CAP - paeds

Question 1

Key points CAP peads

Answer 1

Community acquired pneumonia (CAP) can be diagnosed clinically and is most often due to viruses
Chest X-Ray, blood tests and microbiological investigations are not recommended for routine use in the diagnosis and management of CAP
For non-severe pneumonia, high dose oral amoxicillin is recommended, even for inpatient use
For infants <1 month of age see Recognition of the seriously unwell neonate and young infant and Sepsis guidelines

Question 2

“Complicated pneumonia” - peads

Answer 2

parapneumonic effusion, empyema, lung abscess or necrotising pneumonia

Question 3

hx and examination - CAP peads plus severit assessmet

Answer 3

History
Fever
Tachypnoea at rest
Cough
Increased work of breathing/respiratory distress
Apnoea (neonates)
Abdominal pain
Examination
Appears lethargic/unwell
Hypoxaemia
Tachypnoea
Chest wall in-drawing, retractions, grunting, nasal flaring
Crackles and/or bronchial breathing on auscultation
Absent breath sounds and a dull percussion note suggest a pleural effusion
Assessment of severity
See Assessment of severity of respiratory conditions

Severe pneumonia should be considered if there are clinical features of pneumonia and one or more of:

Severe respiratory distress
Marked tachycardia
Altered mental state
SpO2 <80% or requiring respiratory support (eg CPAP, HFNP)
Complicated pneumonia (see parapneumonic effusion)
Consider sepsis in children with severe pneumonia

Question 4

Ix CAP - peads

Answer 4

Investigations, including chest X-Ray (CXR), are not recommended routinely for CAP, particularly in those with mild disease who are expected to be managed as an outpatient

CXR

Recommended when severe or complicated pneumonia is suspected
Consider repeating if the child deteriorates at any time or fails to clinically improve after 48-72 hours of appropriate antibiotic therapy
Follow-up CXR is not required for those who have uncomplicated pneumonia or small parapneumonic effusion and recover uneventfully
Follow-up CXR is recommended after 6 weeks for:
complicated pneumonia
recurrent pneumonia involving the same lobe or if initial suspicion of a chest mass, anatomical abnormality or foreign body
Severe or complicated pneumonia

UEC for children receiving intravenous fluids
FBE and blood film
Microbiological investigations
Blood culture
Influenza PCR (nasal swab or aspirate)
COVID-19 testing (as per local testing criteria)
Testing for other viral pathogens will not change management
Testing for atypical pathogens is unhelpful as it does not differentiate infection from asymptomatic carriage
Acute phase reactants (including CRP and procalcitonin) cannot distinguish between a viral or bacterial cause nor indicate severity
Consider sepsis

Question 5

Tx CAP - peads

Answer 5

https://www.rch.org.au/clinicalguide/guideline_index/Community_acquired_pneumonia/