Clinicoepidemiological profile and predictors of severe illness in young infants (< 60 days) reporting to a hospital in North India.

OBJECTIVES: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. METHODS: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1%). The primary clinical diagnoses in infants with serious illness needing admission to hospital in the age group <7 days (n = 66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%), diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%) were the common primary diagnoses. Signs that had at least a prevalence of 5% and were strong predictors for all the age categories studied were history of difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0 respectively for the 3 age groups). Additional strong predictors with > 5% prevalence were history of convulsions (OR 7.9, only in 0-6 day age group), lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0 for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.

Clinico-epidemiological profile and validation of symptoms and signs of severe illness in young infants (< 60 days) reporting to a district hospital.

OBJECTIVES: To describe the clinical and epidemiological profile of infants less than 2 months of age reporting to a district hospital and to assess the ability of simple clinical symptoms and signs used by health workers to detect severe illness warranting hospital admission. METHODS: It was an observational study done at a general district hospital at Chandigarh, North India. Infants less than 2 months of age presenting to this hospital were enrolled. All infants were first evaluated by an auxiliary nurse midwife (ANM) to record a pre-determined set of symptoms and signs. A pediatrician who was blinded to the findings of the ANM did an independent assessment for severe illness needing urgent hospitalization. RESULTS: A total of 1268 infants were enrolled. Of these, 356 (28%) were below 7 days of age. Overall, regurgitation, vomiting and stool problems (25%) were the most common presenting complaints in the first 2 months of life, followed by jaundice (22%) and respiratory symptoms (15%). 112 (8.8%) infants were classified as having "severe illness requiring urgent hospital management" by the pediatrician. Nearly half (46%) of the admissions were because of jaundice while 17% each were due to sepsis and pneumonia / lower respiratory tract infection (LRTI). A history of not feeding well (OR 14.7, 8.0 and 11.3 in 0-6, 7-27 and 28-59 days age groups, respectively) and a respiratory rate >60/min (OR 21.5, 6.2 and 10.5 in 0-6, 7-27 and 28-59 days age groups, respectively) had significant positive predictive value to predict severe illness (except jaundice) in all the 3 age groups studied. In the second month of life, severe chest in-drawing (OR 4.6) was also a significant predictor. CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.