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1、Topicsv Respiratory disordersv Respiratory infectionsv PneumoniaRespiratory Disordersv50% of consultation with general practitioners or acute illness in young children and a third of consultations in older childrenv20-35% of acute pediatric admissions to hospital, some of which are life-threateningv
2、Asthma is the most common chronic illness of childhoodvCystic fibrosis is the most common inherited disorder in Caucasians causing chronic diseaseRespiratory Infectionsv The most frequent infections of childhood: 6-8/yearv Pathogens:viruses,bacterial, other pathogensv Host and environmental factorsv
3、 Classification of respiratory infectionsClassification of Respiratory InfectionsAccording to the level of the respiratory tree most involved:v Upper respiratory tract infectionv Lower respiratory tract infectionPneumoniaEnmei Liu Childrens Hospital, CMUCase -1Jack, age four months, is sent at home
4、by his general practitioner because of two days of rapid, laboured breathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was discharged home at three months of age. On examination he was a fever of 37.4C and a respiratory rate of 60 breaths/min. His chest is hyperinfla
5、ted with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes. QuestionDo you have any comments or what do you conclude anything from this case?Case -1Jack, age four months, is sent at home by his general practitioner because of two days of rapid, laboured br
6、eathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was discharged home at three months of age. On examination he was a fever of 37.4C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are gene
7、ralized fine crackles and wheezes. QuestionWhat is pneumonia? Pneumonia is an inflammation of the parenchyma of the lungs. DefinitionQuestionHow about the prevalence of pneumonia?v Pneumonia accounts for approximately 15% of all respiratory tract infections. v Worldwide, about 3 million children die
8、 each year from pneumonia, with the majority of these deaths occurring in developing countries.v Pneumonia remains the most common cause of morbidity in China.IncidenceQuestionHow to classify pneumonia in clinic?v Anatomy v Pathogens v Severity v Duration v Onset siteClassificationv Bronchopneumonia
9、v Lobar or Lobular Pneumoniav Interstitial PneumoniaBased on anatomy or X-ray manifestation Based on etiologyv Bacterial pneumoniav Viral Pneumoniav Mycoplasma Pneumoniav Chlamydia Pneumoniav Acute Pneumoniav Prolonged Pneumoniav Chronic PneumoniaBased on the process of pneumoniav Mild Pneumoniav Se
10、vere PneumoniaBased on the severity of pneumoniav Community Acquired Pneumonia (CAP)v Hospital Acquired Pneumonia (HAP)Based on the onset site of pneumoniaBronchopneumoniaQuestionWhy are children likely have bronchopneumonia?v Characters of childhood airway anatomic structure and their respiratory p
11、hysiologyv Immune function of childhoodv High risk factors: premature baby, underlying disordersQuestionWhat cause bronchopneumonia? Bacteria: Streptococcus pneumoniae, Haemophilus influenzae Viruses MycoplasmaCauses of BronchopneumoniaPathology of PneumoniaInflammaory exudateInflammaory exudatePath
12、ology of PneumoniaQuestionWhat are the pathophysiology of pneumonia?PathogensURTIBronchitisPneumoniaInflammatory exudateObstruction of airwayGas exchange abnormalVentilation abnormalhypoxemiahypercapniatoxinemiatachypneacyanosisralesfevercoughQuestionWhat are the signs and symptoms of pneumonia? The
13、 clinical signs and symptoms of pneumonia depend primarily on the age of the patient, the causative organism, and the severity of the disease. FeverCoughCyanosisTachypeneaRalesout breathing inWith inspiration, the side of the nostrils flares outwardsNasal FlaringWith inspiration, the lower chest wal
14、l moves inLower Chest Wall Indrawingout breathing inFeverCoughCyanosisTachypeneaRalesv Classic findings of pneumonia that occur in adults and older children, such as fever,cough and rales, are often absent in infants and toddlers. v Generally present with nonspecific signs and symptoms including let
15、hargy, irritability, poor feeding, vomiting.v If it appear respiratory failure or other abnormality of other system-severe pneumonia. Important PointsComplicationsv Empyemav Pyopneumothoraxv Pneumatocele v Lung abscesses v AtelectasisLaboratory Examination v White blood cell count and C-reaction pro
16、teinv Pathogens examination:1)Sputum cultures 2)Blood cultures 3)Rapid screening tests for virus or bacterialv Bronchoscopyv Blood gas analysis: hypoxia and/or hypercapniaRadiograph Evaluation v Typical X-ray manifestation of bronchopneumonia is patchy infiltrates bilaterallyv Complication: lung abscesses, empyema, pyopneumothorax, pneumatocele, atelectasisv CT Normal chest X-rayPa
