Community Acquired Pneumonia in Children Clinical Guideline

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Community Acquired Pneumonia in Children Clinical Guideline

Transcript Of Community Acquired Pneumonia in Children Clinical Guideline

Community Acquired Pneumonia in Children Clinical Guideline
V4.0
August 2020

1. Aim/Purpose of this Guideline
1.1. This guideline is for all medical and nursing staff caring for children with Community Acquired Pneumonia.
1.2. This version supersedes any previous versions of this document.
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2. The Guidance
For quick reference guideline see below. Reproduced from: Guidelines for the management of community acquired pneumonia in children: update 2011 British Thoracic Society Community Acquired Pneumonia in Children Guideline Group, October 2011, Volume 66, supplement 2.
2.1. Bacterial pneumonia should be considered:
 Fever >38.5 degrees C
 Chest recession, difficulty in breathing/tachypnoea with respiratory rates:  Infants >50  Preschool >40  School aged >30
 If wheeze is present in a preschool child, bacterial pneumonia is unlikely.
 Presence of crepitations and wheeze may suggest bronchiolitis (see separate guideline).
 Do not routinely give antibiotics for bronchiolitis
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2.2. General 2.2.1. If appropriate children should be managed at home

2.2.2. Oxygen administered to those with saturations <92%

2.2.3.

Intravenous fluids only if required - to be given at 80% maintenance and electrolytes monitored at baseline and daily whilst on IV fluids.

2.2.4.

Chest physio should not be used routinely unless the patient has a neuromuscular condition/ CP/ chronic supportive lung disease associated with a bronchopneumonia

2.2.5. Those treated at home should be given advice about management of fever, hydration and identifying deterioration
2.3. Aetiology
 Viruses are commonly found in younger children

 Strep pneumonia is the commonest bacterial cause in childhood, followed by mycoplasma and chlamydia
2.4. Indicators for admission to hospital in infants:
 Oxygen sats <92% cyanosis

 Respiratory rate > 70/ min

 Intermittent apnoea or grunting

 Poor feeding < 50% normal

2.5. Investigations

2.5.1.

CXR should not be performed routinely in those with uncomplicated LRTI

2.5.2.

Children should be reviewed by middle grade before CXR (includes discussion)

2.5.3.

Children with pneumonia who are not admitted to hospital should not routinely have a CXR

2.5.4.

Acute phase reactants (e.g. CRP) do not distinguish bacterial and viral infections and should not be routinely performed

2.5.5.

NPA (nasopharyngeal aspirate for viral culture) to be considered in children under 18 months

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2.5.6.

No indication for microbiology investigations in milder cases (managed in community)

2.5.7. Follow latest trust guidance on screening for Covid19.

2.6. Antibiotic Management

2.6.1.

Young children < 2yrs old, with only mild symptoms should not routinely receive antibiotics unless clinically indicated.

2.6.2.

PO Amoxicillin 1st choice for 5 days, alternative azithromycin if Penicillin allergic, or in combination if atypical suspected.

2.6.3.

If atypical presentation, macrolides may be used as first line in those >5 years (e.g. Azithromycin for at least 3 days)

2.6.4.

If unable to absorb e.g. vomiting or severe signs and symptoms, treat with IV antibiotics

2.6.5.

Severe pneumonia/systemically unwell/suspected sepsis - Give IV Ceftriaxone and PO Azithromycin and admit.

2.6.6.

Changing to oral antibiotics should be considered on clear signs of improvement

2.7. Follow Up

2.7.1.

In the community - review at 48 hours by GP if no improvement. Advise that the child is reviewed on Paediatric Observations Unit if ongoing fever or increased respiratory effort. If concerns on assessment, consider carrying out CXR to rule out development of effusion in these prolonged cases which are not improving on oral antibiotics.

2.7.2.

Follow up CXR after lobar collapse, round pneumonia or persistent symptoms at 1-2 weeks after 1st CXR. The time frame for repeating a CXR will be based on individual clinical case and from radiology advice based on the initial CXR findings. Be aware that CXR changes can take several weeks to resolve, so a repeat CXR may be suggested at for example 6 – 8 weeks post the initial presentation and imaging. Seek Radiology/Respiratory team advice if unsure.

2.7.3.

Severe pneumonia, empyema and lung abscesses should be followed up until complete resolution. These cases may need to return for clinical review prior to repeat imaging. They should also be followed up in outpatient clinic.

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Italics represent local alterations to guideline
Full guidance available: www.britthoracic.org.uk/guidelines/pneumonia-guidelines.aspx

3. Monitoring compliance and effectiveness

Element to be monitored Lead Tool
Frequency Reporting arrangements
Acting on recommendations and Lead(s) Change in practice and lessons to be shared

Compliance with all elements of guideline
Audit Lead, Respiratory Consultant Audit, individual review, peer review using a WORD or Excel template Annually or earlier if indicated Audit Lead Paediatric Respiratory Consultant Department Audit and Guidelines meeting Paediatric Consultants Department Audit and Guidelines meeting
Required changes to practice will be identified and actioned within 3-6 months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders

4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.

