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Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.
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Objective:To analyze the pulmonary function after pneumonia in children over 3 years old.Methods:This was an observational study recruiting children discharged from Beijing Children′s Hospital, Capital Medical University between January 1, 2016 and December 31, 2017 with the first diagnosis of pneumonia who were re-examined for pulmonary function within 0.5 to 2.0 years follow-up at outpatient department.Medical records during hospitalization, clinical information, pulmonary function and/or chest imaging examination were collected for analyzing lung function and relevant risk factors.Results:A total of 159 eligible patients who were followed up at the outpatient department were recruited, involving 100 patients receiving the lung function examination, and among them, 46 had abnormal lung function.There was no significant correlation between the gender and the pulmonary function after pneumonia ( χ2= 0.975, P=0.323). No correlation was found between the pulmonary function and pneumonia pathogens ( χ2=0.549, P=0.908). Children with severe pneumonia ( χ2=5.154, P=0.023) and abnormal chest imaging after pneumonia ( χ2=4.464, P=0.035) were more likely to have lung dysfunction.Among 74 children over 6 years old, there were 45 cases(60.81%) had pulmonary dysfunction after pneumonia, manifesting as the reduced forced expiration volume in one second (FEV 1), forced vital capacity (FVC), forced expiratory flow at 50% vital capacity, forced expiratory flow at 75% vital capacity, maximum mid-expiratory flow and FEV 1/FVC%. Conclusions:Lung dysfunction may occur after pneumonia, manifesting as small airway dysfunction, obstructive ventilation dysfunction and mixed ventilation dysfunction.The gender and etiology of pneumonia are not correlated with lung dysfunction after pneumonia.Children with severe pneumonia and continuous imaging abnormalities are more likely to have lung dysfunction.
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Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.
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Background: Hypoxaemia is a common complication and a significant predictor of death from pneumonia in children under five years of age. Knowledge of the prevalence of hypoxaemia and clinical signs associated with it may guide use of oxygen in the management of childhood pneumonia in resource-poor settings. This study was carried out to determine the prevalence of hypoxaemia in children with pneumonia and assess the relation between hypoxaemia and age, duration of illness and clinical signs.Methods: This was a descriptive cross-sectional study undertaken between 1st July 2016 and 27th April 2017. Children with pneumonia, aged 2-59 months, who attended Federal Medical Centre, Owerri and met the inclusion criteria, were recruited into the study. Subject evaluation included history and physical examination. Their blood oxygen saturation was determined by pulse oximetry and value less than 90% indicated hypoxaemia.Results: Out of the 144 children with pneumonia, 93(64.6%) were males and 51(35.4%) females giving a male to female ratio of 1.8:1. Median age was 8 months and mean weight (SD) was 8.6 kg (3.6). The overall prevalence of hypoxaemia was 17.4%. Hypoxaemia prevalence was significantly higher in infants (p=0.026) and severe pneumonia (p<0.0001). There was statistically significant association between hypoxaemia and lower chest in-drawing, nasal flaring, suprasternal recession, grunting, lethargy, tachypnoea and tachycardia. With adjustment for confounding variables, only lower chest in-drawing (OR: 9.672; p=0.004), lethargy (OR: 8.103; p=0.020) and grunting (OR: 4.960; p=0.050) predicted hypoxaemia in pneumonia. Each of these signs had a poor combination of sensitivity and specificity.Conclusions: Hypoxaemia is common in childhood pneumonia. Though some clinical signs are significantly associated with hypoxaemia in childhood pneumonia, they may be unreliable in predicting hypoxaemia. Therefore, pulse oximeters should be provided in every health facility for accurate detection of hypoxaemia.
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Objective • To understand the structural changes and related reasons of the average cost of hospitalization of childhood pneumonia in Shanghai, and to propound related policy suggestion. Methods • New grey correlation and degree of structural variation analysis were used to research the average cost of hospitalization of 22 543 children with pneumonia from 2015 to 2018 in a children's specialized hospital in Shanghai. The average cost included 5 categories, i.e. medicine cost, material cost, examination and laboratory cost, labour cost and bed occupation cost. The relational degree and structural changes between each average cost and the average cost of hospitalization were discussed. Results • The new grey correlation analysis showed that the relational degree sort order of each average cost from the highest to the lowest were average examination and laboratory cost (γ3=1.000 0), average medicine cost (γ1=0.862 5), average bed occupation cost (γ5=0.845 1), average labour cost (γ4=0.796 8) and average material cost (γ2=0.786 3). The degree of structure variation analysis showed that the contribution rate of structure variation (CSV) sort order of each average cost in 2015-2018 from the highest to the lowest were average medicine cost (CSV1=36.22%), average bed occupation cost (CSV5=27.65%), average examination and laboratory cost (CSV3=13.91%), average material cost (CSV2=13.78%) and average labour cost (CSV4=8.44%). The average medicine cost and average material cost were negative variation. Conclusion • The average examination and laboratory cost and average medicine cost are the main factors that influenced the average cost of hospitalization of childhood pneumonia. The proportion of the average labour cost is relatively low. It is suggested that the cost structure like raising labour charges and optimizing diagnosis and treatment process should be further adjusted in order to control the growth of medical costs.
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Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms. 'Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.
