because not every pathogen is able to penetrate such a protective barrier.

First of all, you should be wary of highly pathogenic flora, which can destroy defenses and penetrate through the epithelium into the lungs.

A viral infection can cause pneumonia with the following symptom in children aged 3 years - multiple lesions in the lung tissue, which are visible on x-ray. Pneumococcal pneumonia is one of these highly toxic agents that lead to bilateral inflammation, its course is quite difficult for young children. If the baby is already 1 year old, then with proper and timely consultation with a doctor, the disease can be dealt with in 2 weeks. If some other diseases are added, the treatment is slightly delayed.

Children aged 1 year are more likely to experience the following complications:

1. Inflammation of the pleura with a large accumulation of exudate.
2. Bronchial stenosis caused by allergies.
3. Inflammations such as otitis media, tonsillitis, and pharyngitis may occur.

Causes of pneumonia in children

They are as follows:

1. Infectious diseases of the mother during pregnancy.
2. Oxygen starvation or short-term asphyxia during childbirth in the fetus.
3. Secondary acute respiratory infections.
4. Repeated purulent otitis.
5. Congenital abnormalities in the development of the heart and lungs.
6. Blood cancers.
7. HIV is primary or secondary.

Symptoms and signs of pneumonia

Common symptoms of pneumonia in children aged 1 to 3 years:

1. Temperature from 38, which lasts longer than 3 days.
2. Breathing is harsh - audible when listening with a phonendoscope.
3. Frequency breathing movements up to 50 per minute between 12 and 16 months of age. 40 from 16 months to 3 years.
4. The intercostal spaces are retracted.
5. Skin cyanosis.

Symptoms of general intoxication of the body: lethargy, fatigue, blurred consciousness.

Also, a swollen nasolabial triangle is added to the signs of pneumonia in a 1-year-old child. Usually inflammatory diseases at the age of 1-2 years, the lung parenchyma is observed (by type) segmental or lobar. Sometimes there is a collapse of the lung.

Specific symptoms of pneumonia at 1 year

As soon as the newborn turns 1 year old, you can exhale, since the most dangerous time passed. One year old baby, in case of illness, will endure pneumonia more easily. Respiratory failure is also easier here. Thanks to this, under the supervision of a pediatrician, it is possible to cure light form illnesses on an outpatient basis. But still, doctors try to refer the patient to a hospital for treatment, since there is a danger of bronchial obstruction and difficulty breathing, although the percentage is small.

Pneumonia in 2-year-old children

Pneumonia in children over 2 years of age is caused mainly by bacterial infection. Each of them has its own specific disease. For example, pneumococcal pneumonia at 2 years of age, as a rule, rarely causes bilateral inflammation of the pulmonary parenchyma, leading to changes in the mucosa. With good immunity and intake antibacterial drugs pneumonia and its symptoms in children aged 2 years disappear within 14 days.

Symptoms of pneumonia in children aged 2 years are similar to the symptoms of this disease in a 1-year-old child and do not differ significantly.

Pneumonia in children 3 years old

The child experiences significant changes in the blood. The number of leukocytes rises and the number of lymphocytes decreases. And this is considered the norm. Because of this restructuring, the baby's protective forces body and the possible occurrence of inflammatory diseases.

Signs of pneumonia in a 3 year old child:

1. The respiratory rate is about 40 per minute.
2. Cyanosis of the nasolabial triangle.
3. Heat.
4. Intoxication of the body: lethargy, pale skin.

If you notice the listed symptoms of pneumonia in children 3 years old, you should definitely call a doctor.

Other external signs pneumonia in a child aged 3 years:

1. Refusal to eat.
2. Lethargy.
3. Increased sweating.

Treatment

In any case, newborn children must be admitted to a hospital for treatment. If signs of pneumonia are detected in a child who is 2 years old, you should consult a doctor, and after necessary research, will prescribe treatment either at home, for mild pneumonia, or give a referral to the hospital for moderate and severe severity of the pathology.

Treatment principles:

1. Differential diagnosis.
2. Antibiotic drugs are often prescribed before the underlying cause of the disease is determined. When taking them, the baby often experiences white inclusions in the stool.
3. Inhalations.
4. Proper nutrition appropriate for age. It is not recommended to force feed the baby.
5. Massage and exercise therapy after normalization of the condition.

Specific treatment methods will depend on the characteristics of the pathology, sometimes used traditional methods treatment.

Prevention of development pneumonia necessary from birth. This will be one of the conditions for maintaining health, which in turn will reduce childhood disability and mortality.

What preventive measures are currently available:

1. Hib vaccination, which includes antibodies to protect against: Haemophilus influenzae, pneumococcus, measles and whooping cough.
2. Necessarily breast-feeding newborn at least in the first 6 months after birth. And in the future balanced diet, appropriate to the baby's age.
3. Regular hardening child's body.
4. Physical education is important for a child.
5. It is necessary to combat dust and environmental pollution.
6. Do not smoke near your child.
7. Personal hygiene is mandatory, especially in residential areas with a large number of people.
8. Isolation of sick children during the acute period of illness.
9. At feeling unwell child, seek help from a doctor.

Parents must always remember: pneumonia can be avoided if you follow the recommendations outlined and treat your children with care and attention.

Chepurnaya Maria Mikhailovna, Professor, Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Head of the Pulmonology Department

Karpov Vladimir Vladimirovich, Candidate medical sciences, Head of the Department of Childhood Diseases No. 3

Andriyashchenko Irina Ivanovna, Pediatrician of the highest qualification category

Zabrodina Alexandra Andreevna, Pediatrician, Allergist-Immunologist, Children's City Hospital No. 2, Rostov-on-Don

Page editor: Kryuchkova Oksana Aleksandrovna

Etiology. Respiratory diseases in early childhood differ in polyetiology depending on a number of reasons (an outbreak of viral respiratory infections - adenoviral, influenza, etc., age characteristics, previous anamnesis, features of regional pathology, etc.). When studying the etiology of pneumonia of early age, one cannot rely only on the infectious beginning; it is necessary to study other factors: the external environment and the premorbid state of the child, his reactivity and resistance.

