Pneumonia in a child. Consequences and complications of pneumonia in children The most frequent complication of acute pneumonia in children

Inflammation of the lungs is a serious infectious disease that is quite common in young patients. At the modern level of pharmacology, this diagnosis does not sound so threatening. However, the severity of the disease cannot be underestimated, especially if pneumonia is diagnosed in young patients. In children, inflammation often develops very quickly, and this is a direct path to lightning-fast complications. The consequences of pneumonia in children can be severe and even fatal. To prevent this from happening, treatment of children should be started immediately.

Pneumonia in a child

Manifestation of the consequences of pneumonia in children

The defeat of a small part of the lung tissue is always easier than childhood bilateral pneumonia. With a favorable course of pathology and optimal treatment, simple pneumonia is completely cured in a month without any consequences.

Pneumonia differ from each other depending on the type of damage to the body by infectious agents (viruses, bacteria, pathogenic fungi), as well as on the area of inflammation:

focal;
left-sided;
right-sided;
croupous;
segmental;
drain.

Focal and lobar pneumonia

With focal viral pneumonia, only single foci of lesions up to 1 cm in size are formed, and with drainage inflammation, several foci are combined into one large one.

Parents should be wary of croupous, drainage and bilateral pneumonia, which do not pass without leaving a trace and can cause serious consequences. Atypical childhood pneumonia is difficult to treat, the disease is protracted, and antibiotics do not always save the situation. Also, acute purulent destructive pneumonia with the formation of massive foci of inflammation proceeds seriously with frequent complications.

Childhood complicated left-sided pneumonia is a serious concern for pediatricians. Due to poor blood circulation in the left bronchus, antibacterial and other necessary medications cannot fully reach the affected area of the lungs on the left. Thus, the therapy of pneumonia is delayed, and this is the cause of complications.

Varieties of complications

Timely diagnosis of pneumonia symptoms is an important factor in the prevention of possible problems with children's health. All known complications are observed in children both during the course of acute inflammation and after recovery. Pediatrics distinguishes between acute processes that are associated with complications, as well as remote consequences.

Immediate

Complications of pneumonia are observed either during treatment or within 2-3 weeks after recovery. These include:

Neurotoxicosis

Neurotoxicosis. This is an intoxication of the body, which affects the child's brain. Neurotoxicosis manifests itself in several stages. At first, the baby is too active, his emotions range from unreasonable laughter to crying and hysteria. Further, the child becomes inhibited, he loses his appetite, becomes lethargic and depressed. The next stage is even more dangerous: the child's temperature rises sharply, and convulsions begin, right up to respiratory arrest.
Waterhouse-Friederiksen syndrome. This complication also has the character of intoxication, manifests itself in a febrile state, often accompanied by problems with the respiratory system.

Chronic pneumonia is characterized by reduced immunity and frequent relapses of inflammatory processes in the respiratory system.

Delayed

The late consequences that appear in a child who has already had pneumonia include the following:

Pleurisy

Pleurisy. It is characterized by inflammation of the membrane of the lungs - the pleura. It is impossible to cure a child without surgical help.
Lung abscess. The problem manifests itself in the form of the formation of a purulent seal in the tissues of the lung.
Diuresis. Intoxication makes itself felt in the form of urination disorders.
Sepsis and septic shock. The most dangerous complications. Help is provided only in the intensive care unit or the intensive care unit.

The most dangerous complications

The most dangerous complications:

Many complications after pneumonia leave a mark for life and can even pose a serious threat to life. In the absence of treatment or improper therapy, the inflammatory process in young patients often spreads to other organs and is the cause of disturbances in the activity of the heart, gastrointestinal tract, central nervous system and urinary tract. Intoxication gradually captures the fragile organs of the child's body, which causes irreparable damage to the health of the baby, sometimes even death.

Inflammation of the lungs in premature babies

Pneumonia in premature babies, whose immunity is very weak, can occur as an independent pathology or as a complication of other diseases. Due to pneumonia, premature babies can develop both pulmonary and extrapulmonary complications to the same extent. Pulmonary includes: lung atelectasis, pleurisy, bronchopulmonary dysplasia and others. The most common extrapulmonary complications are anemia, rickets, heart and respiratory failure, and physical and mental retardation.

