Scribd
Upload
38 views28 pages

Seminar Child

This document provides an overview of acute respiratory infections in children. It defines upper and lower respiratory tract infections and lists common causal organisms of pneumonia in children, including bacteria like Streptococcus pneumoniae and viruses like respiratory syncytial virus. It also describes the pathophysiology of pneumonia, approaches to assessing severity, typical treatment including antibiotics, and potential complications.

Uploaded by

Aung Khaing Moe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
38 views28 pages

Seminar Child

This document provides an overview of acute respiratory infections in children. It defines upper and lower respiratory tract infections and lists common causal organisms of pneumonia in children, including bacteria like Streptococcus pneumoniae and viruses like respiratory syncytial virus. It also describes the pathophysiology of pneumonia, approaches to assessing severity, typical treatment including antibiotics, and potential complications.

Uploaded by

Aung Khaing Moe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 28

Defence Services Medical Academy

Department of Pediatrics

Acute Respiratory Infection

Presented by 31.1.2024
Cadet Linn Htet
Cadet Ye Mhan
Contents

Definition
Differential diagnoses of a child presenting with acute onset difficult breathing
Common causal organisms of Pneumonia
Pathophysiology of Pneumonia
Assessment of severity of Pneumonia
Treatment
Complications
References
Definition

• Acute respiratory infection is defined as an infection of any part of respiratory


tract less than 30 days duration.

• It is classified as upper respiratory tract infections (URIs) or lower respiratory


tract infections (LRIs).
Upper respiratory tract infection

• An upper respiratory infection ia an infection which involves upper respiratory


tract such as nose,sinuses,pharynx, larynx and trachea.

• It includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, otitis


media .
Lower Respiratory Tract Infection
Differential diagnoses of a child presenting with acute onset difficult
breathing
A. Respiratory Causes
1. Pneumonia
2. Asthma
3. Bronchiolitis
4. Effusion and Empyema
5. Pneumothorax
6. Viral croup
7. Foreign body in the airways
B. Non-respiratory Causes
1.Congestive heart failure
2.Raised intra-cranial tension, e.g., Meningitis
3.Metabolic acidosis, e.g., Diabetic Ketoacidosis, Renal Failure
Common causal organisms for pneumonia in children
Bacteria

 Streptococcus pneumoniae
 Hemophilus influenzae
2 months to 5 years  Staphlococcus aureus (common in <1 yr)

 Group B streptococcus
 Escherichia coli
Under 2 months  Staphlococcus aureus

Viruses  Respiratory syncytial virus (RSV)


 Influenza virus
 Parainfluenza virus
 Measles
 Chickenpox

Others  Fungus
 Protozoa
Pathophysiology of Pneumonia

No pneumonia Pneumonia
Consolidation
Exudation

Coryza symptoms
-Fever
-Running nose
-Cough
-sneez
Pneumonia

Hypoxia

Assessory muscle Working


-IC indrawing
-SC indrawing

Fast Breathing
Severe or very severe pneumonia

Hypoxia
Convulsions

Unconciousness
Danger signs
V vomiting
C convulsions
D unable to drink
U unconscious
S Severe Malnutrition
Assessment of severity of Pneumonia

Age <2 months


Severe pneumonia
 Severe chest indrawing or
 Fast breathing
Very severe pneumonia
 Not feeding
 Convulsions
 Abnormally sleepy or difficult to wake
 Fever/low body temperature
 Slow irregular breathing
Cont.

Age 2 months - 5 years


Pneumonia
 Fast breathing
o <2 months age: >60/min
o 2- 12 months age: >50/min
o months – 5 years age: >40/min
Cont.

Severe pneumonia
 Chest indrawing
Very severe pneumonia
 Not able to drink
 Convulsions
 Drowsiness
 Malnutrition
Chest radiograph
CXR is indicated ONLY in
 Clinical findings are ambiguous
 A complication such as a pleural effusion is suspected
 Pneumonia is prolonged and unresponsive to antimicrobials
White blood cell count
 Increased counts with predominance of polymorphonuclear cells suggests
bacterial cause
 Leucopenia can either suggests a viral cause or severe overwhelming infection
Blood culture
 It should ONLY be performed in severe pneumonia or if poor response to first
line antibiotics
Serology
 Serology is performed in patients with suspected atypical pneumonia, i.e.
- Mycoplasma pneumoniae
- Chlamydia
- Legionella
- Moraxella catarrhalis
Treatment

Criteria for hospitalization


 Severe pneumonia and very severe pneumonia
 Intermittent apnoea
 Severely dehydrated
 Recurrent pneumonia
 Severe underlying disorder (i.e. immunodeficiency)
 Pneumonia refractory to oral antibiotics
 Family not able to provide appropriate observation or supervision
Indications for transfer to ICU
 Hemodynamic instability
 Recurrent apnoea or slow irregular breathing
 Rising respiratory rate and pulse rate with clinical evidence of respiratory distress
 and exhaustion and failure to maintain SpO2 >92% with 8 L of oxygen
Monitoring
 Temperature, heart rate, respiratory rate, SpO2 and respiratory distress including
chest indrawing and use of accessory muscles of respiration should be monitored
4 hourly
Children under 5 years of age
 First choice: Amoxicillin

• (Child 1 month–1 year 62.5 mg 3 times daily

• Child 1–5 years 125 mg 3 times daily

• Child 5–18 years 250 mg 3 times daily) for 7 to 10 days

 Second choice: Co-amoxiclav (30 mg of Amoxycillin/kg/dose 8 hourly) OR

• Azithromycin Child over 6 months 10 mg/kg once daily (max. 500mg once daily) for

5 days
 Macrolide (Azithromycin) if Mycoplasma pneumoniae or Chlamydia
pneumoniae is suspected
 Flucloxacillin if Staph aureus is suspected
•Children age 5 years and older
 Azithromycin 10 mg/kg/once daily for 5 days
•Antibiotic therapy in inpatient setting
•First choice
 IV Benzyl penicillin 0.5 L units/kg/dose 6 hourly OR
 IV Ampicillin (25 mg/kg/dose 6 hourly)
•Second choice
 Co-amoxiclav (30 mg of Amoxycillin/kg/dose 8 hourly) or
 Cefotaxime (50 mg/kg /dose every 8–12 hours; increase to every 6 hours in
very severe infections)
Duration for inpatient setting
 Total duration 7-10 days
 Start with IV and change oral once the clinical response is good and the child
can take orally
Supportive treatment
Fluids
 Patients who are vomiting or who are severely ill may require IV fluids
Oxygen
 It can be given either via nasal cannulae, face mask or head box
Temperature control

• Paracetamol 15 mg/kg/dose every 4-6 hours to reduce discomfort


Complications

• Staphylococcal pneumonia
• Empyema
• Lung abscess
• ARDS
• Respiratory Failure
• Sepsis
References
• Nelson pediatrics 2019 edition
• Pediatrics Management Guidelines ( Third Edition 2018 ).
Thank you so much for your
attention

You might also like