Features of pneumonia in young children. Diagnosis of acute pneumonia

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

Features of pneumonia in young children

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

The most common pathogens are:

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

Immunity at this point is already formed, a 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 the defense and penetrate through the epithelium into the lungs.

A viral infection can cause the following symptom in pneumonia in children at the age of 3 years - multiple lesions in the lung tissue, which are visible on x-rays. Pneumococcal pneumonia is one such highly toxic agent that leads to bilateral inflammation, which is quite difficult for young children. If the baby is already 1 year old, then with the correct and timely visit to the doctor, the disease can be dealt with in 2 weeks. If some other diseases are added, then the treatment is slightly delayed.

In children aged 1 year, the following complications are more common:

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

Causes of pneumonia in children

They are the following:

1. Infectious diseases of the mother during pregnancy.
2. Oxygen starvation or short-term asphyxia in childbirth in the fetus.
3. Secondary ARIs.
4. Recurrent purulent otitis.
5. Congenital abnormalities in the development of the heart and lungs.
6. Cancer diseases of the blood.
7. HIV primary or secondary.

Symptoms and signs of pneumonia

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

1. Temperature from 38, which is observed for more than 3 days.
2. Hard breathing - heard when listening with a phonendoscope.
3. Respiratory rate up to 50 per minute at the age of 12 to 16 months. 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, vague consciousness.

Also, a swollen nasolabial triangle is added to the signs of pneumonia in a child at 1 year old. Usually, inflammatory diseases at the age of 1-2 years of the lung parenchyma are 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, as the most dangerous time has passed. A 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 a mild form of the disease on an outpatient basis. But still, doctors try to refer the patient to the hospital for treatment, since there is a danger of bronchial obstruction and difficulty breathing, although its percentage is small.

Pneumonia in 2 year olds

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

The symptoms of pneumonia in children at 2 years old are similar to the symptoms of this disease in a 1-year-old child and do not have a significant difference.

Pneumonia in children 3 years old

The child has significant changes in the blood. It increases the number of leukocytes and decreases the number of lymphocytes. And this is considered the norm. Because of this restructuring, the baby's defenses are weakened and inflammatory diseases may occur.

Signs of pneumonia in a child of 3 years:

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

Noticing the listed symptoms of pneumonia in children 3 years old, it is necessary to call a doctor.

Other external signs of pneumonia in a child at 3 years old:

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

Treatment

Newborn children in any case should be placed in a hospital for treatment. If signs of pneumonia are found in a child who is 2 years old, you need to see a doctor, and after conducting the necessary research, he will prescribe treatment either at home, with mild pneumonia, or he will give a referral to the hospital with moderate and severe severity of the pathology.

Principles of treatment:

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

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

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

What preventive measures are currently in place:

1. Hib vaccination, which includes antibodies to protect against: Haemophilus influenzae, pneumococcus, measles and whooping cough.
2. Be sure to breastfeed a newborn for at least the first 6 months after birth. And in the future, a balanced diet, appropriate for the age of the baby.
3. Regular hardening of the child's body.
4. Physical education is important for a child.
5. It is necessary to deal with dust and gas contamination of the environment.
6. Do not smoke near your child.
7. Observance of personal hygiene is mandatory, especially in residential areas with a large number of people.
8. Isolation of sick children for the acute period of the disease.
9. If your child is not feeling well, seek medical advice.

Parents should always remember: pneumonia can be avoided if you follow the above recommendations, treat your children carefully and carefully.

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

Karpov Vladimir Vladimirovich, Candidate of Medical Sciences, Head of the Department of Children's 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: Oksana Kryuchkova

Etiology. Respiratory diseases in early childhood differ in polyetiology depending on a number of reasons (an outbreak of viral respiratory infections - adenovirus, influenza, etc., age-related features, previous history, features of regional pathology, etc.). When studying the etiology of pneumonia of an early age, it is impossible to rely only on the infectious onset; 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 pneumonia in early childhood, it is most appropriate to single out two factors - infectious and non-infectious, taking into account, of course, the mutual relationship and influence of both factors. The infectious factor is described in detail in. chapters III and IV.

