Integrated management of neonatal and childhood illness


SEVERE PNEUMONIA OR VERY SEVERE DISEASE



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SEVERE PNEUMONIA OR VERY SEVERE DISEASE A child with cough or difficult breathing and with any of the following signs -- any general danger sign, chest indrawing or stridor in a calm child -- is classified as having SEVERE PNEUMONIA OR VERY SEVERE DISEASE. A child with chest indrawing usually has severe pneumonia. Or the child may have another serious acute lower respiratory infection such as bronchiolitis, pertussis, or a wheezing problem. Chest indrawing develops when the lungs become stiff. The effort the child needs to breathe in is much greater than normal.

A child with chest indrawing has a higher risk of death from pneumonia than the child who has fast breathing and no chest indrawing. If the child is tired, and if the effort the child needs to expand the stiff lungs is too great, the child's breathing slows down. Therefore, a child with chest indrawing may not have fast breathing. Chest indrawing maybe the child's only sign of severe pneumonia.


Treatment In developing countries, bacteria cause most cases of pneumonia. These cases need treatment with antibiotics. Viruses also cause pneumonia. But there is no reliable way to find out if the child has bacterial pneumonia or viral pneumonia. Therefore, whenever a child shows signs of pneumonia, give the child an appropriate antibiotic. A child classified as having SEVERE PNEUMONIA OR VERY SEVERE DISEASE is seriously ill. He needs urgent referral to a hospital for treatments such as oxygen, a bronchodilator or injectable antibiotics. Before the child leaves your clinic, give the first dose of injectable chloramphenicol (if not possible give oral amoxicillin. The antibiotic helps prevent severe pneumonia from becoming worse. It also helps treat other serious bacterial infections such as sepsis or meningitis.
PNEUMONIA A child with cough or difficult breathing who has fast breathing and no general danger signs, no chest indrawing and no stridor when calm is classified as having PNEUMONIA.
Treatment Treat PNEUMONIA with oral amoxycillin. If amoxycillin is not available give oral cotrimoxazole. Show the mother how to give the antibiotic. Advise her when to return for followup and when to return immediately.

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