Pneumonia

Question 1

What are the most common pathogens causing pneumonia in newborns, infants, children over 5

Answer 1

Newborn:
Organisms from mothers genital tract - group B strep, gram-negative enterococci and bacilli

Infants/young children
Respiratory viruses, RSV,
Strep pneumonia, H. influenza
Bordatella pertussis
Chlamydia trachoma's

Over 5
Mycoplasma pneumoniae
Streptococcus pneumoniae
Chlamydia pneumoniae

At all ages:
Mycobacterium tuberculosis

Question 2

What are clinical features of pneumonia?

Answer 2

Fever, cough and rapid breathing
Lethargy
Poor feeding
Unwell child

localised chest, abdo or neck pain is a feature of pleural irritation = bacterial

Question 3

What signs in pneumonia?

Answer 3

Tachypnoea
Nasal flaring
Chest indrawing

Increased RR is the most sensitive sign

End-Inspiratory coarse crackles over the affected area
Other sounds such as dullest on percussion, decreased breath sounds and bronchial breathing are often absent in young children

SaO2 may be decreased

Question 4

What investigations?

Answer 4

Bedside: SaO2
Bloods: FBC, CRP, ESR
Imaging: CXR
Micro: Nasopharyngeal aspirate

Question 5

Management of pneumonia?

Answer 5

Admit if SaO2<92% on air, recurrent apnoea, grunting, inability to maintain adequate fluid intake, feed intake.

Supportive care:
O2 for hypoxia
Analgesia
IV fluids for dehydration and maintenance and sodium balance

Antibiotics:
Newborn - broad spectrum IV
Older infants - oral amoxicillin - co-amoxiclav for unresponsive pneumonia
>5 - amoxicillin or oral macrolide such as erythromycin

If parapneumonic effusion persists - fever despite 48h of abx, drain effusion with US guidance.
Chest drain.