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Background: Rural hospitals in sub-Saharan Africa suffer from numerous disparities in resources and practices, and subsequently patient care is affected.Methods: In order to assess current practices and opportunities for improvement in pulse oximetry use and patient-care handoffs, a cross-sectional survey was administered to clinicians at a referral level hospital serving a large rural area in Shinyanga, Tanzania.Results: Respondents (n=46) included nurses (50%), medical doctors (48%), and clinical officers (2%). A response rate of 92% was achieved, and 81% of clinicians acknowledged routine difficulties in the use of current devices when obtaining pulse oximetry. Although 83% of respondents reported using a written handoff at shift change, information reporting was inconsistent and rarely included specific management guidance.Conclusions: Further research is needed to elucidate handoff practices in developing settings, but there is a large opportunity for novel point-of-care devices and tools to improve both pulse oximetry use and patient care handoffs in rural Africa.
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In this study, the rapid resolution liquid chromatography quadrupole time-of-flight mass spectrometry ( RRLC-QTOF/MS ) was used to profile the metabolites of urine samples from Childhood Pneumonia ( CP) patients and healthy controls and find the potential biomarkers which can support evidence to early diagnose and cure the disease. Choose 10 CP patients ( age 47. 72 ± 2. 35 months) and 10 healthy controls ( age 46 . 65 ± 1 . 97 months ) . The urine samples were analyzed by RRLC-QTOF/MS and then the resulting data matrices were analyzed by principal components analysis ( PCA ) to find the potential biomarkers. Urine samples of CP patients were successfully distinguished from those of healthy controls. A total of two significantly changed metabolites have been found and identified as potential biomarkers. It is suggested that the disorder of purine metabolism and amino acid metabolism may play an important role in the mechanism of CP.
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Background@#Serum procalcitonin is a useful biomarker in establishing the presence of bacterial infections and has been used in algorithms to guide antibiotic treatment among adults. It role in pediatric infections, however, remains unclear. @*Objectives@#This research aims to evaluate the impact of serum procalcitonin in guiding antibiotic therapy among pediatric patients with suspected local or systemic infections. @*Methodology@#Randomized controlled trials comparing procalcitonin-guided antibiotic therapy to clinically guided therapy in pediatric patients with local or systemic infections were searched through MEDLINE, Cochrane, EMBASE, HERDIN and ClinicalTrials.gov. Hand search in various search engines was also done. Outcomes included antibiotic usage, morbidity and mortality. Two reviewers independently assessed potentially relevant studies. Statistical analysis was conducted using RevMan 5.3 using inverse variance weighting and random effects model. @*Results@#Five randomized controlled trials were included. Overall, there was a reduction in antibiotic prescription rate in the procalcitonin group compared to controls for all groups (RD -0.13, 95% CI [-021,0.06]; p <0.00001), however, pooled studies were heterogenous. Subgroup analysis showed that for children with pneumonia, procalcitonin guidance significantly reduced antibiotic prescription rate (RD – 012,95% CI [-021,0.04]; p <0.005 ), and may have potential in reducing the duration of therapy (95% CI [-6.8,2,54], p <0.0001) and antibiotic-related adverse effects (RD- 0.17, 95% CI[-0.24,-0.10], p<0.00001) compared to controls. In one study on neonates with early onset sepsis, procalcitonin guidance reduced antibiotic prescription rate by 27% (p=0.0009) and duration of therapy by 22.4 hours (p=0.0009). Procalcitonin guidance has no significant impact on antibiotic prescription rate in children with fever without a source (RD -0.11, 95% CI[0.28,0.05], p=0.190). @*Conclusion@#Procalcitonin guidance significantly reduces antibiotic prescription rate among children with pneumonia and neonates with early onset sepsis. It has the potential in reducing the duration of antibiotic therapy and antibiotic-related side effects in these populations. ON the other hand, it had no impact among children with fever without a source. These results highlight the need for algorithm-based approaches using procalcitonin cut-off values to guide antibiotic therapy in children.
Subject(s)
Procalcitonin , Neonatal SepsisABSTRACT
<i>Streptococcus pneumoniae</i> is a major worldwide cause of morbidity and mortality. Pneumococcal carriage is considered to be an important source of horizontal spread of this pathogen within the community. Pneumococcal conjugate vaccine (PCV) is capable of inducing serotype-specific antibodies in sera of infants, and has been suggested to reduce nasopharyngeal carriage of vaccine-type pneumococci in children. PCV is generally immunogenic for pediatric patients with invasive pneumococcal disease, with an exception for the infecting serotypes. Based on evidences from the clinical trials of PCV, the health impact of childhood pneumococcal pneumonia appears to be high in developing countries where most of global childhood pneumonia deaths occur. PCV vaccination may prevent hundreds of deaths per 100,000 children vaccinated in developing countries, while PCV vaccination is expected to prevent less than 10 deaths per 100,000 children vaccinated in the developed countries. Therefore, the WHO has proposed a strategy to reduce the incidence of severe pneumonia by 75% in child less than 5 years of age compared to 2010 levels by 2025.
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<i>Streptococcus pneumoniae</i> is a major worldwide cause of morbidity and mortality. Pneumococcal carriage is considered to be an important source of horizontal spread of this pathogen within the community. Pneumococcal conjugate vaccine (PCV) is capable of inducing serotype-specific antibodies in sera of infants, and has been suggested to reduce nasopharyngeal carriage of vaccine-type pneumococci in children. PCV7 is generally immunogenic for pediatric patients with invasive pneumococcal disease, with an exception for the infecting serotypes. Based on evidences from the clinical trials of PCV, the health impact of childhood pneumococcal pneumonia appears to be high in developing countries where most of global childhood pneumonia deaths occur. PCV vaccination may prevent hundreds of deaths per 100,000 children vaccinated in developing countries, while PCV vaccination is expected to prevent less than 10 deaths per 100, 000 children vaccinated in the developed countries. Therefore, the WHO has proposed a strategy to reduce the incidence of severe pneumonia by 75% in child less than 5 years of age compared to 2010 levels by 2025.