Study of risk factors for severe pneumonia among children between 2 months to 5 years of age

Background: Acute respiratory illness is responsible for 19% of all deaths in children in below five years of age and 8.2% of all disability as measured by DALY. Recent studies have added other risk factors to the list including large family size, poor socioeconomic status, family history of bronchitis, advanced birth order, crowding, young age, air pollution, and the use of non-allopathic treatment in early stages of illness. Also, indoor air pollution is one of the major risk factors for acute lower respiratory tract infection in children in developing countries. The objectives of this study were to identify and compare the risk factors associated with severe and very severe pneumonia.Methods: A prospective observational study. Children between 2 months to 5 years with clinical features of severe pneumonia were included in the study. Socioeconomic history like the type of house, family size, sanitary facilities and fuel-based cooking was recorded. Detailed history about immunization, feeding practice and degree of malnutrition was recorded. Chi Square test was used to determine significant differences between two groups.Results: Total 150 patients could be included in the study. Immunization status shows that 74% were completely immunized, 9% were unimmunized and 17% were partially immunized. Most of the children were breast fed 95.33% and only 4.67% were bottle fed. 30% of the cases were grade 3 and 4 PEM and anemic. The socioeconomic status showed 84% were belonged to grade 3,4 and 5 and 16% belonged to grade 1 and 2. 96.67% were living in ill ventilated kutcha house with poor sanitation facilities and nearly 94% were living in house with fuel other than LPG.Conclusions: Factors like previous history of similar illness, inappropriate immunization for age, anemia, PEM grade 3 and 4, poor housing condition, and indoor air pollution were significantly associated with severity of pneumonia. While severity of illness, PEM grade 3 and 4 and associated illness were the important risk factors for mortality.

Association between breastfeeding and clinical outcomes of infants with very severe pneumonia

Objective@#To determine the association of breastfeeding with the clinical outcomes of infants with very severe pneumonia. @*Methods@#This retrospective study included intubated, full-term infants between one to six months of age admitted for very severe pneumonia at the critical care units of the National Children’s Hospital from 2005 to-2015. The 52 subjects per type of feeding (exclusively breastfed and non-exclusively breastfed) were selected using simple random sampling. We examined the association between the type of feeding with the length of ICU stay, ventilator days, health-care-associated infection (HAI) and mortality.@*Results@#A total of 104 infants were included in the study. The exclusively breastfed (EBF) infants stayed for a shorter amount of time in the ICU than the non-exclusively breastfed (NEBF) infants (p-value = 0.0067). The EBF infants had shorter intubation period and mechanical ventilation use (p value=0.001), and less HAI (p-value = 0.015). There were more infants with very severe pneumonia who died from the NEBF group but no significant association (p-value = 0.076) was found between mortality and the type of feeding. @*Conclusion@#Exclusively breastfed infants who were admitted for very severe pneumonia at the critical care areas showed better outcomes in terms of shorter ICU stay and ventilator use, and lower incidence of HAI as compared to the NEBF infants. However, data showed no significant association between mortality and type of feeding.

Observational Follow-up Study on a Cohort of Children with Severe Pneumonia after Discharge from a Day-care Clinic in Dhaka, Bangladesh.

Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (≈90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death.

Interstitial Lung Disease and Profound Hypoxaemia in a Severely-malnourished Child with Very Severe Pneumonia and Potential Lymph-node Tuberculosis: An Uncommon but Serious Co-morbidity.

A nine-month old boy was initially admitted at the Acute Respiratory Infection Unit of Dhaka Hospital of icddr,b and soon after transferred to the Intensive Care Unit of the same hospital. The boy had problems of very severe pneumonia (confirmed by radiology), severe hypoxaemia, severe malnutrition, and Down’s syndrome. The patient was treated according to the hospital protocol for the management of pneumonia and malnutrition. During the hospital stay, hypoxaemia was persistent with very little improvement of pneumonia; a number of differentials, such as pneumocystis jirovecii pneumonia, lymph-node tuberculosis, were added to the problems. Subsequently, the patient’s hypoxaemia improved with the empirical use of antitubercular drugs. However, the patient again developed persistent hypoxaemia and, after unsuccessful treatment for a hospital-acquired pneumonia, the problems further expanded to include interstitial lung disease (ILD). This was confirmed by high-resolution computed tomography, and the patient was treated with prednisolone for 6 months, along with antitubercular drugs. He fully recovered from ILD, hypoxaemia, and pneumonia both clinically and radiologically. Therefore, severely-malnourished children having wet cough and pneumonia with persistent hypoxaemia should be assessed for the possible existence of interstitial lung disease. This may help provide a prompt and appropriate management to reduce morbidity and deaths in such patients.