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

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

V. M. Afanasiev, B. S. Gusman et al. (1974, 1975) analyzed the sectional material of all autopsies performed at the Children's Clinical Hospital No. 1. In 32.5% of cases, pneumonia was the main cause of death and an aggravating factor in other diseases. In cases where infection with 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 tissues of the lungs, and purely interstitial pneumonia were also 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 of the authors (AV Tsinzerling, 1963, etc.) consider these changes as primary viral pneumonia.

clinical forms. Pneumonia of early childhood has long been attributed to diseases of the whole organism, with the participation of 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 diverse: 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 radiographically, it is detected far from the first days of the disease. Obviously, the development of viremia requires certain conditions, time and reaction of the body.

Each classification of pneumonia should reflect the etiology, clinical presentation, 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 of the pathological process as a whole.

V. I. Molchanov and Yu. F. Dombrovskaya among pneumonias of early age distinguish localized (light), subtoxic, toxic, toxic-septic. To characterize the structural changes in the lungs, their definition is added: 1) localized (light) 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 abscessing pneumonia and abscessing pleuropneumonia.

Localized forms are characterized by the rapid development of pneumonia after a short period of catarrhal phenomena (typical cough, moderate dyspnea on movement and the development of changes in the lungs). The heart sounds are quite sonorous, the pulse is normal, of good filling, corresponds to the temperature. Localized pneumonias occur 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, the elimination of anatomical changes in the lungs does not correspond to clinical recovery. More often they are basal in nature, which indicates the lymphogenous spread of the process.

At a X-ray analysis at the first stage of a disease there is only a perivascular infiltration of pulmonary fabric, but c. at the end of the 1st year, focal, small-focal or segmental pneumonia is often determined. The frequency of lesions of individual segments of the lung in children of different ages is not the same.

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

Polysegmental pneumonia, in contrast to monosegmental ones, proceeds according to the type of catarrhal. Monosegmental pneumonia often proceeds according to the type of croupous (acute onset, high fever, leukocytosis).

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

The localized form often resembles a croupous one (acute onset, high fever, but temperature drop! 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 and adaptive reaction of the body and its immunological system, and on the change of the pathogen as a result of antibiotic therapy (the appearance of new forms or a change in pathogen types).

Primary acute interstitial pneumonia, usually of viral origin, is, as it were, the first stage of lung damage by viruses. It begins more often with shortness of breath with a noisy exhalation, significant cyanosis, deafness of the heart, tones 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 cardiac dullness.

Interstitial pneumonia is characterized by intermittent attacks of collapse with progressive development of marginal or basal emphysema, or characterized by the formation of cavities (pneumocele). This form of pneumonia is more often seen 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 later takes on other forms (focal, segmental). In 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. Radical infiltration ("broom").

dysfunction of the central and autonomic nervous system. Terrible syndrome is a disorder of the function of the gastrointestinal tract (regurgitation, vomiting, frequent stools, flatulence, leading to anhydremia and exsicosis). Against this background, clinically and radiologically formed pneumonia is gradually detected.

The X-ray picture of acute interstitial pneumonia was exhaustively described by N. A. Panov in 1947. It is typical for it to have thickened perilobular and perialveolar septa, giving the affected areas of the lungs a kind of “cellular” appearance (Fig. 57). The second extremely important symptom of the radiographic 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 typical for diffuse interstitial pneumonia. However, along with this, focal interstitial pneumonia often occurs. It is localized in the basal part of the right upper lobe, basal and medial lower supraphrenic areas of the lungs (Fig. 58).