In the etiology of early childhood pneumonia, it is most appropriate to distinguish two factors - infectious and non-infectious, taking into account, of course, the mutual connection and influence of both factors. The infectious factor is described in sufficient detail in. chapters III and IV.

Pathomorphology. According to M.A. Skvortsov (1946), histological studies in interstitial pneumonia indicate thickening of the alveolar septa due to their infiltration by fibroblasts and macrophages, as well as infiltration of peribronchial tissue.

The lumens of the bronchi, unlike those in ordinary exudative pneumonia, are free. In some cases, in the epithelial lining of the bronchi and, less commonly, the alveoli, numerous giant cells with special inclusions are detected. Along with this, atelectasis, severe hyperemia, often swelling of the interlobar septa, and sometimes fluid accumulation and hemorrhage in the alveoli are noted. These changes explain the characteristic interstitial pneumonia rapid development of hypoxemia. Similar changes were found during artificially created hypoxemia in experimental animals. (Yu. F. Dombrovskaya, 1961). The same changes in the interstitial tissue of the lungs can also occur secondarily during the hematogenous spread of a septic infection, which indicates a hyperergic response of the lung tissue.

V. M. Afanasyeva, B. S. Gusman et al. (1974, 1975) analyzed sectional material from all autopsies performed at Children's Clinical Hospital No. 1. In 32.5% of cases main reason death and an aggravating factor in other diseases were pneumonia. In cases where infection by bacterial flora was not observed, influenza viruses, adenovirus and PC virus were detected with a disease duration of 1 to 3 days. Interstitial inflammation, hemorrhages and edema in the lung tissues, and pure interstitial pneumonia have also been established. The morphological changes observed by the authors in acute respiratory viral diseases consist of impaired vascular permeability, hemorrhage into the lung tissue and lymphohistiocytic infiltration of the interalveolar septa. Most authors (A.V. Tsinzerling, 1963, etc.) consider these changes as primary viral pneumonia.

Clinical forms. Pneumonia of early childhood has long been classified as a disease of the whole body, involving all organs and systems, the dysfunction of which determines the severity and form of the disease. The peculiarities of the structure and functions of the respiratory organs explain their tendency to diffuse processes in the lungs with respiratory failure.

According to morphological changes based on clinical and radiological studies, acute pneumonia in young children is varied: interstitial, small-focal, large-focal, focal, segmental, confluent. When infected with respiratory viruses, the reaction of the lung tissue may be limited to the participation of the interstitial system of the lungs (interstitial and hilar pneumonia). Clinically and even radiologically, it is not detected from the first days of the disease. Obviously, the development of viremia requires known conditions, time and reaction of the body.

Each classification of pneumonia should reflect the etiology, clinical picture, pathogenesis and morphological assessment. However, it is more rational for the clinician to base the classification on the reaction of the macroorganism and the form pathological process generally.

V.I. Molchanov and Yu.F. Dombrovskaya among early-age pneumonias distinguish localized (lung), subtoxic, toxic, toxic-septic. To characterize structural changes in the lungs, their definition is added: 1) localized (mild) forms: interstitial, small focal, large focal, segmental pneumonia; 2) subtoxic, 3) toxic forms: interstitial, small focal and confluent mono- and polysegmental pneumonia; 4) toxic-septic form: small and large abscess pneumonia and abscess pleuropneumonia.

Localized forms are characterized by the rapid development of pneumonia after a short period of catarrhal symptoms (typical cough, moderate shortness of breath when moving and the development of changes in the lungs). The heart sounds are quite sonorous, the pulse is normal, well-filled, and corresponds to the temperature. Localized pneumonia occurs in children with high resistance.

Before the use of sulfonamides and antibiotics, the duration of the disease was 5-7 days. Currently, with the use of antibiotics, this period is reduced. However, even with such a favorable form, clinical recovery does not correspond to the elimination of anatomical changes in the lungs. More often they are basal in nature, which indicates the lymphogenous spread of the process.

On radiography, at the first stage of the disease there is only perivascular infiltration lung tissue, but c. At the end of the 1st year, focal, small-focal or segmental pneumonia is often determined. Frequency of individual lesions lung segments is not the same for children of different ages.

According to the Children's Clinic I MMI named after. I.M. Sechenov and others, segments II, VI, IX and X are most often affected. With moderate pneumonia, along with monosegmental pneumonia, polysegmental pneumonia can also develop,

Polysegmental pneumonia, unlike monosegmental pneumonia, occurs as catarrhal pneumonia. Monosegmental pneumonia often follows the lobar type (acute onset, high temperature, leukocytosis).

The blood reaction in the localized form is different. Along with leukocytosis, poitrophilosis and a shift of the formula to the left, an increase in ESR, especially with a sluggish course, an unchanged morphological picture blood.

The localized form often resembles lobar (acute onset, high fever, but a drop in temperature! Lytic). In the transition of a localized form to subtoxic and toxic, exogenous superinfection and autoreinfection are important, depending both on the state of the protective-adaptive reaction of the body and its immunological system, and on a change in pathogen as a result of antibiotic therapy (the appearance of new forms or a change in types of pathogen).

Primary acute interstitial pneumonia, usually of viral origin, is the first stage of lung damage by viruses. It often begins with shortness of breath with noisy exhalation, significant cyanosis, deafness of heart sounds and tachycardia, up to embryocardia. Emphysema develops rapidly with a sharp swelling of the chest and emphysematous swelling of the edges of the lungs, covering the cardiac dullness.

Interstitial pneumonia is characterized by periodically occurring attacks of collapse with the progressive development of marginal or basal emphysema, or characterized by the formation of cavities (pneumocele). This form of pneumonia is more often observed with influenza and PC virus infection, mainly in the first months of life. Observations show that due to the addition of bacterial flora, interstitial pneumonia subsequently takes on other forms(focal, segmental). During the acute period of its development, the syndrome of toxicosis, hypoxemia, and so on is most pronounced.

Rice. 57. Interstitial pneumonia in a child aged 1 month (subtoxic form). Severe emphysema. Root infiltration (“broom”).

dysfunction of the central and autonomic nervous system. A terrible syndrome is a disorder of the gastrointestinal tract (regurgitation, vomiting, frequent bowel movements, flatulence, leading to anhydremia and exicosis). Against this background, clinically and radiologically formed pneumonia is gradually revealed.

