Pediatric Pneumonia Questions & Answers

1. UNICEF, Save the Children, and Every Breath Counts. Every child’s right to survive: a 2020 agenda to end pneumonia deaths. UNICEF. Available at https://www.unicef.org/reports/every-childs-right-survive-pneumonia-2020. 2020 Jan; Accessed: June 4, 2020.

2. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008 May. 86 (5):408-16. [QxMD MEDLINE Link].

3. Shah VP, Tunik MG, Tsung JW. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013 Feb. 167 (2):119-25. [QxMD MEDLINE Link].

4. Metinko AP. Neonatal pulmonary host defense mechanisms. Polin RA, Fox WW, eds. Fetal and Neonatal Physiology. 3rd ed. Philadelphia, Pa: WB Saunders Co; 2004. 1620-73.

5. Barnett ED, Klein JO. Bacterial infections of the respiratory tract. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, Pa: Elsevier Saunders Co; 2006. 297-317.

6. Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest. 1997 Jul. 112(1):235-43. [QxMD MEDLINE Link].

7. Li F, Zhang Y, Shi P, Cao L, Su L, Fu P, et al. Mycoplasma pneumoniae and Adenovirus Coinfection Cause Pediatric Severe Community-Acquired Pneumonia. Microbiol Spectr. 2022 Apr 27. 10 (2):e0002622. [QxMD MEDLINE Link].

8. Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004 Apr. 113(4):701-7. [QxMD MEDLINE Link].

9. Stoll BJ, Hansen NI, Higgins RD, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul. 24(7):635-9. [QxMD MEDLINE Link].

10. Mishaan AM, Mason EO Jr, Martinez-Aguilar G, et al. Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J. 2005 Mar. 24(3):201-6. [QxMD MEDLINE Link].

11. Kotecha S, Hodge R, Schaber JA, Miralles R, Silverman M, Grant WD. Pulmonary Ureaplasma urealyticum is associated with the development of acute lung inflammation and chronic lung disease in preterm infants. Pediatr Res. 2004 Jan. 55(1):61-8. [QxMD MEDLINE Link].

12. Katz B, Patel P, Duffy L, Schelonka RL, Dimmitt RA, Waites KB. Characterization of ureaplasmas isolated from preterm infants with and without bronchopulmonary dysplasia. J Clin Microbiol. 2005 Sep. 43(9):4852-4. [QxMD MEDLINE Link]. [Full Text].

13. Heggie AD, Bar-Shain D, Boxerbaum B, Fanaroff AA, O'Riordan MA, Robertson JA. Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants. Pediatr Infect Dis J. 2001 Sep. 20(9):854-9. [QxMD MEDLINE Link].

14. Ballard HO, Bernard P, Whitehead V, et al. Determining the incidence of Ureaplasma spp. and its role in development of bronchopulmonary dysplasia. [Abstract 3858.111]. Pediatric Academic Societies Meeting 2009. Baltimore, MD. May 3, 2009. aps-spr.org. Available at http://www.abstracts2view.com/pas/view.php?nu=PAS09L1_3037. Accessed: November 5, 2010.

15. Tsolia MN, Psarras S, Bossios A, et al. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis. 2004 Sep 1. 39(5):681-6. [QxMD MEDLINE Link].

16. Nascimento-Carvalho CM, Ribeiro CT, Cardoso MR, et al. The role of respiratory viral infections among children hospitalized for community-acquired pneumonia in a developing country. Pediatr Infect Dis J. 2008 Oct. 27(10):939-41. [QxMD MEDLINE Link].

17. Juvén T, Mertsola J, Waris M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 2000 Apr. 19(4):293-8. [QxMD MEDLINE Link].

18. [Guideline] Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). Recommended Adult Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2023. Available at https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. 2023 Feb 10; Accessed: March 10, 2023.

19. Tajima T, Nakayama E, Kondo Y, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. J Infect Chemother. 2006 Dec. 12(6):372-9. [QxMD MEDLINE Link].

20. Thomson J, Hall M, Ambroggio L, et al. Aspiration and non-aspiration pneumonia in hospitalized children with neurologic impairment. Pediatrics. 2016 Feb. 137 (2):e20151612. [QxMD MEDLINE Link].