How to avoid complications

Since the most common causes of complications after pneumonia in children are reduced immunity or an advanced stage, complications can be avoided in the following ways:

in all ways to increase the immunity of the child. This is hardening, the correct daily routine, moderate physical activity, good nutrition;
timely clinical diagnosis of the disease;
timely treatment of infectious pathologies of the nasopharynx and other respiratory diseases, which often cause pneumonia and its complications;
strict adherence to all recommendations of the attending pediatrician.

To avoid complications, children with pneumonia under 1 year old are monitored and treated in a hospital, older children, depending on the course and type of disease, can be treated at home. The tendency to relapse of pneumonia and the appearance of complications necessarily require constant monitoring by a pediatrician and comprehensive treatment.

Signs of complications of pneumonia in children can appear both during the course of this disease, and some time after the onset of a period of relative improvement. There are immediate acute complications of pneumonia in children and long-term consequences. The latter can remind of themselves with various calcifications, strands and lime deposits throughout the subsequent life of a person. Therefore, the treatment of pneumonia in children should be approached responsibly. It is also necessary to take adequate medical measures at the first signs of complications of pneumonia. Acute respiratory and heart failure, arising as a complication, can lead to the death of the child.

Respiratory failure- This is the most common type of complications in the course of any form of pneumonia in young and middle-aged children. Signs of complications of pneumonia in the form of respiratory failure are characteristic of this condition. These are shortness of breath, shallow breathing, blueness of the lips and nasolabial triangle, increased breathing rate.

There is a special classification of respiratory failure:

I degree- shortness of breath occurs with the usual physical activity;
II degree- shortness of breath with minor physical exertion;
III degree- significant shortness of breath at rest.

Classification of respiratory failure for young children:

I degree- shortness of breath, tachycardia during exercise (for babies, exercise is considered - breastfeeding, crying, excitement). The determined oxygen pressure in arterial blood is 80-65 mm Hg. Art .;

II degree- shortness of breath, tachycardia at rest, its significant increase during exercise. Minor cyanosis of the lips, blue discoloration of the limbs. Inflation of the wings of the nose, retraction of the intercostal spaces when breathing. The child is lethargic, irritable. The determined oxygen pressure in arterial blood is 65-50 mm Hg. Art .;

III degree- shortness of breath up to 80-100 respiratory movements per minute at rest. General cyanosis (bluish tint) of the skin, mucous membranes. Accessory muscles take part in the act of breathing. Encephalopathy (impaired consciousness) can develop against the background of oxygen starvation of the brain. The determined oxygen pressure is below 50 mm Hg. Art.

Treatment of complications after pneumonia in children

Treatment of complications after pneumonia in children begins with the elimination of symptoms of oxygen starvation and respiratory failure. There are general principles for the treatment of respiratory failure. They include: aerotherapy, oxygen therapy, maintaining free airway patency, improving the factors of blood movement along the bed of large and small vessels, transporting oxygen from the lungs to tissues, improving the function of tissue respiration, eliminating violations of the oxygen-alkaline balance.

Aerotherapy- oxygen therapy through a nasal catheter, which is inserted into the lower nasal passage. In this case, the child receives 25-35% of the required amount of oxygen. Oxygen should be given continuously for 2-10 hours.

Maintaining airway patency - improving the drainage function of the bronchi. To do this, use mucolytics (drugs that thin phlegm). To improve intravascular circulation, 2.4% aminophylline is used in a solution for intravenous injection at a dose of 0.1 ml / kg to children under 1 year of age, 1 ml for each subsequent 1 year; xanthinol nicotinate, warm-moist inhalation.

To improve hemodynamics, the use of cardiac glycosides (strophanthin or korglikon) is allowed. Strofantin - 0.05% for children in the age group up to 1 year in a single dose of 0.1-0.15 ml, one or two injections per day are given intravenously in a 10% glucose solution slowly, from 1 year - at a dosage of 0.2 -0.4 ml for each year of the baby's life, depending on the severity of the condition, in a 10% glucose solution slowly.