The X-ray picture of acute interstitial pneumonia was comprehensively described by N.A. Panov in 1947. It is typically characterized by the presence of thickened perilobular and perialveolar septa, giving the affected areas of the lungs a peculiar “cellular” appearance (Fig. 57). The second extremely important symptom of the x-ray picture is a gentle infiltrative change in the peribronchial tissue, but without noticeable involvement of the bronchi. The same infiltrative changes can be seen in the root sections of the lungs. This picture is characteristic of diffuse interstitial pneumonia. However, along with this, focal interstitial pneumonia often occurs. It is localized in the basal part of the right upper lobe, hilar and medial lower supraphrenic areas of the lungs (Fig. 58).

In the future, along with this, damage to the bronchial alveolar system occurs with foci of pneumonia, hemorrhoids,

Rice. 58. Interstitial pneumonia in a 13-month-old child (toxic form, influenza A).

of a tragic nature, the permeability of the membranes to liquid increases and a diffuse accumulation of liquid appears in the cavity of the alveoli, which further complicates gas exchange. The infiltrative process leads to the further formation of collagen fibers. All this explains the occurrence of respiratory failure with scant signs of changes in lung tissue.

Toxic forms of pneumonia in early childhood should be characterized as a complex severe disorders respiratory, cardiovascular, central and autonomic nervous systems, gastrointestinal tract, as well as metabolic processes. Toxic forms often develop gradually, but rapid development can also occur. The appearance of the patient indicates serious illness: along with pallor, cyanosis of the lips and face, persistent cough and shortness of breath, anxiety or depression is noted. Arterial blood pressure is reduced or increased, the pulse is frequent and small. The borders of the heart quickly increase to the right. At the same time, the liver enlarges, the tone decreases and the lumen of the capillaries decreases (impaired microcirculation). Marble-toned leather.

Main clinical syndromes with toxic pneumonia there are pronounced respiratory failure in the form of shortness of breath and cardiovascular disorders. These disorders occur against the background of hypoxia and acidosis.

Dyspnea as a manifestation of pulmonary and pulmonary-heart failure is of a different nature depending on the age of the child, the etiology of pneumonia and, most importantly, the premorbid condition of the child, i.e. the presence of rickets, exudative diathesis, allergies and previous pneumonia.

The main regulator of respiratory movements, as is known, is the vagus, so the doctor, based on determining the rhythm, type, frequency and depth of breathing, can judge the degree of hypoxia and the associated respiratory and metabolic acidosis. Respiratory failure increases with the development of pulmonary emphysema of various localizations (basal, marginal, focal, segmental, bilateral and unilateral) (Fig. 59, 60, 61, a, b).

Toxic phenomena in severe pneumonia often arise gradually even in the subtoxic stage, but in some cases, in the very first days or hours of the disease, a picture of general toxicosis develops. The reaction of the nervous system during toxic pneumonia sometimes simulates meningitis and meningoencephalitis, a “convulsive syndrome” associated with increased intracranial pressure and brain hypoxia (tension of the large fontanelle in children in the first months of life).

The leading syndromes of respiratory failure are shortness of breath and hypoxia (oxygen deficiency), which has been established clinically and experimentally (Yu. F. Dombrovskaya et al., 1961). Dyspnea as an indicator of pulmonary heart failure requires complex pathogenetic therapy, primarily restoration of bronchial conduction.

In toxic forms of pneumonia, disturbances in the respiratory functions of the lungs are accompanied by acidosis. The tendency to acidosis in young children is explained by the weak buffering properties of extracellular fluid, since the level of hemoglobin, protein and bicarbonates - the main blood buffers - in the first months of life is lower than in adults.

Toxic pneumonia is characterized by extremely striking phenomena of nervism - meningeal and meningoencephalic syndromes, intestinal paresis, vascular collapse, and a drop in blood pressure. For severe cases, typical muscle hypotonia, lack of tendon reflexes, bloating, lack of swallowing, diarrhea. Thus, the whole picture described

Rig. 59. Fine-focal and interstitial pneumonia in a 5-month-old child (toxic form).

Rice. 60. Finely focal confluent pneumonia in a 1-month-old child (toxic form).

Rice. 61. Segmental pneumonia in an 11-month-old child (toxic form).

toxic pneumonia is in the nature of a severe stress reaction. According to a number of authors, prematurity and low birth weight predispose to the manifestation of respiratory failure, which is obviously associated with insufficient differentiation of the reticular formation. For any form of the syndrome respiratory disorders Atelectasis occurs easily, especially in the first months of life.

It is noteworthy to compare the indicators of the function of the symnatic-adrenal system, in particular the excretion of adrenaline, with the degree of acidosis accompanying the disturbance of the acid-base state.

The cardiovascular system in toxic forms of pneumonia reflects the entire complex of disorders of the basic processes, viremia, toxemia, sensitization, acidosis and hypoxemia. In the early period of the disease, in the presence of respiratory hypoxia and acidosis, acute pulmonary heart syndrome is clinically detected

Severe syndromes of toxic pneumonia include the reaction of the urinary system. Already in the early period of toxicosis, protein in the urine, diuric phenomena and periodic urinary retention up to anuria appear. IN acute period a decrease in creatinine clearance is often observed (from 76.3 to 40.2% of normal), less often in the level of urea nitrogen with a normal value of residual serum nitrogen. In the presence of progressive respiratory failure and toxicosis, relative renal failure associated with hypoxia, shortness of breath, vomiting and loose stools.

In very severe forms of pneumonia, the concentration of residual nitrogen remains above normal and the ratio of urea nitrogen to residual nitrogen reaches 82.4%. The genesis of these phenomena is complex and requires a thoughtful approach and control. With a prolonged course of toxic pneumonia, pyelonephritis often occurs due to disturbances in the rhythm of activity individual areas(dyskinesia) of the urinary tract (pelvis, ureters, bladder) with subsequent infection with staphylococcus and pathogenic strains of Escherichia coli.

