0071643192.pdf

PEDIATRICS

■ Rust-colored sputum:S. pneumoniae

■ Bullous myringitis:M. pneumoniae

■ Rales: Alveolar fluid

■ Bronchial breath sounds: Consolidation

■ Dullness to percussion/decreased breath sounds: Pleural effusion

■ Wheezing/rhonchi: Bronchial congestion

DIAGNOSIS

■ Mainly still a clinical diagnosis

■ CXR helpful for confirmation

■ Bacterial pneumonia classically presents with focal or unilobar infiltrates.

■ Strep pneumonia is associated with round infiltrates.

■ Elevated WBC > 15,000 cells/mL.

■ Elevated CRP is associated with bacterial pneumonia.

TREATMENT

■ Antibiotics: Traditionally penicillins or cephalosporins are prescribed.

Macrolides (erythromycin, clarithromycin or azithromycin) should be

given if there is concern of an atypical pneumonia. Fluoroquinolones

(such as levofloxacin or gatifloxacin) are also effective for older patients

and patients with cystic fibrosis.

■ Any child discharged with the diagnosis of pneumonia should be reevalu-

ated in 24–48 hours to ensure appropriate response to therapy.

COMPLICATIONS

■ Bacteremia, with risk of developing 2° infections, such as meningitis or

septic arthritis

■ Empyema

■ Respiratory failure

■ Apnea, particularly in infants

SUDDEN INFANT DEATH SYNDROME

■ SIDS is the unexplained death of an infant under the age of 1 year.

■ Peak incidence is ages 2–5 months.

■ 90% of all cases occur in infants before the age of 6 months.

SYMPTOMS/EXAM

Infant is typically found lifeless in crib.

DIFFERENTIAL

The etiology of SIDS is unclear. Some evidence suggests SIDS may be

related to apnea, accidental suffocation, or an immature ability to respond to

noxious stimuli (such as rising serum CO 2 and falling serum O 2 ). Fewer than

5% of cases are thought to be due to child abuse.

RISKFACTORS

■ Sleeping in prone position

■ Mother who smokes (during pregnancy or postnatally)