Pneumonia call inflammation of pulmonary fabric of, mainly, infectious origin at which alveoluses are surprised. Course of this disease at children has a number of features.
This dangerous disease is quite often called pneumonia - under the influence of various factors the pathological process develops in pulmonary fabric, causing a syndrome of respiratory frustration. At children the disease is among enough heavy and demands treatment in the conditions of a hospital.
Causes of pneumonia
Pneumonia is considered a polietiologichny disease. The type of the concrete activator can be connected with a condition of immunity of the child, conditions of his life and location (in case of hospital pneumonia).
It is possible to distinguish from microorganisms which can be causative agents of this disease:
- pneumococcus (is detected in about a quarter of the diseased);
- mycoplasma (about 30%);
- chlamydias (about 30%).
Besides, a cause of illness can become staphylococcus (golden and epidermal), fungi, mycobacteria of tuberculosis, a hemophilic stick and some other activators, including viruses (flu, paraflu, a rubella, a cytomegalovirus, etc.).
In particular, in an organism of kids of age from six months to five years which ached at home most often doctors I find a pneumococcus and a hemophilic stick. At preschool children and pupils of elementary grades, especially during the aestivo-autumnal period, the pneumonia caused by a mycoplasma prevails.
In case of a community-acquired pneumonia own (endogenous) bacterial flora from a nasopharynx becomes more active more often, however also penetration of the activator from the outside is not excluded.
Carry to factors which can contribute to the development of pneumonia:
- SARS;
- overcooling of an organism;
- hit in airways of the child of emetic masses when vomiting or food or foreign matters.
Besides, the lack of vitamins and insufficiently developed immunity can play a fatal role. The risk of pneumonia increases also at little patients with rickets, congenital heart disease, after patrimonial injuries, serious stressful situations, against the background of a mukovistsidoz.
Intrahospital (hospital) pneumonia is observed when the child in the conditions of a hospital is treated for any other disease. Pneumonia in such cases is caused by the activators resistant to action of antibiotics. Among so-called "hospital" strains - a klebsiyell, proteas, a sinegnoyny stick, staphylococcus. The pneumonia caused and endogenous microorganisms of the patient is not excluded.
According to statistical data, in recent years the incidence of pneumonia at children up to 3 years is about 20 cases on one thousand, and children of more advanced age have about 6 cases on one thousand.
Pneumonia symptoms
The clinical picture depends on a type of pneumonia - according to existing classifications, this disease can be:
- one - or bilateral;
- focal;
- segmentary (when inflammation extends, covering all segment of a lung);
- drain (several segments are mentioned);
- share (inflammation is localized in the top or lower share).
Besides, depending on localization of inflammation allocate:
- bronchial pneumonia;
- pleuropneumonia;
- exudative pleurisy (at emergence of liquid in a pleural cavity, the state can complicate a course of disease).
The clinic also depends on age of the child. Children of more advanced age have a symptomatology more accurate and characteristic whereas at the least patients after the minimum manifestations the heavy respiratory insufficiency, oxygen starvation quickly enough develops.
Usually the first manifestations of pneumonia are such general signs as tearfulness, the complicated nasal breath, deterioration in appetite, drowsiness. Later temperature can suddenly increase, remaining on a mark more than 38 °C within several days. By then there is also an increase of breath and warm reductions, integuments turn pale.
Cough at pneumonia can develop only for the fifth or sixth day, it can be a miscellaneous - deep or superficial, dry or damp, paroxysmal. When involving in inflammatory process of bronchial tubes the phlegm begins to appear.
Among symptoms from other systems are probable:
- muscular pains;
- skin rashes;
- violations of a chair (diarrhea);
- spasms - at patients of infantile age against the background of high temperature.
Carry higher to clinical manifestations of staphylococcal pneumonia (up to 40 °C) temperature which does not get off within several days (up to ten days). In this case the disease is characterized by the sharp beginning and fast increase of expressiveness of symptomatology.
Diagnostics
During survey the doctor can draw a conclusion on intoxication and respiratory insufficiency, rattles in easy and other important symptoms.
Pneumonia quite often comes to light during an auskultation of lungs, taking into account the accompanying clinical manifestations and data received at poll of the patient or his parents. At a thorax prostukivaniye over the site of defeat the shortening of a sound is often observed. However the lack of this sign cannot exclude pneumonia.