In the future, along with this, there is a lesion of the bronchial alveolar system with foci of pneumonia hemorrhagic

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

of a tragic nature, the permeability of membranes to liquid increases and a diffuse accumulation of liquid appears in the cavity of the alveoli, which makes gas exchange even more difficult. The infiltrative process leads to the formation of collagen fibers in the future. 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 of severe disorders of the respiratory, cardiovascular, central and autonomic nervous systems, gastrointestinal tract, and metabolic processes. Toxic forms often develop gradually, but there may be rapid development. The appearance of the patient indicates a serious illness: along with pallor, cyanosis of the lips and face, persistent cough and shortness of breath, there is anxiety or depression. Arterial blood pressure is reduced or increased, the pulse is frequent and small. The borders of the heart rapidly increase to the right. At the same time, the liver increases, the tone decreases and the lumen of the capillaries decreases (impaired microcirculation). Marble skin.

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

Shortness of breath 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 state of the child, that is, the presence of rickets, exudative diathesis, allergies and pneumonia.

The main regulator of respiratory movements, as you know, 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 respiratory and metabolic acidosis associated with it. Respiratory failure increases with the development of pulmonary emphysema of various localization (basal, marginal, focal, segmental, bilateral and unilateral) (Fig. 59, 60, 61, a, b).

Toxic phenomena in severe pneumonia often occur 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 in toxic pneumonia sometimes simulates meningitis and meningoencephalitis, "convulsive syndrome" associated with increased intracranial pressure and brain hypoxia (tension of the large fontanel in children in the first months of life).

The leading syndromes of respiratory failure are shortness of breath and hypoxia (oxygen deficiency), which is established in the clinic and experiment (Yu. F. Dombrovskaya et al., 1961). Shortness of breath as an indicator of pulmonary heart failure requires complex pathogenetic therapy, primarily the restoration of bronchial conduction.

In toxic forms of pneumonia, violations of 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 the 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 bright phenomena of nervism - meningeal and meningoencephalic syndromes, intestinal paresis, vascular collapse, and a drop in blood pressure. For severe cases, muscle hypotension, absence of tendon reflexes, bloating, lack of swallowing, and diarrhea are typical. Thus, the whole described picture

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

Rice. 60. Small-focal confluent pneumonia in a child 1 month old (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. With any form of respiratory distress syndrome, atelectasis easily occurs, especially in the first months of life.

Noteworthy is the comparison of indicators of the function of the symnatic-adrenal system, in particular the excretion of adrenaline, with the degree of acidosis accompanying the violation of the acid-base state.

The cardiovascular system in toxic forms of pneumonia reflects the whole complex of violations of the main 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 the acute period, there is often a decrease in creatinine clearance (from 76.3 to 40.2% of the norm), less often in the level of urea nitrogen with a normal residual serum nitrogen. In the presence of progressive respiratory failure and toxicosis, relative renal failure develops associated with hypoxia, shortness of breath, vomiting and loose stools.

In a very severe form of pneumonia, the concentration of residual nitrogen is higher than 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 on the basis of a disturbance in the rhythm of the activity of certain sections (dyskinesia) of the urinary tract (pelvis, ureters, bladder), followed by infection with staphylococcus aureus 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 both to dysfunction of the vagal and sympathetic-adrenal systems, and to direct infection. Violation of the water and electrolyte balance is of key importance, therefore, in toxic forms of pneumonia, in parallel with respiratory and cardiovascular disorders, a severe syndrome of intestinal toxicosis often occurs - bloating or, conversely, retraction of the abdomen, vomiting, profuse diarrhea, exsicosis.

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

Liver changes - enlargement, pain - are characteristic of cardiovascular insufficiency (acute pulmonary heart). According to a number of studies, the pigment and carbohydrate functions (toxic hepatosis) are temporarily disturbed, which is due to a violation of protein metabolism and a decrease in the demining function of the liver. In connection with this, one of the mandatory drugs is glucose (5-10% solution) with ascorbic acid.

With toxic pneumonia, all types of metabolism are disturbed, as well as vitamin balance. Endogenous vitamin deficiency develops, which is established clinically and laboratory.