In severe pneumonia in children, there is always a decrease in the function of using oxygen in the tissues. One of the main reasons for this is hypovitaminosis, therefore, in severe pneumonia with respiratory failure of the II-III degree, they resort to parenteral administration of vitamins. In case of toxic pneumonia, vitamins are administered intravenously as part of a glucose-vitamin complex: 20-30 ml of 10-20% glucose, 100-200 mg of ascorbic acid, 50-100 mg of cocarboxylase, 5-10 ml of 0.02% riboflavin solution. Cocarboxylase should not be administered in the same syringe with ascorbic acid.

Improving the function of tissue respiration is achieved by prescribing a complex of vitamins C, group B, E, PP.

Respiratory failure III and even II degree if a child has an abundant amount of sputum, which he cannot cough up himself, this is an indication for active cleaning of the trachea and bronchi. This procedure is performed against the background of muscle relaxation with short-acting relaxants, for example, seduxen (in young children). Intubation of the trachea is performed, followed by flushing it with isotonic sodium chloride solution (no more than 1 ml of solution is taken for 1 kilogram of the child's weight) with antibiotics. In recent years, prolonged catheter intubation has been widely used in these cases. It simplifies repeated sanitization and significantly reduces inflammatory lesions. As a result, a large content of carbon dioxide in the lungs is weakened with ventilation failure. To improve the patient's adaptation to the tracheal tube, sedatives are prescribed during the first day.

Treatment of complications of pneumonia in the heart

Cardiovascular insufficiency is the most common condition in children with severe pneumonia. If untreated, it can lead to the development of chronic processes of circulatory failure and endocarditis.

Lack of blood circulation- the state of the body, in which the circulatory system does not independently provide a full blood supply to organs and tissues.

Modern classification of the degrees of circulatory insufficiency:

I degree- shortness of breath, tachycardia appear only with physical exertion;
II-A degree- shortness of breath and tachycardia at rest, which significantly increase with exertion, slight enlargement of the liver, initial manifestations of congestion in the lungs, pastiness;
II-B degree- significant pronounced shortness of breath, tachycardia, enlarged liver, edema, decreased urine output;
III degree- irreversible changes in organs and tissues.

Manifestations of cardiovascular insufficiency in pneumonia in children can occur several hours after the onset of the disease. This is due to the developing intoxication and dehydration of the body. The clinic of acute heart failure is subdivided according to the degree of localization of the process:

A - acute right ventricular failure- development of stagnation, mainly in the systemic circulation. Symptoms: pale skin color with a bluish tinge, cyanosis of the nasolabial triangle, pasty skin of the face and swelling of the legs, shortness of breath, cough, tachycardia, enlarged heart, pain in the liver and its enlargement;
B - acute left ventricular failure.

There is a pulmonary increase in pressure, circulatory disorders in the vessels of the small circle, an increase in the permeability of the alveolar-capillary membranes, which leads to the development of pulmonary edema (increased shortness of breath, cyanosis, noisy breathing, bubbling, coughing with foamy sputum, weak pulse, low blood pressure). On auscultation, the heart sounds are muffled, there are a lot of moist rales in the lungs.

Acute vascular insufficiency with a decrease in pressure can be with insufficient adrenal function, toxicosis, dehydration, coma.

To relieve the symptoms of such a complication of pneumonia as cardiovascular failure, emergency therapy is required. All medical measures should be carried out quickly and only under the guidance of an experienced physician. Therapy for acute vascular insufficiency includes:

jet injection of prednisolone hydrochloride (2 mg / kg) or hydrocortisone (10-15 mg / kg);
administration of plasma, 5% albumin (10-20 ml / kg for 30-40 minutes);
if ineffective - intravenous drip dopamine (dopamine) at an initial dose of 8 or 10 mcg per kilogram of body weight and then (with increasing pressure) - 3-5 mcg per kilogram of body weight;
with blood pressure below 60 mm Hg. Art. artificial ventilation of the lungs is proposed.

In case of a deficiency in the supply of energy resources to the heart, panangin, potassium chloride, cocarboxylase, riboxin, "polarizing mixture" are added to therapy once a day
(a 10% glucose solution is taken at the rate of 10 ml per 1 kg of the child's weight and added for every 100 milliliters of a solution of 2 units of insulin and 4 milliliters of 7.5% potassium chloride in an injection solution, the mixture is injected intravenously).