21. Denny FW, Clyde WA Jr. Acute lower respiratory tract infections in nonhospitalized children. J Pediatr. 1986 May. 108(5 Pt 1):635-46. [QxMD MEDLINE Link].

22. Thompson WW, Shay DK, Weintraub E, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004 Sep 15. 292(11):1333-40. [QxMD MEDLINE Link].

23. Black SB, Shinefield HR, Ling S, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J. 2002 Sep. 21(9):810-5. [QxMD MEDLINE Link].

24. Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010 Jan. 125(1):26-33. [QxMD MEDLINE Link].

25. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004 Dec. 82(12):895-903. [QxMD MEDLINE Link]. [Full Text].

26. Shah S, Bachur R, Kim D, Neuman MI. Lack of predictive value of tachypnea in the diagnosis of pneumonia in children. Pediatr Infect Dis J. 2010 May. 29(5):406-9. [QxMD MEDLINE Link].

27. Wingerter SL, Bachur RG, Monuteaux MC, Neuman MI. Application of the World Health Organization criteria to predict radiographic pneumonia in a US-based pediatric emergency department. Pediatr Infect Dis J. 2012 Jun. 31(6):561-4. [QxMD MEDLINE Link].

28. Jones BP, Tay ET, Elikashvili I, et al. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest. 2016 Jul. 150 (1):131-8. [QxMD MEDLINE Link].

29. Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Feb. 33(2):166-73. [QxMD MEDLINE Link].

30. Murphy CG, van de Pol AC, Harper MB, Bachur RG. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007 Mar. 14(3):243-9. [QxMD MEDLINE Link].

31. Rutman MS, Bachur R, Harper MB. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009 Jan. 25(1):1-7. [QxMD MEDLINE Link].

32. Wubbel L, Muniz L, Ahmed A, et al. Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J. 1999 Feb. 18(2):98-104. [QxMD MEDLINE Link].

33. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of america. Clin Infect Dis. 2011 Oct. 53(7):e25-76. [QxMD MEDLINE Link].

34. Andrews AL, Simpson AN, Heine D, Teufel RJ 2nd. A cost-effectiveness analysis of obtaining blood cultures in children hospitalized for community-acquired pneumonia. J Pediatr. 2015 Dec. 167 (6):1280-6. [QxMD MEDLINE Link].

35. Waris ME, Toikka P, Saarinen T, et al. Diagnosis of Mycoplasma pneumoniae pneumonia in children. J Clin Microbiol. 1998 Nov. 36(11):3155-9. [QxMD MEDLINE Link]. [Full Text].

36. Chaaban H, Singh K, Huang J, Siryaporn E, Lim YP, Padbury JF. The role of inter-alpha inhibitor proteins in the diagnosis of neonatal sepsis. J Pediatr. 2009 Apr. 154(4):620-622.e1. [QxMD MEDLINE Link].

37. Blaschke AJ, Heyrend C, Byington CL, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011 Apr. 30(4):289-94. [QxMD MEDLINE Link]. [Full Text].

38. Neuman MI, Harper MB. Evaluation of a rapid urine antigen assay for the detection of invasive pneumococcal disease in children. Pediatrics. 2003 Dec. 112(6 Pt 1):1279-82. [QxMD MEDLINE Link].

39. Rothrock SG, Green SM, Fanelli JM, Cruzen E, Costanzo KA, Pagane J. Do published guidelines predict pneumonia in children presenting to an urban ED?. Pediatr Emerg Care. 2001 Aug. 17 (4):240-3. [QxMD MEDLINE Link].

40. Geanacopoulos AT, Lipsett SC, Hirsch AW, Monuteaux MC, Neuman MI. Impact of Viral Radiographic Features on Antibiotic Treatment for Pediatric Pneumonia. J Pediatric Infect Dis Soc. 2022 May 30. 11 (5):207-213. [QxMD MEDLINE Link].

41. Schenck EJ, Rajwani K. Ultrasound in the diagnosis and management of pneumonia. Curr Opin Infect Dis. 2016 Apr. 29 (2):223-8. [QxMD MEDLINE Link].

42. Hu QJ, Shen YC, Jia LQ, Guo SJ, Long HY, Pang CS, et al. Diagnostic performance of lung ultrasound in the diagnosis of pneumonia: a bivariate meta-analysis. Int J Clin Exp Med. 2014. 7 (1):115-21. [QxMD MEDLINE Link].

