see also: [[Pneumonia#Round pneumonia]] ![[D8ED4090-865C-4E8F-8EF9-D850BC0ACB24.png]] GBS in neonates causes rapid fulminant illness # Symptoms - decreased appetite - fever - rapid breathing - nasal flaring - grunting - retractions - irritability # Causes ## Bacterial - Group B Strep most common cause in neonates - other common causes: strep pneumo, h flu, chlaymdia ## Chlamydia pneumonia - **afebrile** - tachyponic - staccato cough - **conjunctivitis** - hyperinflation ## viral - RSV, paraflu, adenovirus ## pertussis - paroxysms of cough and cyanosis, post tussive vomiting, rectal prolapse, diaphragm rupture # When to get CXR Recommended: - when *severe or complicated pneumonia* is suspected - if the child deteriorates at any time or fails to clinically improve after 48-72 hours of appropriate antibiotic therapy - Follow-up CXR is not required for those who have uncomplicated pneumonia or small parapneumonic effusion and recover uneventfully Follow-up CXR is recommended after 6 weeks for: - complicated pneumonia - recurrent pneumonia involving the same lobe or if initial suspicion of a chest mass, anatomical abnormality or foreign body Otherwise, Chest X-Ray (CXR), blood tests and microbiological investigations are not recommended for routine use in the diagnosis and management of CAP. - no CXR if mild disease and clinical signs suggesting PNA and pts who are appropriately managed in community # treatment Amoxicillin 30mg/kg (up to 1g) oral TDS for 3-5 days - There is no proven benefit from treatment with macrolides for *atypical pneumonia* (eg mycoplasm pneumoniae) but they may be considered in severe pneumonia not responding to treatment ## penicillin hypersensitivity - Azithromycin 10 mg/kg (max 500 mg) oral daily - Doxycycline 50 mg (<26 kg), 75 mg (26-35 kg), 100 mg (>35 kg) oral BD