UMEM Educational Pearls

Title: Pediatric Pneumonia (submitted by Connor Lundy, MD)

Posted: 3/29/2013 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

You have diagnosed an infant or child with pneumonia. How do you decide if they need admission?

The Pediatric Infectious Disease Society and the British Thoracic Society each have guidelines from 2011 to help with this decision.

The Pediatric Infectious Disease Society recommend inpatient therapy for the following

1) oxygen saturation <90%

2) infants less than 3-6 months of age with bacterial infection being the likely etiology

3) pneumonia from suspected or documented virulent pathogen such as CA-MRSA

4) children in whom home care is questionable, outpatient follow-up is not available or who cannot comply with outpatient therapy

The British Thoracic Society identify risk factors likely to require hospitalization:

1) oxygen saturation <92%

2) respiratory rate > 70 breaths/min (>50 breaths/min in older children)

3) significant tachycardia for level of fever

4) prolonged capillary refill time > 2 seconds

5) breathing difficulty

6) intermittent apnea or grunting

7) not feeding or signs of dehydration

8) chronic medical conditions/comorbidities

References:

"The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines bythe Pediatric Infectious Diseases Society and the Infectious Diseases Society of America"

http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2011%20CAP%20in%20Children.pdf

"Guidelines for the management of community acquired pneumonia in children: update 2011" BTS

http://www.brit-thoracic.org.uk/Portals/0/Guidelines/Pneumonia/CAP%20children%20October%202011.pdf