Overview of Bronchopneumonia
Bronchopneumonia, also known as lobular pneumonia, is the most common type of pneumonia in children. Its incidence and mortality rates among children in developing countries are markedly higher than those in developed nations. Similar to other developing countries, childhood pneumonia poses a severe threat to children’s health in China, ranking first in both incidence and mortality. In China, pneumonia accounts for 24.5% to 65.2% of pediatric inpatients. Among the 1.05 million annual deaths of children under five, 300,000 are caused by pneumonia, making it the leading fatal disease for this age group. According to pediatric statistics from 16 domestic medical institutions, bronchopneumonia makes up 93.7% of 22,504 hospitalized pneumonia cases, predominantly affecting infants and young children.
Bronchopneumonia mostly occurs in winter and spring or during abrupt weather changes. In some regions of South China, however, cases peak in summer. Crowded living spaces, poor ventilation, polluted air and abundant pathogenic microorganisms greatly increase infection risks. The disease can be triggered by bacteria or viruses. Pathologically, it is classified into ordinary bronchopneumonia (mainly bacterial) and interstitial bronchopneumonia (mainly viral), while the clinical diagnosis generally adopts the unified term bronchopneumonia.
Clinical Manifestations of Bronchopneumonia
Onset can be acute or insidious, and most patients present mild upper respiratory tract infection symptoms beforehand. Mild cases start with rhinorrhea, mild cough, low-grade fever and poor appetite. After 1 to 3 days, high fever of 38℃–39℃ suddenly develops, accompanied by aggravated cough and shortness of breath. Some children develop abrupt fever, cough, dyspnea and irritability directly. In weak infants, onset is usually slow with low-grade fever, indistinct cough and lung signs; common manifestations include refusal to feed, milk choking, vomiting and dyspnea.
Respiratory Symptoms and Signs
The early stage presents with irritating dry cough; during the acute phase, wheezing intensifies while coughing slightly eases; the recovery stage features productive wet cough with gurgling phlegm in the throat. Respiratory rate rises above 40 breaths per minute, accompanied by nasal flaring and even three-concave sign (suprasternal fossa, infrasternal fossa and intercostal retractions).
Lung Auscultation
Chest signs are often unremarkable in the early stage, with only rough or slightly weakened breath sounds. As lesions expand, dull percussion notes appear, and fine crackles can be heard in both lungs, most obvious at the lung bases during deep inspiration. Coarse moist rales emerge in the recovery phase.
Prevention of Bronchopneumonia
1. Strengthen daily care and physical exercise
Ensure adequate nutrition for infants with timely complementary feeding. Develop healthy dietary and hygiene habits; preventing rickets and malnutrition is critical to avoiding severe pneumonia. Conduct regular physical training from an early age: keep windows open for ventilation, ensure sufficient sunlight exposure, and arrange frequent outdoor activities or outdoor naps to enhance cold resistance and adaptability to temperature fluctuations, reducing susceptibility to respiratory infections and pneumonia.
2. Block acute respiratory infections and respiratory infectious diseases
Minimize infants’ contact with patients suffering from respiratory infections, especially fragile babies who are prone to progressing to pneumonia after exposure. Prevent and treat respiratory infectious diseases that may induce severe pulmonary complications, such as pertussis, influenza adenovirus infection and measles. Extra caution is required for children with immunodeficiency or those receiving immunosuppressants.
3. Prevent complications and secondary infections
Infants already diagnosed with pneumonia have weakened immunity and are vulnerable to co-infections. Take proactive measures to avoid severe complications with poor prognoses such as empyema and pyopneumothorax. Isolate patients infected with different pathogens in wards; separate recovering children from newly admitted ones. Medical staff must follow strict disinfection and isolation protocols when caring for different patients. Studies have shown that fumigation with traditional Chinese herbs such as atractylodes and mugwort can reduce airborne pathogens and prevent cross-infection.
The prognosis depends on the child’s age, timely control of pulmonary inflammation, quantity and virulence of pathogenic bacteria, antibiotic sensitivity, the child’s immune status and presence of severe complications. Timely diagnosis and integrated traditional Chinese and Western medicine therapy have significantly lowered mortality and complication rates in recent years.
Treatment of Bronchopneumonia
1. Nursing Care
Maintain well-ventilated wards with a temperature of approximately 20℃ and relative humidity of 60%. Supply sufficient vitamins and protein; encourage frequent water intake and small, frequent meals. Keep the respiratory tract unobstructed by promptly clearing upper airway secretions and turning the child regularly to reduce pulmonary congestion, facilitating inflammation absorption and sputum discharge. To avoid cross-infection, mild pneumonia can be treated at home or outpatient clinics. For hospitalized children, separate acute-phase patients from recovering ones, and bacterial pneumonia patients from viral pneumonia patients.
2. Oxygen Therapy
Oxygen therapy is a core intervention to correct hypoxemia and prevent respiratory failure as well as cerebral and pulmonary edema. Administer oxygen immediately upon detection of hypoxia. Continuous nasal cannula oxygen inhalation is the most common method, discontinued only after hypoxia resolves. Masks, nasal prongs, head hoods or oxygen tents are adopted for newborns, children with excessive nasal secretions or those unresponsive to nasal cannula oxygen. Excessively high oxygen concentration, high flow rates or prolonged oxygen supply may trigger adverse reactions such as diffuse pulmonary fibrosis and retinopathy of prematurity. Mechanical ventilation with intermittent positive pressure ventilation or continuous positive airway pressure is implemented without delay for severe hypoxia accompanied by respiratory failure to improve ventilation.
3. Antibacterial Treatment
Antibiotics are indicated for bacterial pneumonia, mycoplasma pneumonia, chlamydia pneumonia and viral pneumonia complicated with secondary bacterial infection. Conduct culture and drug sensitivity tests on throat secretions, blood or thoracentesis fluid before treatment to select targeted effective antibiotics.
4. Antiviral Treatment
Ribavirin yields certain therapeutic effects for early adenovirus pneumonia, while efficacy is limited for advanced cases. It can also be trialed for influenza viral pneumonia.
Immune preparations have been widely used domestically for viral pneumonia in recent years. Specific equine serum works well for early adenovirus pneumonia without complications. Interferon inhibits intracellular viral replication and boosts macrophage phagocytosis, exerting a moderate therapeutic effect on viral pneumonia. Nebulized whey protein inhalation alleviates symptoms and shortens treatment courses for respiratory syncytial virus pneumonia.
5. Symptomatic Treatment
Avoid overusing antitussives for cough with sputum, as cough suppression hinders sputum clearance. Expectorants including Compound Glycyrrhiza Mixture, 10% Ammonium Chloride Solution, Ipecac Syrup and Dike Syrup can be prescribed to prevent bronchial obstruction by phlegm.
For thick sputum, ultrasonic nebulization with 5mg chymotrypsin diluted in 15–20ml normal saline or houttuynia cordata aerosol inhalation is recommended. For severe dry cough disturbing sleep and feeding, 0.5% codeine syrup can be administered occasionally (0.1ml/kg, 1–3 times daily). Codeine suppresses both cough reflex and respiration, so overdosage or frequent use is prohibited. Dextromethorphan (0.3ml/kg, 3–4 times daily) relieves cough without inhibiting breathing.