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Appendix 1. Governance Information

Document Title
This document replaces (exact title of previous version): Date Issued/Approved:
Date Valid From:

Community Acquired Pneumonia in Children Clinical Guideline V4.0 Clinical Guideline for the management of community acquired pneumonia in children V3.0
July 2020
August 2020

Date Valid To: Directorate / Department responsible (author/owner): Contact details:
Brief summary of contents

August 2023
Dr Daniel Hiley, Paediatric SHO/ Dr Kathryn Thomas, Paediatric Consultant, Respiratory team.
01872 252463
Clinical Guideline for the management of community acquired pneumonia in children.

Suggested Keywords:
Target Audience
Executive Director responsible for Policy: Approval route for consultation and ratification:

Children. Pneumonia

RCHT

CFT



Medical Director

KCCG

Paediatric consultants Child Health Audit and Guidelines meeting 16/7/2020

General Manager confirming approval processes

Mary Baulch

Name of Governance Lead confirming approval by specialty and care group management meetings Links to key external standards
Related Documents:
Training Need Identified? Publication Location (refer to Policy on Policies – Approvals and Ratification): Document Library Folder/Sub Folder

Caroline Amukusana
None Guidelines for the management of community acquired pneumonia in children: update 2011 British Thoracic Society Community Acquired Pneumonia in Children Guideline Group October 2011 Volume 66 supplement 2 No
Internet & Intranet  Intranet Only
Clinical/ Paediatrics

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Version Control Table

Date

Version No

Summary of Changes

October 2012

V1.0 Initial Issue

January 2014

V2.0 Reformat only

November 2017

V3.0

No changes

Changes Made by (Name and Job
Dr.DermToittleD)alton Dr.A.Prendevillepaediatric consultant
Tabitha FergusDeputy ward manager-reformat only
Anne Prendiville Paediatric Consultant

July 2020

V4.0

Updated to new trust format Title change National guidance re antibiotics reviewed – no changes to main content of guideline. Additional comment re Covid screening section 2.5. Additional advice section 2.7

D.Hiley (SHO) K.Thomas (Paediatric Consultant)

All or part of this document can be released under the Freedom of Information Act 2000
This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing
Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.

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Appendix 2. Initial Equality Impact Assessment

Section 1: Equality Impact Assessment Form

Name of the strategy / policy /proposal / service function to be assessed Community Acquired Pneumonia in Children Management Clinical Guideline V4.0

Directorate and service area: Child Health

Is this a new or existing Policy? Existing

Name of individual/group completing EIA Child Health Audit and Guidelines Group

Contact details: 01872 252463

1. Policy Aim Who is the strategy / policy / proposal / service function aimed at?
2. Policy Objectives
3. Policy Intended Outcomes

Clear guideline for the management of community acquired pneumonia in children.
Clear guideline for the management of community acquired pneumonia in children. Evidenced based standardised practice.

4. How will you measure the outcome?

Audit and review.

5. Who is intended to benefit from the policy?
6a). Who did you consult with?

Children and families

Workforce x

Patients

Local groups

External

Other

organisations

b). Please list any groups who have been consulted about this procedure. c). What was the outcome of the consultation?

Child Health Audit and Guidelines group Approved

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7. The Impact

Please complete the following table. If you are unsure/don’t know if there is a negative impact

you need to repeat the consultation step.

Are there concerns that the policy could have a positive/negative impact on:

Protected Characteristic

Yes No Unsure

Rationale for Assessment / Existing Evidence

Age

X

Sex (male, female

non-binary, asexual

X

etc.)

Gender

reassignment

X

Race/ethnic

communities

X

/groups

Disability

(learning disability,

physical disability,

sensory impairment,

X

mental health

problems and some

long term health

conditions)

Religion/

other beliefs

X

Any information provided should be in an accessible format for the parent/carer/patient’s needs – i.e.
available in different languages if required/access to an interpreter if required
Those parent/carer/patients with any identified additional needs will be referred for additional support
as appropriate - i.e to the Liaison team or for specialised equipment.
Written information will be provided in a format to meet the family’s needs e.g. easy read, audio etc

Marriage and civil

partnership

X

Pregnancy and

maternity

X

Sexual orientation

(bisexual, gay,

x

heterosexual, lesbian)

If all characteristics are ticked ‘no’, and this is not a major working or service

change, you can end the assessment here as long as you have a robust rationale

in place.

I am confident that section 2 of this EIA does not need completing as there are no highlighted

risks of negative impact occurring because of this policy.

Name of person confirming result of initial impact assessment:

Child Health Audit and Guidelines group

If you have ticked ‘yes’ to any characteristic above OR this is a major working or service change, you will need to complete section 2 of the EIA form available here: Section 2. Full Equality Analysis

For guidance please refer to the Equality Impact Assessments Policy (available from the document library) or contact the Human Rights, Equality and Inclusion Lead [email protected]

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