The same data were obtained in the experiment under artificial hypoxia. This suggests that the redox processes in the tissue respiration system during hypoxia are disturbed from the very beginning and are restored extremely slowly. These data convincingly indicate the need for targeted therapeutic measures in pediatric practice (vitamins, exercise therapy, long-term dispensary observation and, if possible, sanatorium aftercare).

The pathogenesis of toxicosis in pneumonia is complex. It is necessary to take into account the effect of a viral-bacterial infection on the systems that regulate homeostasis, which causes the main forms of the pathological process - hypoxia and acidosis. However, both pathological processes almost always have a "premorbid" soil (repeated respiratory diseases, rickets, exudative diathesis, allergies). In essence, 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 vegetative-endocrine systems are disrupted, the electrolyte balance decreases and the permeability of the capillary walls increases. The primary agent for a stress reaction that causes acidosis and hypoxia may be the direct effect of viral and bacterial toxins on regulatory mechanisms (neurotropic, pneumotropic viruses), which causes the acute development of a toxic syndrome (potassium, sodium, phosphorus, vitamin deficiency, amino acid and protein imbalance). ). The decrease in adaptive-protective mechanisms explains the easy occurrence of respiratory failure of varying degrees in early childhood. In particular, respiratory failure of the 1st 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 the cells of the reticular substance and increased excitability of the vagus nerve. As you know, at an early age, the frequency, type, rhythm and depth of breathing are easily subject to fluctuations in a healthy child. Reserves for violation of external respiration at an early age are much less. Due to certain anatomical and physiological features of infancy, ventilation of the lungs increases only due to increased breathing.

The response of all body systems in pneumonia in early childhood is also diffuse; functional disturbances quickly occur.

The most indicative activity of succinate dehydrogenase is experimentally established by the change in my 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 enzymes of energy metabolism 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 way to correct the developed enzyme deficiency is the introduction of vitamins B1 B2 and C.

Toxic-septic pneumonia develops more often against the background of toxic forms, and also 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, which is not sensitive to all antibiotics). Pathogenic flora is more often determined - plasmacoagulating staphylococcus, giving abundant growth. With the development of septic complications, a distinct increase in antibody titers (antistaphylococcal agglutinins, antistreptolysin O) to isolated microbes

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

robs. Along with this, with the secondary microbial flora, the content of fungi and Escherichia coli increases. In the genesis of the development of the septic phase are: 1) sensitization by microbes, products of impaired metabolism and formed 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 are the deterioration of the general condition, fever, anxiety, an increase in 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, a large number of small abscesses are found in the lungs that do not cause a characteristic x-ray picture. Currently, due to early hospitalization of patients and massive antibiotic therapy, at the first suspicion of a septic process, these forms are relatively rare.

Rice. 63. Staphylococcal pneumonia in a child 3 months old.

rarely, but all such patients are subject to the supervision of a pediatric surgeon in a specialized department.

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

The use of oxygen in high concentrations can lead not only to pulmonary fibrosis, but also to retinal fibroplasia. 100% oxygen concentration is only acceptable for short periods in intensive care.

The birth weight of a child is even more important for oxygen therapy than the degree of its maturity. So, for preterm infants weighing less than 2000 g, the risk of retinopathy occurs already at an oxygen concentration of 30%. In addition to continuous clinical monitoring, monitoring of oxygen therapy should include determination of blood gases, acid-base status, blood pressure, hemoglobin levels, temperature, and ophthalmoscopy. Similar recommendations were given by the American Academy of Pediatrics in 1971. The best results are observed with the introduction of humidified oxygen passed through 50% alcohol. Oxygen is administered through nasal catheters or in a portable plexiglass tent (“house”), as well as with an aerosol.

