Pneumonia (peds) - Revision history

Ostermayer at 17:13, 17 January 2026

2026-01-17T17:13:49Z

← Older revision		Revision as of 17:13, 17 January 2026
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	{{~~Peds top~~}} ~~[[pneumonia]]~~		{{PediatricPage\|pneumonia}}
	==Background==		==Background==
	[[File:Number of deaths from pneumonia in children under 5, OWID.svg\|thumb\|Death rates from pneumonia in children under 5 (2017).]]		[[File:Number of deaths from pneumonia in children under 5, OWID.svg\|thumb\|Death rates from pneumonia in children under 5 (2017).]]

Modanq: /* Diagnosis */ Added finding of "round pneumonia"

2025-07-19T18:45:26Z

Diagnosis: Added finding of "round pneumonia"

← Older revision		Revision as of 18:45, 19 July 2025
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	**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)		**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
	**May have negative CXR early in disease or in cases of dehydration; infiltrate may "blossom" after providing rehydration and repeat imaging<ref>Feldman C. Pneumonia in the elderly. Clin Chest Med. 1999;20(3):563-573. doi:10.1016/s0272-5231(05)70236-7</ref>		**May have negative CXR early in disease or in cases of dehydration; infiltrate may "blossom" after providing rehydration and repeat imaging<ref>Feldman C. Pneumonia in the elderly. Clin Chest Med. 1999;20(3):563-573. doi:10.1016/s0272-5231(05)70236-7</ref>
			**Well-circumscribed round/oval opacity (“round pneumonia”), usually in a posterior lower-lobe segment of children < 8 y; mimics a mass but clears with antibiotics
	**Absence of CXR findings does not preclude diagnosis; high clinical suspicion with adventitious breath sounds can be consistent with pneumonia despite negative imaging		**Absence of CXR findings does not preclude diagnosis; high clinical suspicion with adventitious breath sounds can be consistent with pneumonia despite negative imaging
	**Immunocompromised patients may not manifest radiographic evidence of pneumonia despite suggestive clinical findings		**Immunocompromised patients may not manifest radiographic evidence of pneumonia despite suggestive clinical findings

Rossdonaldson1 at 23:05, 13 December 2023

2023-12-13T23:05:17Z

← Older revision		Revision as of 23:05, 13 December 2023
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	[[File:CT scan of the chest, demonstrating right-sided pneumonia.jpg\|thumb\|CT chest showing right sided pneumonia]]		[[File:CT scan of the chest, demonstrating right-sided pneumonia.jpg\|thumb\|CT chest showing right sided pneumonia]]
	[[File:PNA_US.gif\|thumb\|Hepatization of the lung and dynamic air bronchograms present in patient with LLL pneumonia. Source: POCUS Atlas]]		[[File:PNA_US.gif\|thumb\|Hepatization of the lung and dynamic air bronchograms present in patient with LLL pneumonia. Source: POCUS Atlas]]
	==Workup==		===Workup===
	===Likely Outpatient===		====Likely Outpatient====
	*Imaging		*Imaging
	**[[CXR]], consider for:		**[[CXR]], consider for:
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	**[[Influenza]]		**[[Influenza]]

	===Sick/Likely Inpatient===		====Sick/Likely Inpatient====
	''Above plus:''		''Above plus:''
	*CBC		*CBC
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	**Clinical judgement ''plus'' radiographic evidence alone should guide therapy (strong recommendation, moderate quality of evidence)		**Clinical judgement ''plus'' radiographic evidence alone should guide therapy (strong recommendation, moderate quality of evidence)

	==Diagnosis==		===Diagnosis===
	*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity		*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
	*[[CXR]]		*[[CXR]]
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	**Sensitivity 82% and specificity 94% (adults)<ref>Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis. J Emerg Med. 2019;56(1):53-69. doi:10.1016/j.jemermed.2018.09.009</ref>		**Sensitivity 82% and specificity 94% (adults)<ref>Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis. J Emerg Med. 2019;56(1):53-69. doi:10.1016/j.jemermed.2018.09.009</ref>

	==~~Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>~~==		==Management==
	{{Pediatric pneumonia treatment}}		{{Pediatric pneumonia treatment}}

Rossdonaldson1: /* Background */

2023-12-13T22:06:02Z

Background

← Older revision		Revision as of 22:06, 13 December 2023
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	==Background==		==Background==
	[[File:Number of deaths from pneumonia in children under 5, OWID.svg\|thumb\|Death rates from pneumonia in children under 5 (2017).]]		[[File:Number of deaths from pneumonia in children under 5, OWID.svg\|thumb\|Death rates from pneumonia in children under 5 (2017).]]
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	*Most common site of infection in neonates		*Most common site of infection in neonates