According to some experts, the least patients have a pneumonia "easier to see, than to hear". The fact is that even in the absence of changes when listening there are obvious such symptoms of pneumonia as short wind, retraction of auxiliary muscles, cyanosis of a nasolabial triangle, refusal of food.
At suspicion of pneumonia immediately carry out radiological survey which not only can confirm the diagnosis, but also give an idea of localization and level of distribution of inflammatory process in lungs.
Also the clinical analysis is rather informative. At pneumonia it shows:
- growth of number of leukocytes;
- increase in number of stab leukocytes;
- the increased SOE level demonstrating inflammation.
However pneumonia can proceed also against the background of lack of so characteristic changes in blood.
By results of the bacteriological analysis of slime from a nose and a pharynx and also a phlegm (at an opportunity) the concrete type of the activator and also its sensitivity to antibiotics is defined.
At suspicions on the virus nature of a disease apply a virologic method, for diagnosis of a chlamydial and mikoplazmenny infection - IFA and PCR.
According to indications (at heavy course of a disease and risk of development of complications) do to patients the ECG and other researches.
Treatment
At the confirmed diagnosis children of younger age are hospitalized in a hospital, as well as more senior patients with signs of respiratory insufficiency. Doctors convince parents not to refuse hospital as the course of a disease is unpredictable. At pneumonia the weight of a state can increase very quickly.
The issue of the emergency hospitalization of the child with pneumonia is resolved taking into account and some other factors, in particular:
- existence of anomalies of development and congenital diseases;
- presence of associated diseases;
- possible hypotrophy;
- immunodeficiency;
- socially unprotected family, etc.
Doctors allow treatment of children of age is more senior than three years in house conditions only in case of full confidence in thorough performance of all appointments.
The main component of therapy of patients with pneumonia – the medicines calculated on the causative agent of a disease. About efficiency of treatment it is usually possible to judge 1-2 days later, by objective yielded, to results of laboratory researches and also repeatedly made pictures of a X-ray analysis.
In case the condition of the patient does not improve, asked about change of the scheme of treatment, or medicines combine with medicines of other group.
Usually at treatment of pneumonia at children antibiotics from three main groups are used:
- ampicillin, amoksiklav (semi-synthetic penicillin);
- azithromycin, erythromycin (macroleads);
- cephalosporins II and III of generations.
To patients at whom the disease proceeds hard also appoint aminoglycosides, imipinema.
The pneumonia caused by legionelly treat mainly rifampicin. At therapy of fungal pneumonia appoint such medicines as amfoteritsin In, fluconazole, etc.
Ftorkhinolona at treatment of patients of children's age are applied only in extreme cases, when it comes to vital indications.
While high temperature remains, the high bed rest is necessary for patients.
Intravenous desintoxication is applied in the most hard cases and also at the complications which developed against the background of pneumonia.
To patients with extensive inflammatory process for prevention of destruction of pulmonary fabric in the first three days sometimes appoint medicines gordoks, kontrikat also other anti-proteases.
Among other medicines which are used at pneumonia at children:
- febrifugal (at threat of development of spasms against the background of high temperature at kids);
- nonsteroid anti-inflammatory medicines (diclofenac, ibuprofen) - at persistent fever;
- short courses of corticosteroids - at complications in the form of pleurisy;
- ACC, Bromhexine, the mukobena both other mucolytics and expectorant means - in case of persistent cough with the dense, hardly separated phlegm;. mucolytics are appointed.
Fluidifying of a phlegm is promoted sufficient drink, by inhalations with warm alkaline mineral water or 2% solution of baking soda.
At pneumonia also physiotherapeutic methods of treatment are considered as effective, including an induktotermiya, the microwave oven, an electrophoresis. The massage and physiotherapy exercises connected right after disappearances of fever allow to accelerate recovery process and to reduce risk of development of complications after the postponed pneumonia
An important role is played by ensuring necessary volume of liquid. At pneumonia the child has to drink as much as possible - water, fruit drinks, herbal teas, vegetable broths and compotes, depending on age. Kids of age about one year a day are recommended to drink the volume of liquid, equal 140 ml/kg of their weight (including breast milk or mix if the child is on the artificial or mixed feeding).
Recovery period
Complex improving measures are recommended to the recovering patients:
- regular walks in the fresh air;
- the oxygen cocktails made with juice and herbs;
- full-fledged diet and vitamin therapy.
The children who had pneumonia have to be observed for the next year at the local pediatrician, periodically taking a blood test and visiting the ENT specialist, the allergist and the pulmonologist.