B
COMMON PAEDIATRIC CONDITIONS
Pneumonia
Pneumonia is secondary to infection and inflammation of the lung parenchyma and may result in the appearances of consolidation on the chest X-ray as shown in the image here. It can be localised or widespread. Clinical findings include reduced air entry on the affected side, crackles and bronchial breathing. The patient is likely to have pyrexia and raised inflammatory markers.
Figure: Right lower zone air space shadowing with loss of the right heart border consistent with a right middle lobe pneumonia.
Pneumonia is secondary to infection and inflammation of the lung parenchyma and may result in the appearances of consolidation on the chest X-ray as shown in the image here. It can be localised or widespread. Clinical findings include reduced air entry on the affected side, crackles and bronchial breathing. The patient is likely to have pyrexia and raised inflammatory markers.
Chest X-ray findings:
- Consolidation, air bronchograms
- Associated pleural effusion
Treatment:
- Antibiotics (usually oral) and oxygen if hypoxic
- If the patient is septic then the ‘sepsis six’ protocol should be followed (see Circulation Chapter)
Asthma
Asthma causes inflammation and bronchoconstriction of the airways leading to a narrowed bronchial lumen. A reduced peak expiratory flow rate (PEFR) is usually present. Acute exacerbations of asthma present with respiratory distress, tachypnoea, tachycardia, and widespread wheeze.
Chest X-ray findings:
- Usually hyperinflation, but often no other specific findings, consider whether pneumothorax or infection is present
Treatment:
- High flow oxygen
- Bronchodilation
- Salbutamol and Ipratropium bromide nebulised - dose varies with age (can be back to back if not improving)
- In acute exacerbation of asthma, bronchodilatation can be achieved either using metered dose inhaler with a spacer device or via oxygen derived nebuliser. Different sizes and types of spacers are used depending upon age of the child.
- Prednisolone 1mg/kg or intravenous hydrocortisone 4mg /kg should be added to treat the inflammation
- If the patient doesn’t improve after these measures call senior help urgently. They may be considered for intravenous magnesium sulphate, aminophylline or salbutamol.