Even relatively favorable forms of pneumonia (localized) with slight acidosis and hypoxia are almost always accompanied by dyspeptic symptoms (regurgitation, frequent stools). This is due to both dysfunction of the vagal and sympathetic-adrenal systems, and direct infection. Violation of the water-electrolyte balance is of key importance, therefore, in toxic forms of pneumonia, in parallel with respiratory and cardiovascular disorders, severe intestinal toxicosis syndrome often occurs - bloating or, conversely, retraction of the abdomen, vomiting, profuse diarrhea, exacerbation.

Abdominal syndrome occurs in both toxic and toxic-septic forms. In toxic forms it has an acute character intestinal infection with frequent bowel movements, vomiting and severe bloating without signs of peritoneal irritation. It should be regarded as infectious enterocolitis staphylococcal or other bacterial nature. Along with this (more often with toxic pneumonia), intestinal paresis with stool retention occurs. However, with toxic-septic pneumonia this is typical for the development of pyopneumothorax or pleural empyema.

Changes in the liver - enlargement, pain - are characteristic of cardiovascular failure (acute cor pulmonale). According to a number of studies, pigment and carbohydrate functions are temporarily impaired (toxic hepatosis), which is caused by impaired protein metabolism and a decrease in the deamination function of the liver. In connection with this one of the mandatory medicines is glucose (5-10% solution) with ascorbic acid.

With toxic pneumonia, all types of metabolism are disrupted, and also vitamin balance. Endogenous vitamin deficiency, which is established clinically and laboratory.

The same data were obtained in an experiment under artificial hypoxia. This suggests that redox processes in the tissue respiration system during hypoxia are disrupted from the very beginning and are restored extremely slowly. The data presented convincingly indicate the need for targeted therapeutic measures in pediatric practice (vitamins, physiotherapy, long dispensary observation and, if possible, sanatorium follow-up treatment).

The pathogenesis of toxicosis in pneumonia is complex. It is necessary to take into account the effect of viral-bacterial infection on systems regulating homeostasis, which causes the main forms of the pathological process - hypoxia and acidosis. However, both pathological processes almost always have a “premorbid” basis (recurrent respiratory diseases, rickets, exudative diathesis, allergies). Essentially, each of the mentioned anamnestic factors leaves an imprint on the manifestations of these syndromes. It has been established that with exudative diathesis and rickets, even before pneumonia, the functions of the neurohumoral and autonomic-endocrine systems are disrupted, and the electrolyte balance and the permeability of capillary walls increases. The primary agent for the stress reaction causing acidosis and hypoxia may be the direct effect of viral and bacterial toxins on regulatory mechanisms (neurotropic, pneumotropic viruses), which causes the acute development toxic syndrome(deficiency of potassium, sodium, phosphorus, vitamins, amino acid and protein imbalance). A decrease in adaptive and protective mechanisms explains the easy occurrence of respiratory failure of varying degrees in early childhood. In particular, respiratory failure of the first degree is expressed even with catarrh of the respiratory tract and mild pneumonia with unstable hypoxia. This is due to the imperfection of the physiological mechanisms of respiration, insufficient differentiation of cells of the reticular substance and increased excitability of the vagus nerve. As is known, at an early age the frequency, type, rhythm and depth of breathing are easily subject to fluctuations and healthy child. Reserves in case of violation external respiration much less at an early age. Due to certain anatomical and physiological characteristics of infancy, pulmonary ventilation increases only due to increased breathing.

The response of all body systems during pneumonia in early childhood is also diffuse in nature; functional impairment quickly occurs.

The most indicative of the activity of succinate dehydrogenase is that experimental work has established a change in the enzyme in connection with the degree of hypoxia. The same data were obtained from histochemical studies of the lungs of dead children. A number of other energy metabolism enzymes also reflect the degree of developing hypoxia.

The restoration of these indicators occurs simultaneously with a decrease in the severity of the disease. An active method of correcting developed enzyme deficiency is the introduction of vitamins B1, B2 and C.

Toxic-septic pneumonia develops more often against the background of toxic forms, as well as depending on autoinfection or exogenous reinfection (staphylococcus, streptococcus, virus). Toxic-septic forms are especially difficult during exogenous reinfection (superinfection with the so-called hospital staphylococcus, not sensitive to all antibiotics). More often determined pathogenic flora- plasmacoagulating staphylococcus, giving abundant growth. With the development of septic complications, a clear increase in antibody titers (antistaphylococcal agglutinins, antistreptolysin O) to the isolated microorganisms is detected.

Rice. 62. Staphylococcal pneumonia in a 5 month old child. Stage of infiltration with outcome in abscess formation.

robes Along with this, with secondary microbial flora, the content of fungi and E. coli increases. The genesis of the development of the septic phase includes: 1) sensitization by microbes, products of impaired metabolism and the formation of specific antibodies; 2) a progressive decline in the body’s resistance; 3) the nature of pulmonary changes, localization, prevalence.

The first signs of the transition of toxic pneumonia to toxic-septic pneumonia are deterioration general condition, fever, anxiety, increasing leukocytosis with a neutrophilic shift. A typical x-ray picture is determined (Fig. 62, 63, a, b).

In addition to acute septic complications, toxic-septic pneumonia can occur latently, with moderate fever. According to pathologists, in such cases they find in the lungs a large number of small abscesses that do not cause a characteristic x-ray picture. Currently, due to the early hospitalization of patients and massive antibiotic therapy at the first suspicion of a septic process, these forms are relatively common.

Rice. 63. Staphylococcal pneumonia in a 3-month-old child.

rare, but all such patients are subject to observation by a pediatric surgeon in a specialized department.

Treatment of pneumonia. In recent years, the question of the need for controlled oxygen therapy in the treatment of pneumonia in children has arisen. Oxygen can have a direct toxic effect on the alveoli, mucous membrane of the trachea and bronchi, which has been proven by numerous experiments on animals. At oxygen concentrations above 80%, two phases were identified: 1) acute, exudative (swelling of the interstitium, alveoli, intra-alveolar exudation, hemorrhage, swelling and destruction of the capillary endothelium); 2) subacute, multiferative (fibrosis with fibroblastic proliferation of the interstitium).

Use of oxygen in high concentrations can lead not only to pulmonary fibrosis, but also fibroplasia of the retina of the eyes. 100% oxygen concentration is only permissible for short periods of time during intensive care.