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

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

Attracting 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

The obligatory supply of fresh air at all times 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. and the gas composition of the blood under the influence of fresh atmospheric air (the child’s stay in the garden in the arms of a nurse or mother) compared with the effect of oxygen in the ward (Yu. F. Dombrovskaya, A. N. Dombrovsky, A. S. Chechulin, A. A. Rogov, 1961). The use of oxygen in children under high pressure (in a pressure chamber) has not yet found wide recognition.

Antibiotics in the treatment of pneumonia occupy a leading place. 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 far from always according to indications.

In addition to the 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 in 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, blood circulation, oxygen debt, etc.). The rate of resorption is closely related to the rate of entry of antibiotics into 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 for individual organs and tissues have not been studied enough. To assess the effectiveness of antibiotics, you need to remember the ways of their excretion from the body (urine excretion, their metabolism in the body, deposition in organs and tissues). In addition, the excretion of antibiotics is carried out by 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 implement this reaction, it is necessary to achieve close-to-normal indicators of the internal environment of the body. The effectiveness of antibiotics is associated with a complex pathogenetic treatment of pneumonia, taking into account the impairment of the functions of individual systems.

Antibiotics, in addition to therapeutic, have side effects. Their direct toxic effect is rarely observed. More often, side effects are associated with compounds (conjugates) formed in the body that cause a pathological reaction of the antigen-antibody type. The side effect of antibiotics manifests itself as a "drug allergy", well known to pediatricians and expressed in the form of a polymorphic rash, edema in the area of ​​antibiotic administration. Subtle manifestations of drug allergy with the introduction 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 up to anaphylactic shock.

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

An adverse reaction to the administration of antibiotics is far from being manifested in all children, but the doctor must take into account the possibility of their occurrence and catch the first syndromes of the development of a pathological response.

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

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

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

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

Definition. Pneumonia is an acute inflammatory process in the 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. Ways of penetration (aerogenic, lymphogenic, hematogenous) Penetration and reproduction of microbes occurs at the point of transition of the terminal bronchi to the alveolar ones, with the involvement of the bronchial, interstitial and alveolar tissues. The inflammatory process in the wall of the alveolus impedes gas exchange between the blood and the alveolar air. Hypoxia and hypercapnia develop. There are shifts in the function of the central nervous system, cardiovascular system, 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, croupous and interstitial pneumonia are distinguished. According to severity - uncomplicated and complicated, along the course - acute and protracted.

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

In the analysis of blood: leukocytosis, neutrophilia, with a stab shift to the left, increased ESR, anemia.

Variants of the clinical course. The most severe are staphylococcal pneumonia in young children and pneumonia against the background of: malnutrition, ECD, rickets.

The examination includes: analysis of blood, urine, feces for eggs of worms, X-ray of the lungs, ECG, KOS(with severe course), immunogram (with prolonged course), electrolytes in sweat (with prolonged course), virological examination.

Differential Diagnosis with bronchitis, bronchiolitis, respiratory allergies.

Treatment. Protective regime, good nutrition, aeration, sanitation (nasal passages). Antibiotic therapy, taking into account the etiological factor (ampicillin, ampioks, gentamicin, t-P cephalosporins), macrolides (if an "atapic pathogen" is suspected).

Expectorant therapy for wet cough (broths of elecampane, fennel, mother-and-match, oregano), bromhexine, mukaltin, lazolvan.

Physiotherapy: alkaline inhalations, saline-alkaline + massage (at normal body temperature), thermal, paraffin, ozocerite 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 (synopneumonia and metapneumonic pleurisy, pulmonary destruction, lung abscess, pneumothorax, pyopneumothorax) and extrapulmonary (toxic shock, disseminated intravascular coagulation, cardiovascular insufficiency, respiratory distress syndrome of age-related hype)

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

Clinic. In the debut of the disease (1st degree of toxicosis), general toxic manifestations come to the fore: lethargy, loss of appetite, agitation, fever. Then (stage II of toxicosis) cardiovascular changes join: tachycardia, deafness of tones, hemodynamic shifts. Severe condition These two zones of toxicosis are observed in any moderate pneumonia and disappear on the background of efferent antibiotic therapy. At stage III of toxicosis, changes in the nervous system are noted - impaired consciousness, convulsions, more often drowsiness, stupor. In rare cases, pneumonic toxicosis can be complicated by DIC.