43. Sherman MP, Goetzman BW, Ahlfors CE, Wennberg RP. Tracheal asiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics. 1980 Feb. 65(2):258-63. [QxMD MEDLINE Link].

44. Gauvin F, Dassa C, Chaïbou M, Proulx F, Farrell CA, Lacroix J. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med. 2003 Oct. 4(4):437-43. [QxMD MEDLINE Link].

45. Gauvin F, Lacroix J, Guertin MC, et al. Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children. Am J Respir Crit Care Med. 2002 Jun 15. 165(12):1618-23. [QxMD MEDLINE Link].

46. Labenne M, Poyart C, Rambaud C, et al. Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med. 1999 Nov. 27(11):2537-43. [QxMD MEDLINE Link].

47. Falade AG, Mulholland EK, Adegbola RA, Greenwood BM. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Ann Trop Paediatr. 1997 Dec. 17(4):315-9. [QxMD MEDLINE Link].

48. Klein JO. Diagnostic lung puncture in the pneumonias of infants and children. Pediatrics. 1969 Oct. 44(4):486-92. [QxMD MEDLINE Link].

49. Wigglesworth JS. Perinatal Pathology. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1996. 131-57, 184-7.

50. Handy LK, Bryan M, Gerber JS, Zaoutis T, Feemster KA. Variability in antibiotic prescribing for community-acquired pneumonia. Pediatrics. 2017 Apr. 139 (4):[QxMD MEDLINE Link].

51. Lipshaw MJ, Florin TA, Krueger S, et al. Factors Associated With Antibiotic Prescribing and Outcomes for Pediatric Pneumonia in the Emergency Department. Pediatr Emerg Care. 2021 Dec 1. 37 (12):e1033-8. [QxMD MEDLINE Link].

52. Handy LK, Bryan M, Gerber JS, Zaoutis T, Feemster KA. Variability in Antibiotic Prescribing for Community-Acquired Pneumonia. Pediatrics. 2017 Apr. 139 (4):[QxMD MEDLINE Link].

53. Kuehn BM. Inappropriate Antibiotic Use for Pneumonia Common. Medscape Medical News. Available at http://www.medscape.com/viewarticle/876918?src=soc_tw_170313_mscpedt_news_fm_pneumonia#vp_1. March 08, 2017; Accessed: June 5, 2020.

54. Williams DJ, Hall M, Gerber JS, et al. Impact of a national guideline on antibiotic selection for hospitalized pneumonia. Pediatrics. 2017 Apr. 139 (4):[QxMD MEDLINE Link].

55. Tafelski S, Lange M, Wegener F, Gratopp A, Spies C, Wernecke KD, et al. Pneumonia in pediatric critical care medicine and the adherence to guidelines. Minerva Pediatr (Torino). 2022 Aug. 74 (4):447-454. [QxMD MEDLINE Link].

56. Cohen HA, Gerstein M, Loewenberg Weisband Y, Richenberg Y, Jacobson E, Cohen M, et al. Pediatric Antibiotic Stewardship for Community-Acquired Pneumonia: A Pre-Post Intervention Study. Clin Pediatr (Phila). 2022 Nov. 61 (11):795-801. [QxMD MEDLINE Link].

57. Colbourn T, King C, Beard J, Phiri T, Mdala M, Zadutsa B, et al. Predictive value of pulse oximetry for mortality in infants and children presenting to primary care with clinical pneumonia in rural Malawi: A data linkage study. PLoS Med. 2020 Oct. 17 (10):e1003300. [QxMD MEDLINE Link].

58. Willwerth BM, Harper MB, Greenes DS. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med. 2006 Oct. 48(4):441-7. [QxMD MEDLINE Link].

59. Muszynski JA, Knatz NL, Sargel CL, Fernandez SA, Marquardt DJ, Hall MW. Timing of correct parenteral antibiotic initiation and outcomes from severe bacterial community-acquired pneumonia in children. Pediatr Infect Dis J. 2011 Apr. 30(4):295-301. [QxMD MEDLINE Link].

60. [Guideline] Cincinnati Children''s Hospital Medical Center. Evidence based care guideline for community acquired pneumonia in children 60 days through 17 years of age. Cincinnati (OH): Cincinnati Children''s Hospital Medical Center. Jul. 2006. Available at http://guideline.gov/index.aspx. Accessed: September 22, 2010.

