Recurrent and Persistent Pneumonia in Children
Recurrent pneumonia in children is a challenge even to the pediatric pulmonologist. Recurrent pneumonia is defined as that pneumonia which has occurred repeatedly for more than two times in a duration of 1 year or three episodes in any time frame. Persistent pneumonia is a chronic, non-resolving pneumonia in which there is a persistence of symptoms and radiographic abnormalities for more than 1 month. The difference between recurrent and persistent pneumonia is that in between two episodes the child is symptom free and is radiologically improved. One has to first ascertain that it is indeed a recurrent lower respiratory tract infection before making either of this diagnosis. Recurrent pneumonia needs to be managed and appropriately treated as it could prove to be potentially dangerous to the child.
Various causes of recurrent or persistent pneumonia in children
Some of the underlying or predisposing factors include:
- Aspiration Syndrome â€“ This is when the food or drink that the child swallows due to some reason accidently enters the airways and causes cough usually in bouts and may also result in pneumonia. This is the most common underlying cause in children with recurrent pneumonia
- Anatomical or structural anomalies of lungs like cleft palate, trachea-oesophageal fistula
- Immune disorders and immunological abnormalities
- Congenital Heart Defects
- Gastroesophageal Reflux (GERD)
- Sickle cell anemia
- Bronchial asthma
- Bronchiectasis: Different causes of bronchiectasis are cystic fibrosis, primary ciliary dyskinesia, recurrent aspiration, retained foreign body, and immunodeficiency.
- Aspirations due to neuromuscular problems with swallowing problems
- Congenital anomalies like pierre robin syndrome, tracheomalacia
Diagnosing recurrent or persistent pneumonia in children
The following tests may be ordered by your pediatrician / pediatric pulmonologist
- Chest X-ray: The presence and location of pneumonia can been see on X-ray.
- Blood test: like complete Hemogram, inflammatory markers and other relevant tests
- Sputum test: This test helps to find out the cause of the underlying problem like bacterial or tuberculosis infection.
- Induced sputum analysis: When the child is small and cannot expectorate and bring out the sputum, it is collected by inducing the child to produce more secretions by nebulizing with 3% hypertonic saline and then sucking out the secretions produced
- Pulse oximetry: This is done to check the blood oxygen saturations.
- CT (computerized tomography) chest: This is used to find the pattern, extent and location and the type of abnormal radiological findings to give the possible diagnosis
- Flexible bronchoscopy: This may be used by your pediatric pulmonologist to evaluate the airways in real time, under direct vision, and to collect samples from the lower airways for pathological analysis. Also, in some cases this procedure proves to be therapeutic like removal of mucus plugs and thick secretions, which clears the airway.
- Special tests: like sweat chloride test may be required when chronic lung diseases like cystic fibrosis is suspected
- Genetic tests: Mutation analysis is done when genetic diseases like cystic fibrosis and primary ciliary dyskinesia is suspected, in order to effectively manage the child and alos for genetic counselling of the parents for future siblings
Treatment of recurrent or persistent pneumonia in children
Type of treatment is disease specific and depends on the extent, severity of the infection and the age as well as the immune status of the child. If the severity is not much and the child is comfortable, oral antibiotics as home therapy can be given. However, in severe cases, hospitalization for parenteral or intravenous therapy is required.
- o Antibiotics: These are used in cases of bacterial pneumonia.
- Intravenous fluids: are given when the oral intake is insufficient
- Supportive treatment: like antipyretics for fever and antiemetics for vomiting may be required.
The last and most important part of management is the identification of the underlying cause of recurrent pneumonia and planning an effective and specific treatment for the child. Do consult your pediatric pulmonologist in case your child has recurrent pneumonia.