In case of heart failure of the first degree, sufficient measures are - protective regimen, oxygen therapy, korglikon in combination with panangin and cocarboxylase, increased doses of ascorbic acid and pyridoxine hydrochloride.

In case of coronary insufficiency, neurovegetative blockade is performed with the obligatory use of papaverine and droperidol, cardiac glycosides are prescribed. Eufillin is contraindicated as a drug that increases the oxygen demand of the heart muscle. If necessary, its appointment should carefully evaluate the general condition of the sick child and the possible risks.

Comprehensive measures for the treatment of pulmonary edema:

oxygen therapy;
defoaming (inhalation for 30-40 minutes with a gas mixture containing vapors of 30% ethyl alcohol, antifomsilan);
airway maintenance (regular suction of the contents from the bronchial tree);
the appointment of antipsychotics;
the use of diuretics (intravenous furosemide at a dose of at least 2 mg / kg).

only in a hospital setting.

Pneumonia is one of the most dangerous diseases of the respiratory tract in children, which in some cases (as a rule, with delayed diagnosis or inadequately prescribed treatment) can lead to death, especially in newborns.

It is not so much to be afraid of pneumonia itself in children, its consequences and complications pose a much greater danger.

The consequences of pneumonia in children, both immediate and delayed, are extremely unfavorable.

Immediate complications

Such that arose in the first two days after the onset of the disease. These include:

Delayed complications of pneumonia

These include:

Diagnosis of complications

In addition to collecting complaints, anamnesis and assessing the objective status, data from additional instrumental or laboratory research methods are needed to diagnose complications of the disease. A (repeat) chest x-ray is mandatory. The presence of a rounded homogeneous shadow will indicate an abscess of the lung, a large darkening without clear contours in any of the sinuses will indicate an accumulation of pus (or effusion) in the pleura. The fluid level will indicate the presence of pyopneumothorax. An important analysis will be a general analysis of blood and urine. As a rule, with complications of pneumonia, there will be pronounced signs of the inflammatory process (leukocytosis, neutrophilia with a stab shift to the left, increased ESR).

In the presence of a generalized inflammatory response to systemic inflammation, it is necessary, first of all, dynamic monitoring of the state of vital organs - the heart, kidneys and brain. There should be dynamic control over such indicators as heart rate (pulse), blood pressure level, saturation (oxygen saturation level), respiratory rate. Hourly diuresis should be monitored. For complete clarity of the picture of renal failure, it is necessary to measure the level of creatinine in dynamics, to calculate the rate of glomerular filtration, the quantitative indicator of electrolytes. If necessary, hemodialysis should be performed on the child, connected to an artificial lung ventilator.

Abscess with a breakthrough in the bronchus.

Consequences of uncomplicated pneumonia

If pneumonia began to be treated at the wrong time, but complications did not develop in this case, then, most likely, everything will end simply with the formation of a scar in the lungs (that is, replacement of the affected area of the lung parenchyma with fibrous, connective tissue). Clinically, it will not manifest itself, most likely, but it will stand out on the X-ray with an inhomogeneous shadow.

Pleurisy.

In addition, a much more unpleasant consequence is possible - the formation of bilateral pneumonia. As a rule, bilateral pneumonia is associated with the addition of atypical microflora (Legionella in most cases) to a common infection (pneumococcal, streptococcal, staphylococcal). This is an extremely unfavorable variant of the course of pneumonia in children for recovery, as it leads to severe respiratory failure. On the x-ray, there will be bilateral darkening, as with lobar pneumonia, only on both sides. Such pneumonia is even more severe than unilateral pneumonia complicated by pleurisy or abscess. Has all the above-mentioned signs of a systemic immune response, is treated only in a hospital intensive care unit. It is necessary to connect the child to a ventilator, parenteral feeding (that is, solutions of nutrients - aminoven, lipofundin and glucose 5% should be injected intravenously). And even with the observance of absolutely all measures, one way or another related to the prevention of complications, bilateral pneumonia with the addition of atypical microflora has a very poor prognosis in terms of recovery.

Output

All deaths are associated, as a rule, with complications of pneumonia, which were not diagnosed and treated in time.

Video: Strengthening immunity after antibiotics - Dr. Komarovsky

The child's body is most susceptible to bacteria and viruses when the body is weakened after illness, therefore, complications of pneumonia in children are very difficult, especially at the age of four years.

