Dr Amita Pandey's presents on childhood pneumonia

7/24/2019 Dr Amita Pandey's presents on childhood pneumonia

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Dr Amita Pandey

Professor, Deptt of Obs & Gyn,

K G Medical University, Lucknow


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Statistics

Pneumonia & diarrhoea are the greatest killers ofchildren under 5 globally accounting for one in fourdeaths

Incidence of pneumonia in children under five isestimated to be about 156 million new episodes eachyear worldwide, of which 151 million are in thedeveloping countries

With 2,97,114 deaths, India tops of the list of thesecountries

WHO estimates that death due to pneumoniaoccurs in 1 in 3 cases


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Mortality due to childhood

pneumonia

Strongly linked to

- malnutrition- poverty

- inadequate access to health care

In India disease more frequently seen in rural andurban poor


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Types of Neonatal Pneumonia

Infective

- GBS

- Hemophilus influenzae- Enterococci

- Other Gram negative cocci

- Staph aureous

Non-infective- Diffuse alveolar damage

- Non-specific interstitial pneumonia

- Aspiration


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Source of Infection in Neonates

Trans-placental

Acquired during pregnancy from overt or subclinical maternalinfection

Intra-partum/ AscendingAcquired during delivery by passage through an infected birthcanal or by ascending infection if delivery is delayed afterrupture of membranes

Post-partum

Acquired after delivery from contact with an infected motherdirectly (eg, TB ) or through breastfeeding (eg, HIV, CMV) orfrom contact with health care practitioners & hospitalenvironment


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Risk factors for Neonatal Pneumonia Preterm labor

PROM > 18 hrs

Chorio-amnionitis in mother Maternal genito-urinary infection

Recurrent maternal urinary tract infection

Antenatal infections in mother known to transmittransplacentally


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Other contributing factors Malnutrition

Vitamin deficiency

Illiteracy of mothers resulting in unhygienic & unhealthypractices

Unhygienic living spaces

Bad health planning

Low budgetary allocation for health


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Neonatal Pneumonia- Pathophysiology

Limited defense in fetus leads to early dissemination of

infection

Infection causes infiltration & destruction ofbronchopulmonary tissue

Fibrinous exudation into alveoli leads to inhibition of

pulmonary surfactant function & respiratory failure

Presentation very similar to respiratory distress syndrome(RDS) & differentiating the two in a premature baby can

be very difficult


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Types of Neonatal Pneumonia

Early onset (3 days)

Usually acquired from the

environment

More likely in preterm

infants, particularly those

with prolonged

hospitalization & use of IVcatheters


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Signs & Symptoms

Elevated respiratory rate

Retraction

Grunting

Nasal flaring

Poor feeding

Abdominal distention

Increased secretion in airways

Central cyanosis


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Investigations

CBC

Chest X-ray

Blood culture

Inflammation markers- CRP, cytokines

Arterial blood gases


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Goals of Therapy Eradicate infection

Provide adequate support of gaseous exchange to ensure

survival and well being of infant

Decrease long lasting lung changes that adversely affect

lung function, quality of life & susceptibility to future

infections

Parenteral nutritional support


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Morbidity following Neonatal

Pneumonia Chronic lung disease

Prolonged need for respiratory support

Childhood otitis media

Reactive airway disease

Severity of subsequent childhood respiratory infections


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Mortality following Neonatal Pneumonia Mortality rate of early-onset sepsis is 3 to 40%

Mortality of late-onset sepsis is 2 to 20% (that of late-

onset GBS is about 2%)

Fatality rate is 2 to 4 times higher in LBW infants than in

full-term infants

Extremely LBW infants who develop sepsis have a

significantly greater risk of poor

outcome


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Prevention and Control of Pneumonia

Vaccination (Streptococcus pneumoniae & HIB)

Access to care & use of antibiotics- appropriate facility for

case management in CHC

Exclusive breastfeeding for first 6 months of life

Control of indoor air pollution and provision of a healthy

environment

Prevention of exposure to tobacco smoke

Educate parents about hand washing & prevention of

future exposure

Longitudinal surveillance with future problems


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(contd.)

Improvement in maternal nutrition & prevention of lowbirth weight

Aggressive management of preterm labor Consider intrapartum chemoprophylaxis in mothers at

risk for GBS infection

Antepartum & intrapartum antibiotics in mothers with

PROM & chorioamnionitis Prevention and management of HIV infection

In case of meconium aspiration, suction of tracheaimmediately after birth


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(contd.) Proper care of infant

Pneumococcal & infuenza immunization

Immunoglobulins


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Thank you

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Dr Amita Pandey's presents on childhood pneumonia