61. Neuman MI, Kelley M, Harper MB, File TM Jr, Camargo CA Jr. Factors associated with antimicrobial resistance and mortality in pneumococcal bacteremia. J Emerg Med. 2007 May. 32(4):349-57. [QxMD MEDLINE Link]. [Full Text].

62. Barber J Jr. Narrow-Spectrum Antibiotics Effective for Pediatric Pneumonia. Medscape Medical News. Oct 29 2013. [Full Text].

63. Williams DJ, Hall M, Shah SS, et al. Narrow Vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia. Pediatrics. 2013 Nov. 132(5):e1141-8. [QxMD MEDLINE Link].

64. Williams DJ, Edwards KM, Self WH, et al. Effectiveness of β-lactam monotherapy vs macrolide combination therapy for children hospitalized with pneumonia. JAMA Pediatr. 2017 Dec 1. 171 (12):1184-91. [QxMD MEDLINE Link].

65. Braude AC, Hornstein A, Klein M, Vas S, Rebuck AS. Pulmonary disposition of tobramycin. Am Rev Respir Dis. 1983 May. 127(5):563-5. [QxMD MEDLINE Link].

66. Pennington JE. Penetration of antibiotics into respiratory secretions. Rev Infect Dis. 1981 Jan-Feb. 3(1):67-73. [QxMD MEDLINE Link].

67. Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics. 2006 Jan. 117(1):67-74. [QxMD MEDLINE Link].

68. Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Adjunctive therapies for community-acquired pneumonia: a systematic review. J Antimicrob Chemother. 2008 Oct. 62(4):661-8. [QxMD MEDLINE Link].

69. Lassi ZS, Haider BA, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2010 Dec 8. CD005978. [QxMD MEDLINE Link].

70. Vilas-Boas AL, Fontoura MS, Xavier-Souza G, et al. Comparison of oral amoxicillin given thrice or twice daily to children between 2 and 59 months old with non-severe pneumonia: a randomized controlled trial. J Antimicrob Chemother. 2014 Jul. 69 (7):1954-9. [QxMD MEDLINE Link].

Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA Professor of Emergency Medicine and Clinical Pediatrics, Weill Cornell Medical College; Attending Physician, Departments of Emergency Medicine and Pediatrics, Lincoln Medical and Mental Health Center; Adjunct Professor of Emergency Medicine, Adjunct Professor of Pediatrics, St George's University School of Medicine, Grenada

Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Academy of Urgent Care Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, Association of Clinical Research Professionals, Public Responsibility in Medicine and Research, Society for Academic Emergency Medicine, Society for Simulation in Healthcare

Disclosure: Nothing to disclose.

Marie-Micheline Lominy, MD Attending Physician, Lincoln Medical Center; Physician in Pediatric Adolescent Medicine, Boston Children's Health Physicians

Marie-Micheline Lominy, MD is a member of the following medical societies: American Academy of Pediatrics, Haitian Medical Association Abroad, Haiti Red Cross Society

Disclosure: Nothing to disclose.

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Disclosure: Nothing to disclose.

Brent R King , MD, MMM Clive Nancy and Pierce Runnells Distinguished Professor of Emergency Medicine; Professor of Pediatrics, University of Texas Health Science Center at Houston; Chair, Department of Emergency Medicine, Chief of Emergency Services, Memorial Hermann Hospital and LBJ Hospital

Disclosure: Nothing to disclose.

Jeff L Myers, MD, PhD Chief, Pediatric and Congenital Cardiac Surgery, Department of Surgery, Massachusetts General Hospital; Associate Professor of Surgery, Harvard Medical School

Disclosure: Nothing to disclose.

Mark I Neuman, MD, MPH Assistant Professor of Pediatrics, Harvard Medical School; Attending Physician, Division of Emergency Medicine, Children's Hospital Boston

Mark I Neuman, MD, MPH is a member of the following medical societies: Society for Pediatric Research

Disclosure: Nothing to disclose.

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Manika Suryadevara, MD Fellow in Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Upstate Medical University

Disclosure: Nothing to disclose.

Isabel Virella-Lowell, MD Department of Pediatrics, Division of Pulmonary Diseases, Pediatric Pulmonology, Allergy and Immunology

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Disclosure: Nothing to disclose.

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