Download Pneumonia (child)

File 63 Respiratory Problems
 Pneumonia (child)
Recommend
 If baby under 3 months of age contact MO immediately
 Severe dehydration is unusual in pneumonia unless there are abnormal fluid losses
from frequent diarrhoea or vomiting
Background
 Children with co-existent illnesses are more at risk. Examples are bronchiolitis and
chronic lung disease (e.g. due to prematurity)
Related topics:
 Upper respiratory tract infection (child) page 527
Bronchiolitis, page 533
 Immunisation program page 316
1.
May present with:
 Cough dry or with sputum, fever, tachycardia
 Rapid breathing, nasal flaring, grunting respirations and chest recession in
infants, cyanosis, apnoea in infants
2.
Immediate management:
 If severe administer oxygen via nasal prongs ( up to 2 L/min) or non-rebreather
mask (see O2 Delivery systems) to maintain O2 saturation >94%. If >94% not
maintained consult MO
 Consult MO
3.
Clinical assessment:
 Obtain patient history including
 past episodes or complications
 length of time signs or symptoms have been present
 any history of asthma, bronchiolitis, chronic lung disease
 ask if child has stopped breathing (apnoea) for short periods of time
 ask about fluid intake and output (wet nappies, passing urine, diarrhoea)
 medications taken
 Perform standard clinical observations + O2 saturations*. Of particular
importance is the respiration rate and the temperature
 Perform physical examination including:
 inspect the respiratory system for respiratory distress – grunting, nasal faring,
sternal / intercostal recession
 auscultate the chest for air entry and any added sounds (crackles or
wheezes)
 inspect lips, tongue, extremities for cyanosis
 inspect for signs of dehydration – moist tongue, skin elasticity (severe
dehydration is unusual)
 inspect skin surface for any skin rash
 Check vaccination status, see Immunisation program
 *(Oxygen desaturation is largely a feature of airways disease, and only occurs in
pneumonia with quite extensive disease when the child appears clinically unwell.
Whereas it occurs in airways disease with well-looking but distressed children).
4.
Management:
 Consult MO using the following flow chart as a guide
File 63 Respiratory Problems
Mild pneumonia:
 MO may advise:
 chest X-ray if available
 oral Amoxycillin if not allergic; IM Penicillin Benzathine (Bicillin LA) if there is
likely to be a lack of observance with oral medication; Roxithromycin if
allergic to Penicillin or atypical pneumonia is suspected
 Encourage rest and increase oral fluids
 Treat fever with regular Paracetamol to make more comfortable
Moderate / severe pneumonia:
 Give oxygen via non-rebreather (see O2 delivery systems) to maintain O2
saturation >94% (if not already in place). If >94% not maintained consult MO
 Give oral fluids as tolerated
 MO may advise:
 insert IV cannula - if possible take blood cultures prior to commencing
antibiotics
 IV fluids - it is usual to start with Normal Saline or Hartmann’s Solution; MO
will advise quantities and rate
 commence antibiotics, eg. IV Penicillin if moderate or IV Ceftriaxone and
Flucloxacillin if severe; although only about 10% of cases of definite bacterial
pneumonia will be blood culture positive, the vast majority of cases labelled
pneumonia have airways disease and “secondary bacterial infection” is fairly
uncommon from all the recent studies.
 evacuation / hospitalisation
See Simple Analgesia Protocol (back cover)
File 63 Respiratory Problems
5.
Follow up:
 Patients with mild pneumonia who are not evacuated / hospitalised should be
reviewed daily
 Consult MO if the patient is not improving
 See next MO clinic
6.
Referral / Consultation:
 Consult MO on all occasions pneumonia is suspected
 Some children with pneumonia will require a paediatric referral
References
1.
2.
3.
4.
Arroll B and Kenealy T, Antibiotics for the common cold and acute purulent
rhinitis. Cochrane Database of Systemic Reviews, 2008 (Issue 4).
Therapeutic Guidelines, Respiratory tract Infections. 2008, Therapeutic
Guidelines Ltd: Melbourne.
Therapeutic Guidelines, Pharyngitis and/or tonsillitis. 2006, Therapeutic
Guidelines Ltd: Melbourne.
Therapeutic Guidelines, Meningitis: management prior to hospitalisation. 2006,
Therapeutic Guidelines Ltd: Melbourne.