Title: Pediatric Pneumonia
題目：小兒肺炎
Author 作者: Mimi Lu

You have diagnosed an infant or child with pneumonia.  How do you decide if they need admission?
你剛剛診斷一個嬰兒或兒童患有肺炎。如何決定患兒需不需要住院治療？
The Pediatric Infectious Disease Society and the British Thoracic Society each have guidelines from 2011 to help with this decision.
美國兒科感染病學會和英國胸科學會在2011年發表的指南將有助于你的決定。
 The Pediatric Infectious Disease Society recommend inpatient therapy for the following
美國兒科感染病學會住院治療標準

1) oxygen saturation <90% 氧飽和度低于90％
2) infants less than 3-6 months of age with bacterial infection being the likely etiology
3－6個月嬰兒高度懷疑有細菌感染
3) pneumonia from suspected or documented virulent pathogen such as CA-MRSA
由可疑或證實的惡性病原菌（如院外獲得的MRSA）導致的肺炎
4) children in whom home care is questionable, outpatient follow-up is not available or who cannot comply with outpatient therapy
不能落實可靠的家庭治療，不能隨診，不能遵守門診治療方案
 
The British Thoracic Society identify risk factors likely to require hospitalization:
英國胸科學會明確了需要住院的幾個危險因素：
1) oxygen saturation <92% 氧飽和度低于92％
2) respiratory rate > 70 breaths/min (>50 breaths/min in older children)
呼吸頻率每分鐘超過70次（大一點的小孩超過50次）
3) significant tachycardia for level of fever 與發病程度不相符的心動過速
4) prolonged capillary refill time > 2 seconds 毛細血管充盈時間超過2秒鐘
5) breathing difficulty 呼吸困難
6) intermittent apnea 間歇性呼吸停止
7) not feeding or signs of dehydration 不能口入或有脫水征
8) chronic medical conditions/comorbidities 慢性疾病或合并癥
 
References 參考文獻:
"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"
http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2011%20CAP%20in%20Children.pdf

"Guidelines for the management of community acquired pneumonia in children: update 2011" BTS
http://www.brit-thoracic.org.uk/Portals/0/Guidelines/Pneumonia/CAP%20children%20October%202011.pdf