A child's birth weight is even more important for oxygen therapy than his or her degree of maturity. Thus, for premature infants weighing less than 2000 g, the risk of retinopathy occurs already at an oxygen concentration of 30%. In addition to continuous clinical observation, monitoring of oxygen therapy should include determination of blood gas composition, acid-base status, blood pressure, hemoglobin level, temperature and ophthalmoscopy. Similar recommendations were made by the American Academy of Pediatrics in 1971. Best results observed with the introduction of humidified oxygen passed through 50% alcohol. Oxygen is administered through nasal catheters or in a portable plexiglass tent (“house”), or with an aerosol.

The duration of oxygen therapy for pneumonia is difficult to limit.

When oxygen therapy is used, its negative aspects must also be taken into account. At the IX International Congress of Pediatricians in Copenhagen, complications associated with the use of pure oxygen or a mixture with a high content of oxygen (over 80%) in newborns were widely discussed for the first time. The most severe complication is the so-called retrolental fibroplasia or retinopathy with incurable blindness in a child.

Involving both in the hospital and at home, the doctor should not forget about the leading importance of therapy with fresh cool air, i.e. constant ventilation

Mandatory delivery fresh air at any time of the year has long been considered a system for treating oxygen deficiency. Clinical and laboratory studies (1956-1960) showed faster normalization of both pneumograms. so and gas composition blood under the influence of fresh atmospheric air (a child being held in the garden nurse or mother) compared to the effect of oxygen in the ward (Yu. F. Dombrovskaya, A. N. Dombrovsky, A. S. Chechulin, A. A. Rogov, 1961). Use of oxygen in children under high blood pressure(in a pressure chamber) has not yet found wide acceptance.

Antibiotics occupy a leading place in the treatment of pneumonia. The doctor is faced with the task of choosing the appropriate antibiotic, taking into account the history of the child who received antibiotics before this disease (tolerance to antibiotics, their nature, quantity, form of reaction), as well as family history. It should be taken into account that a significant percentage of children already in the 1st year of life receive a variety of antibiotics, not always according to indications.

In addition to basic information about the mechanism of action of a particular antibiotic, it is necessary in each case to take into account the so-called kinetics of antibiotics in the body, associated with the functioning of a number of barrier systems of the body and the resorption of antibiotics.

Resorption depends not only on the dose and physicochemical properties of antibiotics, but also on the state of the microorganism (pH of the environment, diet, circulatory condition, oxygen debt, etc.). The rate of resorption is closely related to the rate at which antibiotics enter the blood, so in severe cases it is necessary to select antibiotics for intravenous administration. The nature of the distribution of antibiotics in the body and their tropism to individual organs and tissues have not been sufficiently studied. To assess the effectiveness of antibiotics, you need to remember the ways of their elimination from the body (excretion in urine, their metabolism in the body, deposition in organs and tissues). In addition, antibiotic excretion occurs through the lungs, intestines and biliary tract.

Currently, it is believed that only a few antibiotics act bactericidal, but mostly bacteriostatically, or rather biostatically, through their metabolites. To carry out this reaction, it is necessary to achieve indicators of the internal environment of the body that are close to normal. The effectiveness of antibiotics is associated with complex pathogenetic treatment of pneumonia, taking into account the impaired functions of individual systems.

Antibiotics, in addition to being therapeutic, also have side effects. Their direct toxic effect is rarely observed. More often side effect associated with compounds formed in the body (conjugates) that cause a pathological reaction of the antigen-antibody type. The side effect of antibiotics manifests itself as a “drug allergy”, which is well known to pediatric doctors and is expressed in the form of a polymorphic rash and swelling in the area where the antibiotic was administered. Mild manifestations of drug allergies during the administration of antibiotics escape the attention of the doctor due to the limited rash at the injection site. However, repeated administration of the antibiotic can cause a severe reaction, including anaphylactic shock.

Some antibiotics have more or less established side effects. For example, tetracycline can cause dysfunction of the gastrointestinal tract, penicillin type allergy serum sickness, streptomycin and neomycin are ototoxic (affect the hearing aid), biomycin has side effects on liver function. _A number of antibiotics cause drug-induced hemopathy (leukopenia, thrombopenia, agranulocytosis, erythropenia hemolytic anemia), which often escapes the attention of the doctor. Particularly sensitive hematopoietic system in the first months of life. The so-called gray disease of children in the 1st month of life after the use of chloramphenicol is known.

An adverse reaction to the administration of antibiotics does not occur in all children, but the doctor must take into account the possibility of their occurrence and detect the first syndromes of the development of a pathological response.

Besides more or less early manifestation side effect antibiotics (allergic and allergotoxic reactions), other forms have to be observed: a) long-term allergic sepsis type; b) dysbacteriosis and superinfection (with the appearance of the L-form of bacteria and activation of fungal flora); c) long-term recurrent reactions with dysfunction of organs and systems (pneumopathy, hepatopathy, nephropathy, diarrhea).

For severe heart failure, cardiotopic drugs are used, primarily glycosides that improve myocardial contractility, strophantine at a dose of 0.025 mg/kg, for signs of pulmonary hypertension, aminophylline (2.4% solution) intravenously at 0.1 ml/kg, furosemide (1-2 mg/kg). For bradycardia and bradypnea, cordiamine is prescribed in a dose of 0.5-1 ml. In case of prolonged toxicosis, it is necessary to administer cocarboxylase (50-100 mg), glucose with insulin, potassium preparations and ATP.

Along with cardiac insufficiency, vascular insufficiency develops, leading to impaired peripheral circulation (deficiency of circulating blood volume). To restore it, plasma and blood, 10/0 glucose solution, isotonic sodium chloride solution, and Ringer's solution are administered intravenously. Low molecular weight plasma substitutes are effective in helping to reduce the stagnation of red blood cells in the capillaries and increase blood pressure. They are administered at a dose of 30 ml/kg slowly (over 1 hour). The administration of glucocorticosteroids leads to significant improvement microcirculation (in courses of 3-4 days in doses increased by 2-4 times).

Thus, the fight against cardiovascular failure should be carried out taking into account individual indicators of disruption of this system, against the background of general therapy and nursing the patient.

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

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

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

Pathogenesis. Paths of penetration (aerogenic, lymphogenous, hematogenous) Penetration and reproduction of microbes occurs at the transition point of the terminal bronchi to the alveolar, involving the peribronchial, 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 of the immune system, passive smoking, etc.

