Department of Pediatrics, Dr R.M.L. Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
Indian J Pediatr. 2023 Jul;90(7):693-699. doi: 10.1007/s12098-023-04628-3. Epub 2023 May 19.
Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.
儿童肺炎仍然是一个重大的临床和公共卫生问题。印度因肺炎导致的死亡人数最多，占五岁以下儿童全球死亡率的约 20%。包括细菌、病毒和非典型病原体在内的各种病原体可导致儿童肺炎。最近的研究表明，病毒是儿童肺炎的主要病因之一。在病毒中，呼吸道合胞病毒受到了极大的关注，最近的几项研究报告称其是导致肺炎的重要病原体。缺乏头 6 个月的纯母乳喂养、补充喂养开始和内容不当、贫血、营养不良、因吸烟造成的室内污染以及使用煤和木柴做饭以及缺乏疫苗接种都是重要的危险因素。胸部 X 线通常不用于诊断肺炎，而越来越多地使用肺部超声来检测实变、胸腔积液、气胸和肺水肿（间质性综合征）。C 反应蛋白 (CRP) 和降钙素原的作用相似，可用于区分病毒和细菌性肺炎，但抗生素的使用时间最好根据降钙素原来指导。需要评估新的生物标志物如 IL-6、前降钙素和髓样细胞表达的触发受体 1，以评估其在儿童中的应用。缺氧与儿童肺炎明显相关。因此，应鼓励使用脉搏血氧饱和度仪来早期发现和及时治疗缺氧，以防止不良后果。在评估儿童因肺炎导致死亡风险的现有工具中，PREPARE 评分是最好的，但需要进行外部验证。
