Pneumonia in Children. Dr Colin Gilhooley

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1 Pneumonia in Children Dr Colin Gilhooley

2 Definition Objectives Presentation Epidemiology Causes Transmission Risk Factors Treatment Prevention

3 What is pneumonia?

4 What is pneumonia? Acute respiratory infection Affects the lungs Alveoli are filled with pus and fluid Limits oxygen intake

5 Epidemiology Pneumonia is the leading cause of death in children worldwide. Kills an estimated 1.2 million children under five years every year more than AIDS, malaria and tuberculosis combined. In Uganda accounts for 17% of deaths in children under five.

6 Causes Pneumonia can be caused by viruses, bacteria or fungi. Streptococcus pneumoniae the most common cause of bacterial pneumonia in children; Haemophilus influenzae type b (Hib) the second most common cause of bacterial pneumonia;

7 Pneumonia - Bacterial Streptococcus pneumoniae the most common cause of bacterial pneumonia in children Haemophilus influenzae type b (Hib) the second most common cause of bacterial pneumonia;

8 Pneumonia VIral respiratory syncytial virus is the most common viral cause of pneumonia

9 Pneumonia and HIV Pneumocystis jiroveci is one of the commonest causes of pneumonia. Responsible for at least one quarter of all pneumonia deaths in HIV-infected infants

10 Number of ways. Inhaled. Transmission Air-borne droplets from a cough or sneeze. May spread through blood, especially during and shortly after birth.

11 Presentation Children under five years of age who have cough and/or difficult breathing + fast breathing or lower chest wall indrawing = PNEUMONIA

12 Fast breathing <2 months >60 bpm 2months 1 year >50 bpm 1 5 years >40 bpm

13 Chest indrawing

14 Other signs Cyanosis Crackles Tracheal tug Dull to percussion Head bobbing Fever

15 Other signs

16 Presentation Cough or difficult in breathing + Fast breathing or chest indrawing = PNEUMONIA

17 Risk Factors Patient Vs Environmental

18 Patient Risk Factors Immune systems compromise. malnutrition infants who are not exclusively breastfed. Pre-existing illnesses HIV infections measles

19 Environmental Risk factors indoor air pollution cooking and heating with biomass fuels (such as wood or dung) living in crowded homes parental smoking

20 Treatment?

21 Treatment ABCD

22 Airway Ensure the child has an open airway

23 Breathing Does the child need oxygen?

24 Circulation IS there shock? How severe is the pallor? Is there a tachycardia? Are the femoral pulses palpable?

25 Coma What is the GCS/AVPU IF GCS <8 or AVPU = P or U then reassess the airway to ensure it is safe What is the blood sugar?

26 Convulsions IS there convulsions? If yes; treat them and then ask why is a child with pneumonia having convulsions?

27 Dehydration How severe is the dehydration? What is the best way to give fluids to the child? Is there severe pallor

28 Don t ever forget glucose!!!

29 NOW you can think antibiotics Insert a cannula Take blood for Hb, BS and HIV test IF severe pallor or concerns about severe anaemia group and cross-match Give glucose

30 What antibiotics? Availability Effectiveness Cost

31 Antibiotics Under 2 months Ampicillin 50mg/kg BD if <7d, TDS 7-21d, QDS >21d Gentamicin 5mg/kg (3mg/kg if under 2kg) OD Everyone else Benzylpenicillin 50mg/kg 6 hourly Gentamicin 5mg/kg once daily

32 Why benzylpenicillin Effective against both Strep pneumoniae and H. Influenza the 2 most common causes of bacterial meningitis. Its cheap and available

33 Why not benzylpenicillin Resistance? 6 hourly

34 Why gentamicin? Has synergistic effect with benzylpenicillin Once daily

35 Kidney damage Why not gentamcin

36 Why not ceftriaxone Expensive Avoid drug resistance in the future

37 When to use ceftriaxone Patient deteriorates during admission Patient fails to improve after 48 hours of benzylpenicllin and gentamicin.

38 Pneumonia and HIV Benzylpenicillin Gentamicin cotrimoxazole.

39 Preventation Most effective way to reduce death. Immunise Hib, pneumococcus, measles and whooping cough Nutrition exclusive breastfeeding for the first six months of life. preventspneumonia, Reduces length of the illness if a child does become ill.

40 Prevention Environmental factors indoor air pollution (by providing affordable clean indoor stoves, for example) good hygiene in crowded homes. HIV give cotrimoxazole as prophylaxis.

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