Classification. According to the form, focal, focal-confluent, segmental, lobar and interstitial pneumonia are distinguished. 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 different 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, and 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(at severe course), immunogram (for a prolonged course), electrolytes in sweat (for a prolonged 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 (synpneumonia 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 immunopathological 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 a 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 peripheral circulation, detoxification therapy, treatment of heart failure, prevention and treatment of DIC syndrome, symptomatic therapy.

Principles of treatment for SPP - pleural puncture, then prescribing antibiotic therapy. With adequate antibiotic therapy, the volume of effusion decreases. The volume also increases with repeated puncture 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: regimen, nutrition (sometimes through a tube), treatment of respiratory failure (from high-pressure aeration to oxygen therapy) Antibacterial therapy (2 antibiotics are required; one of them intravenously 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.

And even determining its severity is the color of the skin and visible mucous membranes: cyanosis of the lips and nasolabial triangle, bluish-grayish coloring of the face are a convincing sign, as mentioned above, of oxygen or respiratory failure. A very valuable symptom when examining children is a sharp swelling of the chest due to extensive emphysema of the anterior parts of the lungs. Emphysema is early sign developing pneumonia, and its origin is purely neurogenic, since the development of emphysema is associated with a change in the tone of the vagus nerve. In newborns, chest distension and cyanosis may be the only reliable signs pneumonia. Quite characteristic of pneumonia in newborns are rapidly developing swelling of the face, lips, and tongue, which is associated with impaired vascular permeability. Swelling can spread to the entire torso.

A definite symptom of pneumonia is, of course, shortness of breath, which has some characteristics in early childhood. Inherent small child the so-called groaning, or grunting, shortness of breath or moaning breathing with an increase in speed up to 60-80 per minute are well expressed only after the 5-6th month of life. Due to the rapidly occurring irradiation of irritation, the ratio of pulse and respiration changes sharply, even regardless of temperature.

Pneumonia in children in the first months of life and in newborns is characterized by early onset shallow, intermittent, uneven breathing.

Percussion is usually used quietly and preferably directly, that is, by quietly tapping the chest with a finger; Often, by touch rather than by hearing, it is possible to detect a change in percussion sound. When auscultating, a fuzzy bronchophony is initially detected, mainly when the child is crying, and only later, as the process spreads, are unsharp bronchial breathing heard. For children in the first months of life, a discrepancy between the severity of the general condition, shortness of breath, cyanosis and scant percussion and auscultation data is quite typical. This is explained by the development of numerous tiny foci of pneumonia bordering areas of emphysematous tissue.

In the same way, the improvement in the child’s condition does not parallel the process of resolution in the lungs, but is associated with the restoration of the functions of other organs and systems. A feature of pneumonia in early childhood is the rapid occurrence of pulmonary-cardiac or severe pulmonary and cardiovascular failure.

As mentioned above, oxygen deficiency in early childhood is of a mixed nature - respiratory and cardiovascular. Essentially, the state of the cardiovascular system, as well as the reaction of the nervous system, determines the severity of pneumonia. Extremely valuable auxiliary method Diagnosis of pneumonia is an X-ray examination of the patient.

X-ray diagnosis of pneumonia It is in young children that it has a number of features, and despite all the value of this research method, its significance for the early recognition of pneumonia cannot be overestimated. With fluoroscopy normal lungs infant appear dark, less transparent, with a delicate, vague, almost homogeneous pattern. In addition, changes in blood supply associated with the baby's breathing and crying significantly alter the normal pulmonary pattern. The lungs themselves, due to their large volume and small additional respiratory space, expand little when inhaling and are almost not cleared on the screen. Fluoroscopy is also complicated by the extensive shadow of the mediastinum, as well as its easy displacement and the often enlarged shadow of the thymus gland. All this often gives rise to underestimation of changes in the lungs or misinterpretation of normal physiological phenomena.

It must be taken into account that one of the frequent morphological changes in the lungs during pneumonia in early childhood is emphysema, which, on the one hand, complicates both fluoroscopy and chest radiography, and on the other, more or less sharply changes the shape of the chest. Therefore, fluoroscopy should be performed when the child is in a calm state, since when crying the diaphragm rises upward, and the middle shadow of the heart and large vessels increases, as a result of which the pulmonary pattern becomes less transparent (congestive plethora of the lungs). Often the data obtained from fluoroscopy turn out to be much more scarce than clinical data. It must be borne in mind that X-rays can pass through several lesions at once, but their images on the screen sometimes coincide with each other.

For pediatrician It is extremely important to personally be present during fluoroscopy of your patient and point out those areas of the lungs where the maximum changes are clinically determined. At the same time, for greater accuracy of fluoroscopy, it is necessary to carry out the so-called multi-axial transillumination, i.e., examining the child in several positions with different rotations.

Among the features of pneumonia of early age is the appearance of secondary atelectasis, sometimes leading to x-ray extensive darkening. Small atelectasis eludes fluoroscopy, but more extensive ones, accompanied by changes in lung volume, give a peculiar x-ray picture: the mediastinum shifts to the painful side, the chest sinks. The discrepancy between the clinical picture and fluoroscopy data is also explained by significant vascular disorders. Anatomically, they manifest themselves in pneumonia most often in the form of perivascular infiltrates, which can only be identified with qualified radiography.

X-ray diagnosis of so-called primary interstitial pneumonia can also be difficult, since infiltration of the interstitial tissue of the lungs produces structural changes that are too delicate and difficult to detect not only with fluoroscopy, but also with radiography, despite the severity of the clinical course.

X-ray diagnostics is of great importance not only in establishing the diagnosis of pneumonia, but also for judging the dynamics of their development, since it allows one to monitor the reverse development of the pathological process, which is more persistent compared to clinical manifestations diseases.

From all of the above, it is clear that in early childhood, chest X-ray examination is only an auxiliary diagnostic tool and cannot at all be of decisive importance for the clinician, especially in early stages diseases.

Pneumonia in children is an acute infectious and inflammatory process of various etiologies. The mechanisms of development of the disease are associated with predominant damage to the respiratory parts of the lungs.

