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Inflammation of the lungs (pneumonia)

Pneumonia in children is an acute infectious and inflammatory process of various etiologies. The mechanisms of the development of the disease are associated with a predominant lesion of the respiratory lungs. The respiratory sections of the lungs are the anatomical structures located behind the terminal bronchi - respiratory, alveolar passages and alveoli.

The incidence of pneumonia in children in the first year of life is 15-20 per 1,000 children, from 1 year to 3 years - 5-6 per 1000 children.

The following diseases can be predisposing factors in children: perinatal aspiration pathology, hypotrophy, congenital heart disease with circulatory failure, immunodeficiency states.

In older children, predisposing factors are foci of chronic infection, passive and active smoking, and body hypothermia.

By etiology, acute pneumonia is divided into: bacterial; viral; mycoplasma; rickettsial; fungal; allergic

pneumonia arising from helminth infestations; pneumonia that occurs when exposed to physical and chemical factors.

There are seven forms of bacterial pneumonia: pneumococcal; Friednender; Pseudomonas aeruginosa; hemophilic; streptococcal; staphylococcal;

a group of pneumonia caused by proteome and E. coli. Of the viral pneumonias, the most common are: influenza pneumonia; adenovirus pneumonia; parainfluenza pneumonia; respiratory-pneumonia.

In accordance with the causes and mechanisms of occurrence, primary and secondary pneumonia are distinguished. The latter occur against the background of exacerbations of chronic diseases of the broncho-pulmonary system and other somatic diseases of the child.

For the occurrence of pneumonia, in addition to bacterial or viral agents, a certain set of factors is necessary: ​​1) the entry of mucus into the lungs from the upper respiratory tract -

aerogenic path;

2) microorganism entering the bronchi;

3) the destruction of the protective mechanisms of the respiratory tract;

4) hematogenous, lymphogenous pathways of infection. When pneumonia occurs, ventilation of the lungs and gas exchange are disturbed, and the nutrition of the ventricular myocardium is reduced.

According to the extent of the defeat of pneumonia can be segmental, lobar, total, single and bilateral.

In the mechanism of pneumonia, an important role is played by hypoxia with hypercapnia, which develops as a result of a violation of both external, pulmonary, and tissue respiration.

Table Classification of acute pneumonia in children (S. Rachinsky)

The form Flow Complication
Focal bronchopneumonia Segmental pneumonia Corpuscular pneumonia Interstitial pneumonia Acute Lingering Uncomplicated Complications: obstructive syndrome, toxic, purulent-pulmonary, pleural

The clinical symptoms of pneumonia depend on the type of pneumonia, the magnitude and prevalence of the process.

In focal pneumonia (bronchopneumonia), the process is acute or subacute and develops on the 5-7th day of acute respiratory disease in the form of its second wave. The following symptoms are characteristic:

1) temperature increase;

2) weakness;

3) headache;

4) pain in the chest or under the shoulder blades;

5) cough;

6) increased intoxication.

Shortening of percussion sound is noted above the affected area, with auscultation - bronchophony, weakened breathing, sometimes crepitus.

Radiologically determined amplification of the pulmonary pattern between the foci of inflammation and the roots of the lung.

In a blood test, neutrophilic leukocytosis with a shift to the left, an increase in ESR, is determined.

Segmental pneumonia. In the case of the hematogenous pathway, one or more segments of the lung are affected. Usually the right segments are more often affected. Segmental pneumonia begins acutely with an increase in temperature, symptoms of intoxication are usually expressed, pain in the chest area, sometimes in the abdomen, cough is rare. Symptoms of respiratory failure appear, objective data are weak.

Secondary segmental pneumonia develops against a background of a proceeding respiratory infection, while the symptoms of intoxication are mild.

Segmental pneumonia radiologically manifests itself in separate foci that merge and then capture an entire segment.

Croupous pneumonia. The inflammatory process captures the lobe of the lung or part of it and the pleura. It is rare. Often caused by pneumococcus. The onset is acute. The disease begins with dizziness, poor health, a sharp headache. A temperature of up to 40–41 ° C is noted, often patients complain of chills. Cough in the first three days is rare, dry, then with the release of rusty sputum. Cyanosis and shortness of breath quickly appear. Often in children there is an abdominal syndrome, manifested by pain in the navel, flatulence, and vomiting.

There are four stages during croupous pneumonia.

At the first stage - the tide stage - the shortening of percussion sound with a tympanic hue, weakened breathing is determined, crepitation is periodically heard.