The other most common complications of acute pneumonia are " tmespum. Zadeljut:

synpneumatic kgt and lch "tapnevlunichesky 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 on 7-! About a day from the onset of acute pneumonia. Etiology - pneumococcal. The exudate is always fibrous, and after the loss of fibrin - serous, with low cytosis. Metapneumonic pleurisy is a typical immunopathological process. Diagnosis is made by X-ray and by physical examination.

Currently destructive pneumonia occurs somewhat less frequently. Destructive processes in the zone of pneumonic infiltrate are caused by necrosis of the lung tissue under the influence of the microbial factor. The resulting cavity first 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, a significant leukocytosis with a neutrophilic shift, and a complete lack of effect from antibiotic therapy. Abscesses are less common than bu-yls.

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

Principles of treatment of SPP - pleural puncture, then the appointment of antibiotic therapy. With adequate antibiotic therapy, the volume of effusion decreases. If the volume increases and cytosis increases with repeated puncture, then the antibiotic should be changed. With MGHD - 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 increased aeration to oxygen therapy) Antibacterial therapy (2 antibiotics are required; one of them intravenously in high doses), the use of antibiotics both in aerosols and in the abscess cavity, the pleural cavity Dez intoxication therapy. Stimulation therapy (fresh frozen plasma, antistaphylococcal y-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-gray coloration 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 an early sign of 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 distention and cyanosis may be the only, but fairly reliable signs of pneumonia. Quite characteristic of pneumonia in newborns are rapidly developing swelling of the face, lips, tongue, which is associated with a violation of vascular permeability. Edema can spread to the entire body.

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

For pneumonia in children of the first months of life and in newborns, an early onset of superficial, intermittent, uneven breathing is characteristic.

Percussion is usually used quiet and better direct, that is, with quiet tapping of a finger on the chest; often more by touch than by hearing, it is possible to catch a change in percussion sound. When listening, fuzzy bronchophony is first detected, mainly when the child is crying, and only later, when the process spreads, blurred bronchial breathing is heard. For children in the first months of life, a discrepancy between the severity of the general condition, shortness of breath, cyanosis and poor percussion and auscultation data is quite typical. This is explained by the development of numerous tiny foci of pneumonia, bordering on areas of emphysematous tissue.

In the same way, the improvement of the child's condition does not go in parallel with 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 onset of pulmonary-cardiac or severe pulmonary and cardiovascular insufficiency.

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 the course of pneumonia. An extremely valuable auxiliary method for diagnosing 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 for all the value of this research method, its importance for the early recognition of pneumonia cannot be overestimated. On x-ray, the normal lungs of an infant appear dark, opaque, with a delicate, vague, almost homogeneous pattern. In addition, the change in blood supply associated with the child's breathing and crying significantly changes the usual pulmonary pattern. The lungs themselves, due to their large volume and small additional respiratory space, expand little when inhaled and almost do not appear on the screen. Complicates fluoroscopy and an extensive shadow of the mediastinum, as well as its easy displacement and the often occurring enlarged shadow of the thymus gland. All this often gives grounds for underestimating changes in the lungs or misinterpreting normal physiological phenomena.

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

It is extremely important for a pediatrician to be personally present at the fluoroscopy of his 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-axis transillumination, i.e., the study of the child in several positions with different rotations.

The appearance of secondary atelectasis, sometimes giving extensive darkening on the x-ray, is also among the features of early-age pneumonia. Small atelectasis elude with fluoroscopy, more extensive, accompanied by a change in lung volume, give a kind of x-ray picture: the mediastinum is shifted to the affected side, the chest sinks. The discrepancy between the clinical picture and the data of fluoroscopy is also explained by significant vascular disorders. Anatomically, they manifest themselves in pneumonia most often in the form of perivascular infiltrations, which can only be established with qualified radiography.