The child's condition can worsen during the treatment of the disease, as well as after the onset of improvements in the general condition with improper treatment. Therefore, during the recovery period, a competent recovery process is recommended in order to prevent the onset of possible consequences.

Consequences and complications after pneumonia

Postponed pneumonia in a child can be expressed in asthenic syndrome, when he becomes lethargic, does not want to eat. This condition goes away on its own in a short time.

The consequences of pneumonia in children can be long-lasting and debilitating. Complications of pneumonia in children pose a threat to the life of a small person. The following complications are distinguished:

cardiopulmonary insufficiency;
pleurisy;
total progressive destruction of lung tissue;
abscess or gangrene of the lung;
sepsis;
empyema of the pleura.

Respiratory failure in children is represented by increased breathing, shortness of breath, shallow breathing, blueness of the lips and nasolabial fold, and has three stages of development. At the 1st stage, shortness of breath appears during normal vital activity. At the 2nd, shortness of breath worries with a small life load. Stage 3 is considered permanent and protracted, vomiting joins.

Cardiovascular failure occurs against the background of a severe form of pneumonia in the form of endocarditis due to progressive intoxication and the onset of dehydration of the child's body, the symptoms of which may appear after a couple of hours from the onset of onset. There is swelling, cough with foamy sputum, vomiting, shortness of breath increases, breathing is bubbling and noisy.

Pleurisy (exudative) is an inflammation of the pleura in a protracted or small focal form. The exudate in the form of a liquid, formed in the pleura, presses on the lungs, as a result of which the breathing process becomes difficult. Bacterial infection often joins, and then the fluid becomes purulent, passes into pleural empyema. The fluid is removed with a needle, in difficult situations, surgery is performed to remove pus in the lungs and pleura in children.

Abscesses and gangrene of the lungs are rare in children. It occurs by the formation in the area of the lung focus, filled with purulent masses. Melting of bronchial tissue is formed. There is a bad smell of phlegm, fingers and toes become swollen. To save the child, intravenous administration of antibacterial drugs of the initial stage of the abscess is necessary.

Sepsis is one of the most severe bacteremias, when viruses and bacteria provoke blood poisoning. Symptoms of sepsis in children include high temperature readings, tachycardia and rapid breathing, lowering blood pressure, mental disorientation, low urine output, pallor and moisture of the skin, short-term loss of consciousness. Sepsis can be fatal.

Infection of the blood in the infectious process can involve other organs and systems of the child's body. Against the background of sepsis, a protracted form of meningitis may form, peritonitis, septic arthritis or endocarditis may begin.

There are also complications such as reactive pleurisy, pulmonary edema, destruction of lung tissue and obstruction of the bronchial tree, and extrapulmonary complications: myocarditis, infectious toxic shock, meningitis and meningoencephalitis, etc.

Do's and don'ts after an illness

After suffering pneumonia, you can and should strengthen the immune system, see a pediatrician for a year, drink vitamins, restore the intestinal flora, walk a lot in the fresh humid air, follow the doctor's prescriptions to restore the child's body - massages, exercise therapy, salt rooms. It is advisable to exclude contact of the child with people with acute respiratory infections.

You cannot - take medical medications uncontrollably, physically load the child, expose him to stress, overheat the baby, keep in a closed, unventilated room.

Complications after pneumonia in children will not occur with proper treatment, normal care and well-chosen restorative therapy. It is necessary to completely eliminate all residual effects and increase the immune tone.

The main restorative measures include: physiotherapeutic procedures, taking multivitamin complexes, combating intestinal dysbiosis after antibiotic therapy, taking resorbable drugs and biological activators, phytotherapy, oxygen therapy and aerotherapy.

In order to prevent complications after pneumonia, it is necessary to maintain airway patency, therefore, mucolytics (agents that thin sputum) are prescribed - bromhexine, ambroxol, carbocisteine, acetylcysteine.
To improve vascular circulation, aminophylline is prescribed intravenously, xanthinol nicotinate and warm wet inhalations.

Treat the complications that have arisen with intensive therapy with the inclusion of antibiotics, immunoglobulins, the introduction of fluid in the form of infusion therapy. At temperatures above 40 ° C, use a lytic mixture (chlorpromazine, pipolfen, analgin).