In the second stage, hyperemia of the face develops, often on the side of the lesion, a serious condition. On the side of the lesion, shortening of percussion sound, bronchial breathing, bronchophony are determined. Wheezing is not tapped.

The third stage develops on the 4th-7th day - the cough intensifies, the temperature drops, often critically. Percussion sound takes on a tympanic hue, crepitus appears.

In the fourth stage, the resolution stage, the temperature decreases, a frequent cough appears, and heavy rales of various sizes appear.

On radiographs, the staging of the process is also determined:

in the first stage - strengthening the vascular pattern, limiting the mobility of the diaphragm;

in the second stage, dense shadows appear, corresponding to lobes involving the root and pleura;

in the third and fourth stages, infiltration disappears gradually.

With croupous pneumonia, there is a sharp neutrophilic leukocytosis with a shift to the left, accelerated ESR.

Croupous pneumonia in young children is atypical. Usually the main symptoms of the disease are not clearly expressed. Under the influence of antibacterial therapy, the stages of the inflammatory process are shortened. In the case of irrational therapy, a protracted course of the disease occurs.

Interstitial pneumonia occurs with viral, mycoplasma, pneumocystis, fungal and staphylococcal infections. More often this pneumonia is registered in premature and newborn babies, as well as against the background of dystrophy, immunodeficiency in children.

The disease can be accompanied by severe intoxication, a drop in blood pressure is possible, in addition, changes from the central nervous system, as well as the gastrointestinal tract, are often noted. A debilitating cough with scanty frothy sputum is noted.

With interstitial pneumonia, bloating of the chest is noted.

Percussion - tympanite. Single crepitating and dry rales are heard against the background of weakened breathing.

X-ray emphysema, rebronchial infiltration, cellularity of the interstitial-vascular pattern are detected. On the part of the blood, leukocytosis, an increase in ESR, are detected.

Diagnosis is based on clinical and radiological data.

The clinical symptoms are:

1) temperature reaction;

2) signs of respiratory failure: shortness of breath, cyanosis, participation in the breathing of auxiliary muscles;

3) persistent auscultatory and percussion deviations from the lungs;

4) radiological - focal, segmental, lobar infiltrative shadows;

5) from the blood: leukocytosis, neutrophilia, increased ESR;

6) the effect of ongoing etiological therapy. The course of pneumonia in children depends on the etiology, age

and the presence of various concomitant diseases.
Pneumonia caused by hospital strains of Staphylococcus aureus or gram-negative bacteria is especially severe. The course of pneumonia in these cases is characterized by early abscess formation, a rapid breakthrough of the inflammatory focus in the pleura and the occurrence of pyopneumothorax with a rapid course of the disease.

In the neonatal period, pneumonia has a serious prognosis. Distinguish between acquired and intrauterine pneumonia of newborns.

Intrauterine pneumonia occurs as a result of infection of the fetus during pregnancy or aspiration by infected amniotic fluid, while aspiration can be either intrauterine or intrapartum.

In newborns, pneumonia is often accompanied by atelectasis, as well as destruction of lung tissue.

An important role in the development of pneumonia can play a predisposition to the allergic effects of external factors and the occurrence of catarrhal inflammation of the mucous membranes. With these pneumonias, the attachment of an asthmatic syndrome is characteristic. The course of pneumonia in these cases takes a relapsing character.

In children suffering from rickets, pneumonia develops more often and has a protracted course.

In children with malnutrition occurs more often in connection with a significant decrease in immunity, there is a weak severity of symptoms of pneumonia. Treatment

In the case of moderate and severe forms, children are subject to inpatient treatment. Children of the first year of life - in any form.

The treatment of pneumonia is carried out comprehensively and consists of:

1) the use of etiotropic drugs;

2) oxygen therapy for the development of respiratory failure;

3) the appointment of drugs that improve bronchial conduction;

4) the use of means and methods that ensure the transport of blood oxygen;

5) the appointment of drugs that improve tissue processes


6) the use of drugs that improve metabolic processes

in organism.

A child’s nutrition should be appropriate for the age and needs of the child’s body. However, during intoxication, food should be mechanically and chemically sparing. Due to coughing, foods containing particles that can be aspirated are excluded from the diet. An additional liquid is prescribed in the form of a drink. For this, decoctions of rosehip, blackcurrant, juices are used.

