Outcome Predictors of Severe and Very Severe Pneumonia in Children Between 2 and 59 Months of Age Admitted in a Tertiary Care Hospital (original) (raw)

2017, Indian Journal of Child Health

neumonia is a leading cause of morbidity and mortality in under-five children. According to the recent WHO estimate, pneumonia is responsible for 15% of deaths in the under-fives, killing 9,20,136 children in 2015. Nearly 23% of the total under-fives' death and 20-30% of under-fives' admissions in India are due to pneumonia. According to hospital-based studies, case fatality rate (CFR) was reported to vary between 8.7% and 47% [1-4]. Both community as well as hospital-based studies have highlighted a variety of factors contributing to mortality in childhood pneumonia [3-8]. With socioeconomic progress and improvement in health awareness and referral services, an increasing proportion of pneumonia deaths will occur in hospitals [9]. It is presumed that positive chest X-ray findings are mainly due to the bacterial pneumonia which needs to be treated with antibiotics; hence, we planned to evaluate the risk factors associated with outcome in radiologically proven pneumonia and to compare it with that of the WHO-defined severe and very severe pneumonia. There are only a few studies on other relevant outcomes including the need for change of antibiotics, prolonged hospital stay (i.e., more than 5 days), and need for mechanical ventilation. These factors need to be evaluated so that we can predict the outcome early during illness and can take interventions accordingly. We planned this study to identify these factors and other relevant outcomes so that we can modify the course of illness. MATERIALS AND METHODS This is a hospital-based study over a period of 18 months from November 2013 to March 2015 conducted in pediatrics ward of a tertiary care hospital. The study was conducted after obtaining Institutional Ethics Committee's approval, and patients were enrolled after receiving written consent of the parents/legally acceptable representatives. A total of 300 children of either sex between 2 and 59 months of age with the WHO-defined severe and very severe pneumonia were enrolled in the study [10]. Children having other comorbid conditions such as severe malnutrition, congenital malformations, congenital heart disease, meningitis, severe anemia (hemoglobin <7 gm% or as per the ABSTRACT Objective: The objective of this study was to determine the factors associated with outcome (morbidity and mortality) in children aged 2-59 months with severe and very severe pneumonia. Materials and Methods: This is a hospital-based, prospective, observational study conducted in the pediatric department of a tertiary care hospital. Totally 300 children of either sex between 2 and 59 months of age with the WHO-defined severe pneumonia and very severe pneumonia were enrolled in the study. Associations of outcomes and various clinical symptoms were assessed using Chi-square test first and then through logistic regression models. Results: In our study, 86 (28.7%) children stayed in hospital more than 5 days, 113 (37.7%) needed change in antibiotics, 24 (8%) developed complications (5% effusion and 3% pneumothorax), and 31 (10.3%) expired. Multivariate analysis showed that younger age at presentation, household pollution (cooking fuel other than liquefied petroleum gas), and children who did not receive exclusive breastfeeding were prone to develop more severe pneumonia. Head nodding and cyanosis were independent factors significantly associated with mortality on multiple logistic regression. Radiologically proven pneumonia cases required change in antibiotics more frequently and stayed for longer duration in hospital as compared to clinical pneumonia cases. Conclusions: Children with signs of severe respiratory distress such as head nodding, cyanosis and altered sensorium, anemia, decreased or increased total leukocyte count, and hypoxemia have greater risk of mortality. Children with risk factors including overcrowding, indoor air pollution, lack of exclusive breastfeeding and proper immunization, and abnormal chest radiograph are less likely to respond to the first-line antibiotics; therefore, they may be treated aggressively with the second-line antibiotics from the beginning so that their hospital stay may be reduced.