It is possible to bathe a child after pneumonia when the temperature is normalized. Cleansing the skin promotes skin breathing, flushing toxins, and improving well-being. With the disease itself, at the onset of the disease, only hygienic wiping and care of the genitals are recommended. The water should not be very hot. The room should be warm, bathing should not be long. Drafts are excluded. After the procedure, the child must be thoroughly dried and dressed in warm clothes, which can then be removed later.

When recovering from pneumonia, a child needs positive emotions and support from parents at any age. And the most important thing is good care, fortified food, access to fresh air. All children are prescribed infection control by a doctor.

It is possible to increase the immunity in a child after pneumonia by taking the drug echinacea, herbal medicine, walking in the fresh air, doing sports exercises, treatment in sanatoriums, taking propolis with milk.

Be healthy!

In addition to incorrect and delayed treatment, complications of pneumonia can be caused by the general condition of the body before the onset of the inflammatory process (chronic diseases, age, pregnancy). They are also provoked by the infection that caused pneumonia:

Pneumococcus;
staphylococcus;
streptococcus;
other pathogens are Afanasyev-Pfeiffer's bacillus, Chlamydophila pneumoniae, etc.

Other types of complications

Even with timely and correct treatment, there is a risk of negative consequences of pneumonia. These can be diseases of the circulatory system, muscles, sensory organs. Due to the harmful effects of microorganisms, a patient who has had pneumonia is at risk of developing endocarditis and bacteremia.

Endocarditis is an infection of the inner lining of the heart. After the body is damaged by bacteria and microorganisms, they enter the bloodstream, and from there - into the endocardium that covers the chambers of the heart. Symptoms of the disease are shortness of breath, regular dry cough, chest pains. Without timely treatment, an infectious lesion can develop into acute heart failure and provoke myocardial infarction.

Bacteremia is the entry into the blood of a large number of microorganisms due to pneumonia. It is not always easy to determine that a person has this condition, because the symptoms resemble the flu:

high body temperature (up to 39-40 degrees);
violent cough with thick mucus of green, gray-green and yellow;
septic shock - hypotension (low blood pressure), clouding of consciousness, oliguria (slowing down the formation of urine).

Bacteremia can be detected by examining the patient's blood. Treatment of the disease must be carried out immediately, otherwise the infection will spread to all vital organs - the liver, heart, spinal cord. The treatment uses antibiotics, immunostimulants and ultraviolet light.

Treatment of diseases in young children is a lengthy process in which the smallest details should not be overlooked. At the age of up to 3 years, the child's immunity is just being formed, and complications of pneumonia are quite common. They relate to the general condition of the body, sensory organs and nervous system. In addition to complications that affect the body of adults, children may experience negative age-related changes. They are divided into pulmonary and extrapulmonary. The first type includes changes directly in the respiratory system, the second - deterioration in the work of other organs.

In children of early and school age, after pneumonia, complications in the respiratory process may occur - acute respiratory failure, pleurisy. Infections that cause pneumonia in a child often spread to the cardiovascular system and cause pericarditis, heart murmurs, and infectious toxic shock.

The first visible complication of the extrapulmonary type is a violation of the speech apparatus. Often, 1-1.5-year-old babies already begin to express their thoughts in words, but after suffering pneumonia, they stop talking at all, sometimes up to 4 years. The same disorders are observed in the musculoskeletal system of a 7-14 month old child. The main reason for such unpleasant "inhibitions" is insufficient blood circulation.

A complication of the child's nervous system after treatment for pneumonia is neurotoxicosis, which has several stages. The first is the child's sharp excitability, nervousness. The second stage is a sharp inhibition of reactions, in which the baby's appetite disappears, he does not react well to the appeal of adults to him. After that, the final stage begins - the terminal, in which the child's body temperature rises sharply (up to 40 degrees), convulsions appear, and sometimes breathing disappears (the so-called apnea).

The consequences of pneumonia in a strong child's body are not so terrible as its improper treatment. Antibiotics are the main drugs that are used to relieve inflammation, if their type is incorrectly prescribed, then the child may have hearing problems, intestinal disorders caused by a change in the composition of the microflora.