ORIGINAL ARTICLE

Children with pneumonia: how do they present and how are they managed?

Julia E Clark¹, Donna Hammal², David Spencer³, Fiona Hampton⁴

¹ Department of Paediatric Infectious Disease, Newcastle General Hospital, Newcastle, UK
² SCMS (Child Health), Sir James Spence Institute, Royal Victoria Infirmary, Newcastle, UK
³ Department of Respiratory Paediatrics, Freeman Hospital, Newcastle, UK
⁴ Department of Paediatrics, James Cook University Hospital, Middlesbrough, Cleveland, UK

Correspondence to:
Dr Julia Clark
Department of Paediatric Infectious Disease, Newcastle General Hospital, Westgate Road, Newcastle NE4 6BE, UK; Julia.clark{at}nuth.nhs.uk

Objective: To describe the spectrum of clinical features and management of community acquired pneumonia in the UK.

Design: Prospectively recorded clinical details for all children with possible pneumonia and chest x ray (CXR) changes in 13 hospitals in the North of England between 2001 and 2002.

Results: 89% of 711 children presenting to hospital with pneumonia were admitted; 96% received antibiotics, 70% intravenously. 20% had lobar CXR changes, 3% empyema and 4% required intensive care. Respiratory rate (RR), hypoxia and dyspnoea all correlated with each other and prompted appropriate interventions. Admission in children, not infants, was independently associated with RR, oxygen saturation, lobar CXR changes and pyrexia. Neither C-reactive protein, lobar CXR changes or pyrexia were associated with severity. Children over 1 year old with perihilar CXR changes more often had severe disease (p = 0.001). Initial intravenous antibiotics were associated with lobar CXR changes in infants and children and with dyspnoea, pyrexia and pleural effusion in children. The presence of pleural effusion increased duration of antibiotic treatment (p<0.001). Cefuroxime was the most often used intravenous antibiotic in 61%. Oral antibiotics included a penicillin in 258 (46%), a macrolide in 192 (34%) and a cephalosporin in 117 (21%). Infants stayed significantly longer (p<0.001) as did children with severe disease (p<0.01), effusions (p = 0.005) or lobar CXR changes (p0.001).

Conclusions: There is a high rate of intravenous antibiotic administration in hospital admissions for pneumonia. Despite lobar CXR changes not being independently associated with severe disease, initial lobar CXR changes and clinical assessment in children independently influenced management decisions, including admission and route of antibiotics.

Abbreviations: BTS, British Thoracic Society; CAP, community acquired pneumonia; CRP, C-reactive protein; CXR, chest x ray; IF, immunofluorescence; NG, nasogastric; RR, respiratory rate

Keywords: community acquired pneumonia; childhood pneumonia; lobar pneumonia; severity; antibiotics

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