Rossdonaldson1: /* Background */

2023-12-13T21:06:02Z

Background

← Older revision		Revision as of 21:06, 13 December 2023
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	{{Peds top}} [[pneumonia]]		{{Peds top}} [[pneumonia]]
	==Background==		==Background==
			[[File:Number of deaths from pneumonia in children under 5, OWID.svg\|thumb\|Death rates from pneumonia in children under 5 (2017).]]
	*Most common site of infection in neonates		*Most common site of infection in neonates

Rossdonaldson1: /* Evaluation */

2023-12-13T20:55:42Z

Evaluation

← Older revision		Revision as of 20:55, 13 December 2023
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	==Evaluation==		==Evaluation==
	*Absence of ~~tachypnea~~, ~~respiratory distress~~, and ~~rales/decreased breath sounds rules-out~~ with ~~100% sensitivity~~		[[File:PneumonisWedge09.jpg\|thumb\|[[CXR]] showing prominent wedge-shape area of airspace consolidation in the right lung, characteristic of bacterial [[pneumonia]].]]
			[[File:CT scan of the chest, demonstrating right-sided pneumonia.jpg\|thumb\|CT chest showing right sided pneumonia]]
			[[File:PNA_US.gif\|thumb\|Hepatization of the lung and dynamic air bronchograms present in patient with LLL pneumonia. Source: POCUS Atlas]]
			==Workup==
			===Likely Outpatient===
	*Imaging		*Imaging
	**[[CXR]] ~~is not the gold standard!~~		**[[CXR]], consider for:
	**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
	**Consider for:
	***Age 0-3mo (as part of sepsis workup)		***Age 0-3mo (as part of sepsis workup)
	***<5yr with temperature >102.2, WBC >20K and no clear source of infection		***<5yr with temperature >102.2, WBC >20K and no clear source of infection
	***Ambiguous clinical findings		***Ambiguous clinical findings
	***Pneumonia that is prolonged or not responsive to antibiotics		***Pneumonia that is prolonged or not responsive to antibiotics
	*Consider rapid assays ~~for~~ [[RSV]], [[~~influenza~~]]		*Consider rapid assays:
			**[[Covid-19]]
			**[[RSV]]
			**[[Influenza]]

			===Sick/Likely Inpatient===
			''Above plus:''
			*CBC
			*Chemistry
	*Blood/nasal culture are low yield		*Blood/nasal culture are low yield
	**in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion <ref> Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19. </ref>		**In prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion <ref> Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19. </ref>
	**consider for sicker ones, those with effusions		**consider for sicker ones, those with effusions
			*IDSA does ''not'' support using initial serum [[procalcitonin]] levels to determine whether empiric antibiotics should be initiated.
			**Clinical judgement ''plus'' radiographic evidence alone should guide therapy (strong recommendation, moderate quality of evidence)

			==Diagnosis==
			*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
			*[[CXR]]
			**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
			**May have negative CXR early in disease or in cases of dehydration; infiltrate may "blossom" after providing rehydration and repeat imaging<ref>Feldman C. Pneumonia in the elderly. Clin Chest Med. 1999;20(3):563-573. doi:10.1016/s0272-5231(05)70236-7</ref>
			**Absence of CXR findings does not preclude diagnosis; high clinical suspicion with adventitious breath sounds can be consistent with pneumonia despite negative imaging
			**Immunocompromised patients may not manifest radiographic evidence of pneumonia despite suggestive clinical findings
			**Clinical and radiographic findings do not necessarily correspond: the patient may be improving clinically despite having a worsening appearance on the CXR
			*[[Ultrasound]]
			**Can be considered as an alternative to CXR
			**Sensitivity 82% and specificity 94% (adults)<ref>Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis. J Emerg Med. 2019;56(1):53-69. doi:10.1016/j.jemermed.2018.09.009</ref>

	==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==		==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==

Rossdonaldson1: /* Differential Diagnosis */

2020-07-01T16:18:50Z

Differential Diagnosis

← Older revision		Revision as of 16:18, 1 July 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Pediatric fever DDX}}		{{Pediatric fever DDX}}
			{{Pediatric SOB DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 18:11, 18 May 2020

2020-05-18T18:11:35Z

← Older revision		Revision as of 18:11, 18 May 2020
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			{{Peds top}} [[pneumonia]]
	==Background==		==Background==
	*Most common site of infection in neonates		*Most common site of infection in neonates

Rossdonaldson1: /* References */

2020-04-05T19:31:39Z

References

← Older revision		Revision as of 19:31, 5 April 2020
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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:ID]]		[[Category:ID]]
	[[Category:~~Pulmonology~~]]		[[Category:Pulmonary]]

ClaireLewis: /* References */

2019-10-06T19:57:37Z

References

← Older revision		Revision as of 19:57, 6 October 2019
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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:ID]]		[[Category:ID]]
			[[Category:Pulmonology]]