perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2021-66-1-9-21perinatology-1332Research ArticleПЕРЕДОВАЯEDITORIALВнебольничные пневмонии у детей – проблемы и решенияCommunity-acquired pneumonia in children – problems and solutionshttps://orcid.org/0000-0001-8085-4513ТаточенкоВ. К.TatochenkoV. K.

Таточенко Владимир Кириллович – доктор медицинских наук, профессор, гл. специалист Национального медицинского исследовательского центра здоровья детей,

119991 Москва, Ломоносовский проспект, д. 2, стр. 1

Moscow

tatovk@yandex.ruФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России, Москва, РоссияРоссияNational Medical Research Center for Children’s HealthRussian Federation202129032021661921Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20212021Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1332

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Пневмония у детей остается одним из частых тяжелых заболеваний; несмотря на интенсивное изучение, ее диагностика и лечение не лишены не всегда благополучно решаемых проблем. Цель статьи – обозначить эти проблемы и показать пути их решения в настоящее время.

Критерием диагностики пневмонии является наличие легочного инфильтрата на рентгенограмме. Внебольничные пневмонии чаще всего вызывают пневмококки и микоплазма; респираторные вирусы, грипп обычно служат факторами, способствующими бактериальной инфекции. Высокий уровень гипери гиподиагностики внебольничной пневмонии связан со сходством ее симптоматики с ОРВИ; учет общих нарушений (признаков тяжести болезни) позволяет повысить качество диагностики. Клиническая и рентгенологическая картина дают возможность отличить пневмококковую пневмонию от пневмонии, вызванной микоплазмой. Для улучшения диагностики внебольничной пневмонии необходимо исследовать маркеры воспаления при первом осмотре больного, что невыполнимо в условиях помощи на дому. Рост устойчивости пневмококков к макролидам требует применения амоксициллина в повышенных дозах при внебольничной пневмонии пневмококковой (и неясной) этиологии, а макролидов – только при атипичной пневмонии. Щадящая терапия деструктивных пневмоний, назначение стероидов при метапневмоническом плеврите позволяют избежать инвазивных вмешательств и приводят к хорошей репарации легочной ткани.

Pneumonia in children remains one of the most serious diseases. Despite intensive study, the diagnosis and treatment still present a variety of problems. The article is aimed to identify these problems and show the ways of their solution.

One of the criteria for the diagnosis of pneumonia is pulmonary infiltrate on the X-ray image. Community-acquired pneumonia is often caused by Pneumococci and mycoplasma; respiratory viruses, influenza usually serve as contributing factors for bacterial infection. The high level of hyperand underdiagnosis of community-acquired pneumonia is associated with its similarity with ARVI; the registration of general violations (signs of the severity of the disease) improves the quality of diagnosis. The clinical and radiological picture helps to distinguish pneumococcal pneumonia from pneumonia caused by mycoplasma. To improve the diagnosis of community-acquired pneumonia, it is necessary to study inflammation markers during the first examination of the patient, which is impossible in the conditions of home care. Due to the growth of resistance of pneumococci to macrolides a community-acquired pneumonia of pneumococcal (and unclear) etiology requires the use of amoxicillin in high doses and macrolides (in case of atypical pneumonia). Gentle therapy of destructive pneumonia, steroids for metapneumonic pleurisy allow avoiding invasive interventions and help to repair lung tissue.

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The authors declare that there are no conflicts of interest present.