X-ray diagnostics in so-called primary interstitial pneumonias can also be difficult, since infiltration of the interstitial tissue of the lungs gives too delicate structural changes that are 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 you to monitor the reverse development of the pathological process, which is more resistant than the clinical manifestations of the disease.

From the foregoing, it can be seen that in early childhood, chest x-ray is only an auxiliary diagnostic tool and cannot be of decisive importance for the clinician, especially in the early stages of the disease.

Pneumonia in children is an acute infectious and inflammatory process of various etiologies. The mechanisms of the development of the disease are associated with a predominant lesion of the respiratory sections 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. The following diseases may be predisposing factors in children: perinatal aspiration pathology, malnutrition, congenital heart disease with circulatory insufficiency, immunodeficiency states.

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

According to the etiology, acute pneumonia is divided into:

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

There are seven forms of bacterial pneumonia:

• pneumococcal;
• friednender;
• Pseudomonas aeruginosa;
• hemophilic;
• streptococcal;
• staphylococcal;
• a group of pneumonias caused by Proteus and Escherichia coli.

The most common viral pneumonias are:

• flu pneumonia;
• adenovirus pneumonia;
• parainfluenza pneumonia;
• respiratory sontic pneumonia.

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

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

• the entry of mucus into the lungs from the upper respiratory tract - the aerogenic route;
• entry of a microorganism into the bronchi;
• destruction of the protective mechanisms of the respiratory tract;
• hematogenous, lymphogenous pathways of infection.

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

Clinical symptoms of pneumonia depend on the type of pneumonia, the magnitude and prevalence of the process. With focal pneumonia (bronchopneumonia), the process is acute or subacute and develops on the 5-7th day of an acute respiratory disease in the form of its second wave.

The following symptoms are characteristic:

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

Above the affected area, there is a shortening of the percussion sound, with auscultation - bronchophony, weakened breathing, sometimes crepitus. Radiologically, an increase in the pulmonary pattern between the foci of inflammation and the roots of the lung is determined. In the blood test, neutrophilic leukocytosis is determined with a shift to the left, an increase in ESR.

Segmental pneumonia

In the case of the hematogenous route of spread, one or more segments of the lung are affected. Usually the right segments are most often affected. Segmental pneumonia begins acutely with fever, symptoms of intoxication are usually expressed, pains appear in the chest area, sometimes in the abdomen, cough is rare. Symptoms of respiratory failure appear, objective data are weakly expressed. Secondary segmental pneumonia develops against the background of an ongoing respiratory infection, while the symptoms of intoxication are mild. Segmental pneumonia is radiologically manifested in separate foci, which merge, and then capture the entire segment.

Croupous pneumonia

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

At the first stage - the stages of the tide, - a shortening of the percussion sound with a tympanic shade, weakened breathing, crepitus is periodically heard. In the second stage hyperemia of the face develops, often on the side of the lesion, a serious condition. On the side of the lesion, shortening of percussion sound, bronchial breathing, bronchophony are determined. Wheezes are not audible. Third stage develops on the 4th-7th day - the cough intensifies, the temperature drops, often critically. Percussion sound takes on a tympanic tone, crepitus appears.

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

With croupous pneumonia, there is a sharp neutrophilic leukocytosis with a shift to the left, an acceleration of ESR. Lobar pneumonia occurs atypically in young children. Usually the main symptoms of the disease are not clearly expressed. Under the influence of antibiotic therapy, the stages of the inflammatory process are shortened. In the case of irrational therapy, a protracted course of the disease occurs.