The respiratory sections of the lungs are the anatomical structures located behind the terminal bronchi - the respiratory, alveolar ducts and alveoli. The incidence of pneumonia in children in the first year of life is 15-20 per 1,000 children, from 1 year to 3 years - 5-6 per 1,000 children. Predisposing factors in children may be the following diseases: perinatal pathology aspiration, malnutrition, congenital heart disease with circulatory failure, immunodeficiency states.

In older children, predisposing factors are lesions chronic infection, passive and active smoking, hypothermia.

According to etiology, acute pneumonia is divided into:

• bacterial;
• viral;
• mycoplasma;
• rickettsial;
• fungal;
• allergic;
• pneumonia arising from helminth infestations;
• pneumonia that occurs when exposed to physical and chemical factors.

There are seven forms of bacterial pneumonia:

• pneumococcal;
• Friednender's;
• Pseudomonas aeruginosa;
• hemophilic;
• streptococcal;
• staphylococcal;
• a group of pneumonia caused by Proteus and Escherichia coli.

The most common viral pneumonias are:

• influenza pneumonia;
• adenoviral pneumonia;
• parainfluenza pneumonia;
• respiratory sontial pneumonia.

In accordance with the causes and mechanisms of occurrence, primary and secondary pneumonia are distinguished. The latter occur against the background of exacerbations chronic diseases bronchopulmonary system and others somatic diseases child.

For pneumonia to occur in a child, in addition to bacterial or viral agents, a certain set of factors is necessary:

• entry of mucus into the lungs from the upper respiratory tract is an aerogenic route;
• entry of the microorganism into the bronchi;
• destruction defense mechanisms respiratory tract;
• hematogenous, lymphogenous ways of spreading infection.

When pneumonia occurs in children, ventilation of the lungs and gas exchange are disrupted, and nutrition of the ventricular myocardium is reduced. According to the extent of the lesion, pneumonia can be segmental, lobar, total, unilateral and bilateral. In the mechanism of development of pneumonia, hypoxia with hypercapnia plays an important role, developing as a result of disturbances in both external, pulmonary, and tissue respiration.

Clinical symptoms of pneumonia depend on the type of pneumonia, the size and extent of the process. At focal pneumonia(bronchopneumonia) the process occurs acutely or subacutely and develops on the 5-7th day of acute respiratory disease in the form of its second wave.

The following symptoms are characteristic:

• temperature increase;
• weakness;
• headache;
• pain in the chest or under the shoulder blades;
• cough;
• increased intoxication.

Over the affected area, a shortening of the percussion sound is noted; on auscultation - bronchophony, weakened breathing, and sometimes crepitus. X-ray is determined by the strengthening of the pulmonary pattern between foci of inflammation and roots of the lung. A blood test reveals neutrophilic leukocytosis with a shift to the left, and an increase in ESR.

Segmental pneumonia

In the case of hematogenous spread, one or more segments of the lung are affected. Typically, the right segments are more often affected. Segmental pneumonia begins acutely with an increase in temperature, symptoms of intoxication are usually pronounced, pain appears in the chest area, sometimes in the abdomen, cough is rare. Symptoms of respiratory failure appear, objective data are poorly expressed. Secondary segmental pneumonia develops against the background of ongoing respiratory infection, while the symptoms of intoxication are mild. Segmental pneumonia radiographically manifests itself in separate foci that merge and then capture the entire segment.

Lobar pneumonia

The inflammatory process takes over lung lobe or part of it and the pleura. Rarely seen. Often caused by pneumococcus. The beginning is acute. The disease begins with dizziness, deterioration of health, and a sharp headache. Temperatures up to 40-41 °C are noted, patients often complain of chills. The cough in the first three days is rare, dry, then with the release of rusty sputum. Cyanosis and shortness of breath quickly appear. Often children have abdominal syndrome, manifested by pain in the navel, flatulence, vomiting. There are four stages in the course of lobar pneumonia.

At the first stage - stage of tide, - a shortening of the percussion sound with a tympanic tint, weakened breathing is determined, and crepitus is periodically heard. In the second stage facial hyperemia develops, often on the affected side, serious condition. On the affected side, shortening of percussion sound, bronchial breathing, and bronchophony are determined. No wheezing can be heard. Third stage develops on the 4-7th day - the cough intensifies, the temperature drops, often critically. The percussion sound takes on a tympanic tone, and crepitus appears.

In the fourth stage - resolution stages, - temperature decreases, appears frequent cough, abundant wheezing of various sizes appears. Read more about wheezing here. Radiographs also determine the stages of the process: in the first stage - strengthening of the vascular pattern, limitation of the mobility of the diaphragm; in the second stage, dense shadows appear corresponding to the lobes involving the root and pleura; in the third and fourth stages, infiltration disappears gradually.

With lobar pneumonia, there is a sharp neutrophilic leukocytosis with a shift to the left, and an acceleration of ESR. Lobar pneumonia occurs atypically in young children. The main symptoms of the disease are usually unclear. Influenced antibacterial therapy The stages of the inflammatory process are shortened. In case of irrational therapy, a protracted course of the disease occurs.

Interstitial pneumonia

Interstitial pneumonia occurs with viral, mycoplasma, Pneumocystis, fungal and staphylococcal infections. More often, this pneumonia is recorded in premature and newborn children, as well as against the background of dystrophy, immunodeficiency states in children. The disease may be accompanied by severe intoxication, a drop in blood pressure is possible; in addition, changes in the central nervous system, as well as the gastrointestinal tract, are often observed. There is a debilitating cough with scanty foamy sputum. Interstitial pneumonia causes swelling of the chest. Percussion - tympanitis. Single crepitating and dry rales are heard against the background of weakened breathing. X-ray reveals emphysema, peribronchial infiltration, and cellularity of the interstitial-vascular pattern. From the blood side, leukocytosis and increased ESR are detected.

Diagnosis of pneumonia

Diagnosis is carried out on the basis of clinical and radiological data.

Clinical symptoms are:

• temperature reaction;
• signs of respiratory failure: shortness of breath, cyanosis, participation of auxiliary muscles in breathing;
• persistent auscultatory and percussion abnormalities in the lungs;
• X-ray - focal, segmental, lobar infiltrative shadows;
• from the blood: leukocytosis, neutrophilia, increased ESR;
• the effect of the etiological therapy.