Immediately after admission to the hospital, sputum is taken, swabs for bacteriological examination, then etiotropic treatment is prescribed, which is carried out under the supervision of clinical efficacy, and subsequently, taking into account the results of sputum sensitivity to antibiotics.

In the case of community-acquired pneumonia, macrolides of a new generation are prescribed. In the case of nosocomial pneumonia, cephalosporins of the second and third generations and antibiotics of the reserve group are prescribed.

In pneumonia resulting from intrauterine infection, a new generation of macrolides is prescribed - spiromycin, roxithromycin, azithromycin. In the case of pneumonia in children with immunodeficiencies, cephalosporins of the third and fourth generations are prescribed.

In case of mixed infection, the interaction of the influenza pathogen and staphylococcus, along with the introduction of broad-spectrum antibiotics, anti-influenza γ-globulin of 3–6 ml is administered.

Antibiotics are used comprehensively as follows:

1) cephalosporins;

2) cephalosporins plus aminoglycosides.

Mucolytic therapy, bronchodilators, physiotherapy, immunocorrective treatment are prescribed. With the accumulation of secretions in the respiratory tract, it is necessary to remove the contents of the nasopharynx, larynx, large bronchi. With severe symptoms of respiratory failure, oxygen therapy is used. With signs of heart failure, cardiac glycosides are prescribed - strophanthin, as well as sulfacamphocaine.

Immunotherapy agents are also used.

In the treatment of pneumonia, symptomatic and syndromic therapy is performed. In the recovery period, breathing exercises and physiotherapeutic methods of treatment are of great importance.

To improve the drainage function of the bronchi, agents are used that increase the secretion of sputum or dilute it.

Table Properties of the main expectorant (Pariskaya G.V., Orekhova N.G., 2000)

Name Secretological Secretory motor
Sodium Benzoate ++ -
Ammonium chloride + +++
Potassium iodite +++ +
Bromhexine ++ -
Terpinghydrate ++ ++
Thermopsis + -
N-acetylcystine +++ -
Mukaltin ++ -
Pertusin + +
Althea root - +
Licorice root - +
Elixir of the chest - +
Anise fruit - -
Coltsfoot Leaves - +
Apply drugs that reduce bronchospasm. These include aminophylline.

The prognosis for the timely use of antibiotic therapy is favorable. Discharged from the hospital during the period of clinical recovery are taken to the dispensary. After discharge from the hospital for 2-4 weeks, the child should not attend child care facilities. Children under six months of age are examined once a week, then twice a month; from six to twelve months - once every ten days during the first month, then once a month. After one year to three years, once every first month, then once every three months. Children are examined by an otolaryngologist and a pulmonologist after three years of age - a month after discharge from the hospital, then once a quarter.

Optimal is rehabilitation in hospital departments or in sanatoriums.

The mode is assigned with the maximum use of fresh air.

Daily breathing exercises, exercise therapy with a gradual increase in physical activity are prescribed.

Nutrition should be rational for the appropriate age.

Drug rehabilitation is carried out according to individual indications. Stimulating therapy is carried out by repeated 2-3-week courses: sodium nucleanate, methyluracil, dibazole, ginseng, aloe, infusion eleutherococcus, vitamins

B1, B6, B15, C.

For this purpose phytotherapy is also used. It is used for sanitation of the bronchi and a calming effect on the central nervous system: marshmallow root, peppermint leaf, sage grass, elecampane root, coltsfoot, lime blossom, pine buds, thyme, etc. In children prone to allergic reactions, applied with great care.

Physiotherapy is widely used. Mustard, alkaline and phyto-inhalations, compresses, ozocerite applications on the chest are used.

Chest massage is widely used.

After pneumonia, sanatorium treatment is recommended in local sanatoriums, as well as in the resorts of Gagra, Nalchik, Gelendzhik, New Athos, and the southern coast of Crimea.

Contraindications to sanatorium treatment are:

1) the activity of the inflammatory process in the broncho-pulmonary system;

2) signs of an asthmatic condition;

3) the presence of a "pulmonary heart".

Primary prevention includes a healthy lifestyle of parents, eliminating the effects of harmful effects on the fetus during pregnancy, rational feeding of children, tempering procedures.

Secondary prevention includes:

1) prevention and treatment of acute respiratory infections;

2) early hospitalization of children with pneumonia in children with a burdened premorbid background;

3) timely treatment of malnutrition, rickets, immunodeficiency states;

4) rehabilitation of chronic foci of infection.

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Inflammation of the lungs (pneumonia)

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