Interstitial pneumonia

Interstitial pneumonia occurs with viral, mycoplasmal, pneumocystis, fungal and staphylococcal infections. More often this pneumonia is registered in premature and newborn children, as well as against the background of dystrophy, immunodeficiency states in children. The disease can 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 noted. There is a debilitating cough with scanty frothy sputum. With interstitial pneumonia, swelling of the chest is noted. Percussion - tympanitis. Single crepitating and dry rales are heard against the background of weakened breathing. X-ray reveals emphysema, perebronchial infiltration, cellularity of the interstitial-vascular pattern. On the part of the blood, leukocytosis, an increase in ESR is 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 in breathing of auxiliary muscles;
• persistent auscultatory and percussion deviations from the lungs;
• radiographically - focal, segmental, lobar infiltrative shadows;
• on the part of the blood: leukocytosis, neutrophilia, increased ESR;
• effect of ongoing etiological therapy.

The course of pneumonia in children depends on the etiology, age and 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, a 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 of infected amniotic fluid, while aspiration can be both intrauterine and intranatal. In newborns, pneumonia is often accompanied by atelectasis, as well as destruction of the 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 an asthmatic syndrome is characteristic. The course of pneumonia in these cases takes a recurrent character. In children with rickets, pneumonia develops more often and has a protracted course. In children with malnutrition occurs more often due to a significant decrease in immunity, there is a weak severity of symptoms of pneumonia.

Treatment of pneumonia in children

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

Treatment of pneumonia is carried out in a complex manner and consists of:

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

Nutrition of the child should 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. An additional liquid in the form of a drink is prescribed. For this, decoctions of wild rose, blackcurrant, juices are used.

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

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

Antibiotics are used in a complex according to the following scheme:

• cephalosporins;
• cephalosporins plus aminoglycosides.

Mucolytic therapy, bronchodilators, physiotherapy, immunocorrective treatment are prescribed. With the accumulation of secret in the respiratory tract, it is necessary to remove the contents of the nasopharynx, larynx, large bronchi. With severe symptoms of respiratory failure, oxygen therapy is used.

With signs of heart failure, cardiac glycosides are prescribed - strophanthin, as well as sulfakamphokain. Immunotherapy is also used. In the treatment of pneumonia, symptomatic and post-syndromic therapy is carried out. In the recovery period, breathing exercises, physiotherapy methods of treatment are of great importance. To improve the drainage function of the bronchi, agents are used that increase sputum secretion or liquefy it.

Expectorants:

• sodium benzoate
• Ammonium chloride
• Potassium iodide
• Bromhexine
• Terpinhydrate
• thermopsis
• N-acetylcystine
• Mukaltin
• Pertusin
• marshmallow root
• licorice root
• Elixir chest
• anise fruit
• Leaves coltsfoot

Drugs that reduce bronchospasm are used. Euphyllin belongs to them.

Forecast

The prognosis for the timely use of antibiotic therapy is favorable. Those discharged from the hospital during the period of clinical recovery are taken for dispensary registration. After discharge from the hospital for 2-4 weeks, the child should not visit childcare facilities. 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 departments of hospitals or in sanatoriums is optimal. The mode is assigned with the maximum use of fresh air. Daily breathing exercises, exercise therapy with a gradual increase in physical activity are prescribed. Nutrition should be rational for the appropriate age. Medical rehabilitation is carried out according to individual indications. Stimulating therapy is carried out by repeated 2-3-week courses: sodium nucleate, methyluracil, dibazol, ginseng, aloe, eleutherococcus infusion, vitamins B for these purposes, phytotherapy is also used. It is used for the rehabilitation of the bronchi and a calming effect on the central nervous system: marshmallow root, peppermint leaf, sage grass, elecampane root, coltsfoot, lime blossom, pine buds, thyme, etc. In children prone to allergic reactions, applied with great care. Physiotherapy is widely used. Mustard plasters, alkaline and phyto inhalations, compresses, ozocerite 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 broncho-pulmonary system;
• signs of an asthmatic condition;
• presence of cor pulmonale.

Towards Primary Prevention include a healthy lifestyle of parents, which excludes the impact of hazards on the fetus during pregnancy, rational feeding of children, tempering procedures.

Secondary prevention includes:

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