The course of pneumonia in children depends on the etiology, age and the presence of various concomitant diseases. Pneumonia caused by hospital strains of Staphylococcus aureus or gram-negative bacteria is especially severe. The course of pneumonia in these cases is characterized by early abscess formation, rapid breakthrough of the inflammatory focus into the pleura and the occurrence of pyopneumothorax with a rapid course of the disease.

In the neonatal period, pneumonia has a serious prognosis. There are acquired and intrauterine pneumonia of newborns. Intrauterine pneumonia occurs as a result of infection of the fetus during pregnancy or aspiration by infected amniotic fluid, while aspiration can be both intrauterine and intrapartum. In newborns, pneumonia is often accompanied by atelectasis, as well as destruction of lung tissue.

An important role in the development of pneumonia can be played by a predisposition to allergic effects of external factors and the occurrence of catarrhal inflammation of the mucous membranes. With these pneumonias, the addition of asthmatic syndrome is characteristic. The course of pneumonia in these cases takes on a recurrent nature. In children suffering from rickets, pneumonia develops more often and has a protracted course. In children with malnutrition it occurs more often due to a significant decrease in immunity, and mild symptoms of pneumonia are noted.

Treatment of pneumonia in children

In case of moderate and severe forms, children are subject to inpatient treatment. Children of the first year of life - in any form.

Treatment of pneumonia is carried out comprehensively and consists of:

• use of etiotropic drugs;
• oxygen therapy for the development of respiratory failure;
• prescribing drugs that improve bronchial conductivity;
• the use of means and methods that ensure the transport of oxygen in the blood;
• prescribing drugs that improve tissue respiration processes;
• using means that improve metabolic processes in the body.

The child's nutrition must correspond to the age and needs of the child's body. However, during the period of intoxication, food should be mechanically and chemically gentle. In connection with cough, foods containing particles that can be aspirated are excluded from the diet. Additional fluid is prescribed in the form of a drink. For this, decoctions of rose hips, black currants, and juices are used.

Immediately after admission to the hospital, sputum and swabs are collected for bacteriological examination, then etiotropic treatment is prescribed, which is carried out under the control of clinical effectiveness, subsequently taking into account the results of sputum sensitivity to antibiotics. In case of community-acquired pneumonia, new generation macrolides are prescribed. In case of nosocomial pneumonia, second and third generation cephalosporins and reserve group antibiotics are prescribed.

For pneumonia in children resulting from intrauterine infection, a new generation of macrolides is prescribed - spiromycin, roxithromycin, azithromycin. In case of pneumonia in children with immunodeficiencies, third and fourth generation cephalosporins are prescribed. At mixed infection, the interaction of the influenza pathogen and staphylococcus, along with the introduction of broad-spectrum antibiotics, 3-6 ml of anti-influenza γ-globulin is administered.

Antibiotics are used comprehensively according to the following scheme:

• cephalosporins;
• cephalosporins plus aminoglycosides.

Mucolytic therapy, bronchodilators, physiotherapy, and immunocorrective treatment are prescribed. When secretions accumulate in respiratory tract it is necessary to remove the contents of the nasopharynx, larynx, and large bronchi. For severe symptoms of respiratory failure, oxygen therapy is used.

For signs of heart failure, cardiac glycosides are prescribed - strophanthin, as well as sulfacamphocaine. Immunotherapy is also used. When treating pneumonia, symptomatic and syndromic therapy is carried out. During the recovery period great importance have breathing exercises, physiotherapeutic methods of treatment. For improvement drainage function bronchi, means are used to increase sputum secretion or dilute it.

Expectorants:

• Sodium benzoate
• Ammonium chloride
• Potassium iodide
• Bromhexine
• Terpinhydrate
• Thermopsis
• N-acetylcystine
• Mukaltin
• Pertusin
• Marshmallow root
• Licorice root
• Breast elixir
• Anise fruit
• Coltsfoot leaves

Drugs that reduce bronchospasm are used. These include aminophylline.

Forecast

The prognosis with timely use of antibacterial therapy is favorable. Those discharged from the hospital during the period of clinical recovery are registered at the dispensary. After discharge from the hospital, the child should not attend child care facilities for 2-4 weeks. Children under six months are examined once a week for the first month, then twice a month; from six to twelve months - once every ten days during the first month, then once a month. After one year to three years - once in the first month, then - once every three months.

Children are examined by an otolaryngologist and pulmonologist after the age of three - a month after discharge from the hospital, then once a quarter. Rehabilitation in hospital departments or sanatoriums is optimal. The mode is assigned from maximum use fresh air. Breathing exercises and exercise therapy with a gradual increase in physical activity are prescribed daily. Nutrition should be rational for the appropriate age. Drug rehabilitation is carried out according to individual indications. Stimulating therapy is carried out in repeated 2-3-week courses: sodium nucleate, methyluracil, dibazole, ginseng, aloe, eleutherococcus infusion, B vitamins. Herbal medicine is also used for these purposes. It is used to sanitize the bronchi and have a calming effect on the central nervous system: marshmallow root, peppermint leaf, sage herb, elecampane root, coltsfoot, linden blossom, pine buds, thyme, etc. In children prone to allergic reactions, used with great caution. Physiotherapy is widely used. Mustard plasters, alkaline and phytoinhalations, compresses, and ozokerite applications on the chest are used. Chest massage is widely used. After pneumonia, sanatorium treatment is recommended in local sanatoriums, as well as in the resorts of Gagra, Nalchik, Gelendzhik, New Athos, and the southern coast of Crimea.

Contraindications to sanatorium treatment are:

• activity of the inflammatory process in the bronchopulmonary system;
• signs of an asthmatic condition;
• the presence of a “pulmonary heart”.

TO primary prevention relate healthy image life of parents, excluding the impact of harmful substances on the fetus during pregnancy, rational feeding of children, hardening procedures.

Secondary prevention includes:

• prevention and treatment of acute respiratory viral infection;
• early hospitalization of children with pneumonia with aggravated premorbid background;
• timely treatment of malnutrition, rickets, immunodeficiency states;
• sanitation of chronic foci of infection.