Zapalenia płuc o ciężkim przebiegu u dzieci – charakterystyka kliniczna, powikłania i odległe następstwa

Zdzisława Kycler, Katarzyna Olejniczak, Anna Bręborowicz, Jerzy Alkiewicz, Urszula Bugaj

Streszczenie
A retrospective assessment was carried out of 90 children treated in the years 1986-96 for pneumonia with severe course. On the basis of medical documentation history data, clinical picture, disease course, complications and diagnostic investigations as well as treatment methods were analysed. Before the hospitalization the children were treated exclusively on the basis of clinical data (in only one child the basic diagnostic management was carried out). Treatment included mainly antibiotics 56.3%, bronchodilators 10.4%, inhalatory steroids 2.1%, systemic steroids 12.5%, mucolytic drugs 16.7%. The indication to hospitalization was lack of therapeutic success. The most frequent complications were: pneumothorax, pleural empyema and bacteriaemia. The mean hospital stay was 51.3 days in cases referred from another hospital, and 35.2 days in cases treated in the Institute. Attention is called to excessive use of aminoglycosides. In the second part of the paper 55 children were assessed for general condition and respiratory problems 2-10 years after pneumonia.
In 89.1% cases planned treatment was continued after discharge from hospital. In 50.9% of cases convalescence lasted over 6 weeks and i only 23.6% it was below 2 weeks. Recurrences of lower respiratory tract infections developed in 43.6% of children, as bronchititis, but in 9.1% another pneumonia episodes occurred. Only 12.7% of children required repeated hospitalization. Restricted physical activity was found in 34.5%. Among 40 children subjected to respiratory function tests 35% had ventilation disturbances of restrictive type, and in 17.5% signs of obturation.
The presented results indicate the necessity of specialistic care for children after severe pneumonia, with clinical monitoring of spirometric parameters of respiratory function and adequate rehabilitation procedures.

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