Dr Siti Aishah Saidin

Pakar kanak kanak dan Remaja

Jabatan Pediatrik
Hospital Raja Permaisuri Bainun
Ipoh ,Perak, Malaysia

3/30/2019
• A clinical syndrome
barking cough,
inspiratory stridor,
hoarse voice and respiratory distress of varying severity.
• inflammation of the larynx, trachea and bronchi
• The most common pathogen
parainfluenza virus (74%), (types 1, 2 and 3).
The others are Respiratory Syncytial Virus,
Influenza virus types A and B,
Adenovirus, Enterovirus,
Measles, Mumps and Rhinoviruses
Mycoplasma pneumoniae
Corynebacterium Diptheriae.
 • Low grade fever,
 cough and coryza for 12-72 hours,
 followed by: • Increasingly bark-like cough and
hoarseness.
 • Stridor that may occur when excited, at rest or
both.
 • Respiratory distress of varying degree.
 • Croup is a clinical diagnosis.
 • Mild:
 Stridor with excitement or at rest, with no
respiratory distress.
 • Moderate:
 Stridor at rest with intercostal, subcostal or sternal
recession.
 • Severe:
 Stridor at rest with marked recession, decreased air
entry and altered level of consciousness.
 Indications for Hospital admission
 • Moderate and severe viral croup.
 • Age less than 6 months.
 • Poor oral intake.
 • Toxic, sick appearance.
 • Family lives a long distance from hospital;
lacks reliable transport.
 Mild
 Outpatient
 Dexamethasone 0.15mg/kg
Or prednisolone 1-2mg/kg
Or nebulised Budesonide 2 mg
 Moderate
 Inpatient
 Dexamethasone (0.3-0.6 mg/kg)
And/Or nebulised Budesonide 2 mg stat and 1mg 12hrly

No improvement
Nebuised Adrenaline 0.5mls/kg (1:1000)
 Severe
 inpatient
 Nebuised Adrenaline 0.5mls/kg (1:1000)
 Dexamethasone (0.3-0.6 mg/kg)
 Nebulised Budesonide 2 mg stat and 1mg 12hrly
 Oxygen

No improvement
Intubate and ventilate
 clinical definitions of pneumonia:
 • 1) Bronchopneumonia
 • 2) Lobar pneumonia:
 Aetiology
 • The majority of lower respiratory tract
infections are viral in origin,
 e.g. Respiratory syncytial virus,
 Influenza A or B,
 Adenovirus, Parainfluenza virus.
 Newborns
 Group B streptococcus, Escherichia coli, Klebsiella
species, Enterobacteriaceae
 Infants 1- 3 months
 Chlamydia trachomatis
 Preschool age
 Streptococcus pneumoniae, Haemophilus influenzae
type b, Staphylococcal aureus
 Less common: Group A Streptococcus, Moraxella
catarrhalis, Pseudomonas aeruginosa
 School age
 Mycoplasma pneumoniae, Chlamydia pneumoniae
 Age < 2 months
 Severe Pneumonia
 • Severe chest indrawing
 • Tachypnoea
 Very Severe Pneumonia
 • Not feeding
 • Convulsions
 • Abnormally sleepy, difficult to wake
 • Fever, or Hypothermia
 Mild Pneumonia
 • Tachypnoea
 Severe Pneumonia
 • Chest indrawing
 Very Severe Pneumonia
 • Not able to drink
 • Convulsions
 • Drowsiness
 • Malnutrition
 Tachypnoea is defined as follows :
 < 2 months age: > 60 /min
 2- 12 months age: > 50 /min
 12 months – 5 years age: > 40 /min
 FBC
 CXR
 Serology
 Blood C&S
 Criteria for hospitalization
 • Community acquired pneumonia can be
treated at home
 • Identify indicators of severity in children
who need admission, as pneumonia can be
fatal.
 • Children aged 3 months and below,
 whatever the severity of pneumonia.
 • Fever ( more than 38.5 ⁰C ), refusal to feed and vomiting
 • Fast breathing with or without cyanosis
 • Associated systemic manifestation
 • Failure of previous antibiotic therapy
 • Recurrent pneumonia
 • Severe underlying disorder, e.g. Immunodeficiency
 Streptococcus pneumonia Penicillin, cephalosporins
 Haemophilus influenzae type b Ampicillin,
chloramphenicol, cephalosporins
 Staphylococcus aureus Cloxacillin
 Group A Streptococcus Penicillin, cephalosporin
 Mycoplasma pneumoniae Macrolides, e.g.
erythromycin, azithromycin
 Chlamydia pneumoniae Macrolides, e.g.
erythromycin, azithromycin Bordetella pertussis
Macrolides, e.g. erythromycin, azithromycin
 Antibiotics For children with severe
pneumonia,
 First line Beta-lactams: Benzylpenicillin, moxycillin,
ampicillin, amoxycillin-clavulanate
 Second line Cephalosporins: Cefotaxime,
cefuroxime, ceftazidime Third line Carbapenem:
Imipenam Other agents Aminoglycosides:
Gentamicin, amikacin
 • It is a result of localized bronchiolar and
alveolar necrosis. • Aetiological agents are
bacteria, e.g. Staphylococcal aureus, S.
Pneumonia, H. Influenza, Klebsiella
pneumonia and E. coli. • Give IV antibiotics
until child shows signs of improvement. •
Total antibiotics course duration of 3 to 4
weeks. • Most pneumatocoeles disappear, with
radiological evidence resolving within the first
two months but may take as long as 6 months
 • Fluids
 • Withhold oral intake when a child is in
severe respiratory distress.
 • In severe pneumonia, secretion of anti-
diuretic hormone is increased and as such
dehydration is uncommon. Avoid
overhydrating the child.
 • Oxygen
 • Cough medication
 Not recommended
 • In children with mild pneumonia, their breathing
is fast but there is no chest indrawing.
 • Oral antibiotics can be prescribed.
 • Educate parents/caregivers about management of
fever, preventing dehydration and identifying signs
of deterioration.
 • The child should return in two days for
reassessment, or earlier if the condition is getting
worse.