Pediatric Pneumonia and Bronchiolitis

Understand the definition and epidemiology of bronchiolitis and pneumonia

Bronchiolitis
Inflammation of the bronchioles (small airways)

More specifically, it is a syndrome that occurs in children <2 yrs characterized by upper respiratory symptoms, followed by lower respiratory tract infection with inflammation

Who does Bronchiolitis affect? When? What is it caused be?
Typically affects infants and children <2 years More common in fall and winter months Leading cause of hospitalization in infants and young children Typically viral cause (RSV, Rhinovirus, and parainfluenza virus most common)

How is RSV transmitted?
*Direct contact via virus-containing secretions to nasal/ocular mucosa
*Very contagious- virus can be cultured from surfaces several hours after contact
–Handwashing!!

Know the clinical presentation of bronchiolitis
Fever, coryza, rhinorrhea, nasal congestion for 1-3 days
Then cough and increased work of breathing
Decreased appetite

Apnea is the presenting symptom in 20% of infants hospitalized with RSV bronchiolitis

Physical exam findings for Bronchiolitis
Hypoxemia or cyanosis may be present
Tachypnea
Retractions and signs of respiratory distress
Coarse breath sounds (rales)
Wheezing

Definition of pneumonia
Inflammation and infection of the lung tissue; including visceral pleura, connective tissue, airways and alveoli

Epidemiology of pneumonia
Annual incidence of pneumonia is estimated to be 33/10,000 in children <5 years and 14.5/10,000 in children up to 16 years in the developed world The World Health Organization estimates 156 million cases of pneumonia each year in children under 5 years Hospitalization rates for pneumonia in the US in children <2 has decreased after introduction of pneumococcal vaccine

Know the clinical presentation of Pneumonia
Fever and cough
Decreased appetite, fatigue
Tachypnea, retractions, nasal flaring, grunting
Chest pain
Abdominal pain

Viral pneumonia clinical symptoms
Gradual onset
Prominent URI symptoms
Low grade fever
Non-toxic appearing
Diffuse crackles or rales
CBC: normal WBC with right shift
CXR: streaky/patchy infiltrates bilaterally

Bacterial pneumonia clinical symptoms
More acute onset
Mild or no preceding URI symptoms
High fever
Ill appearing
Localized crackles or lung findings
CBC: elevated WBC with left shift
CXR: lobar/segmental infiltrate or consolidation

Atypical pneumonia
“Atypical” bacterial pneumonia refers to Mycoplasma or Chlamydia
Usually in older children
Presents with constitutional symptoms: fever, malaise, myalgia, sore throat
Gradually worsening non-productive cough

Recognize the most common causes of pneumonia in different age groups
Virus, bacteria, fungi, rickettsiae

Pneumonia in <28 days old
Group B streptococcus (most common bacterial cause)
E Coli
HSV/CMV

Pneumonia in Febrile infants 1-4 months
RSV is most common
S. Pneumoniae, non typable H Flu

Pneumonia in afebrile infants 1-4 months
Chlamydia trachomatis
Mycoplasma hominis
Cytomegalovirus

Pneumonia in children 4 months to 5 years
VIRAL: RSV, Parainfluenza, influenza, adenovirus
Strep pneumoniae

Pneumonia in children >5 yo
Streptococcus pneumoniae
Mycoplasma pneumoniae
Influenza virus
Adenovirus
Chlamydia pneumoniae
Non-typable Haemophilus influenzae

Understand when to hospitalize patients with bronchiolitis
Oxygen saturation <94% Signs of respiratory distress Recent apnea or cyanosis Dehydration If parent unable to care for child at home History of any significant cardiac or pulmonary disorder

Understand when to hospitalize patients with pneumonia
Hypoxemia requiring oxygen
Dehydration
Respiratory distress
Toxic appearing
Underlying conditions that put patient at risk for complications
Failure of outpatient management

Know different diagnostic and treatment modalities for Bronchiolitis
Diagnostic: Clinical and RSV rapid antigen test, CXR
Treatment: Supportive care; IV Fluids and sup O2, NO bronchodilators

Know different diagnostic and treatment modalities for Pneumonia
History and Physical exam
CXR confirmation
CBC, blood culture, sputum, nasopharyngeal swab, mycoplasma serology

Treatment for pneumonia in neonate <1month old
IV Ampicillin and Gentamicin

Treatment for pneumonia in 1-4 month old
Cefuroxime, Cefotaxime or Ceftriaxone

Treatment for pneumonia in 4months-5 years
Amoxicillin
Can give IM dose of Ceftriaxone before starting oral meds

Treatment for pneumonia in >5 years
Amoxicillin or Azithromcyin for atypical

Recognize preventive measures used for bronchiolitis in the pediatric population
Standard hospital precautions
HANDWASHING!!
Gowns and separate stethoscopes
Cohorting all RSV patients
Immunoprophylaxis
Palivizumab (Synagis)- monoclonal antibody against RSV

Palivisumab
Decreases the risk of hospitalization due to RSV in specific patients:
Premature infant <29 wks gestation History of bronchopulmonary dysplasia Hemodynamically significant congenital heart disease High risk patients are given monthly IM injections during RSV season up to 2 years of age

Recognize preventive measures used for pneumonia in the pediatric population
Standard precautions
Handwashing!
Vaccines
Haemophilus influenza type B (HiB)
Pneumococcal conjugate (PCV13)
Influenza vaccine

What is bronchiolitis? Acute viral infection that affects the bronchioles What causes bronchiolitis? Most common = RSV subgroup A Others: adenovirus and parainfluenza virus WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE …

Definition: Pneumonia Inflammation & Infection of the Lung Tissue: Visceral Pleura, Connective Tissue, Airways, & Alveoli Special Etiologies: Pneumonia Aspiration, Immunocompromise, and Sickle Cell Disease WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY …

Respiratory tract lesions such as pediatric croup, bronchiolitis and epiglottitis comprise a group of acute infections that are not prevalent but can be life-threatening. A majority of such infections are reported in younger children and are easily managed with appropriate …

bronchitis: definition inflammation of the large airways that is frequently associated w a URI bronchitis: cause viral agents WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample bronchitis: S&S: cough …

Bronchitis Inflammation of the bronchi, large and midsized airways. Almost always viral (90-95%) but can be bacterial. Risk factors – smoking, COPD, CF Sx: sx of URI, productive cough (clear/purulent), dyspnea, diffuse wheeze, decreased breath sounds, can cause chest pain …

DDX for acute cough Lifethreatening: -*aspiration of foreign body* (otherwise healthy kid) -PE -spontaneous pneumothorax Most Common Causes: -*infection* (viral upper resp infection -asthma (new or exacerbation) -foreign body aspiration -allergic rhinitis -psychogenic cough (bizarre, honking sound, underbreath) Acute on …

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