PRISM score and factors predicting mortality of patients with respiratory failure in the pediatric intensive care unit.

A total of 96 patients with respiratory failure who required mechanical ventilation admitted to the PICU, Chulalongkorn Hospital from July 1998 to June 1999 were reviewed to evaluate the PRISM score for mortality prediction and to identify factors that might influence the outcome. The statistical difference in outcome between the 2 groups (survivors and non-survivors) were underlying diseases, age, maximum positive inspiratory pressure (PIP), maximum positive end expiratory pressure (PEEP), maximum fractional inspiratory oxygen (FiO2) and PRISM score (p < 0.05). However, based on the original logistic regression equation, the predicted mortality from PRISM score in our study was much lower than our actual mortality (2.4% vs 26.0%). The sensitivity and specificity of mortality predicted by PRISM score calculated at cut-off r = 0.0 (expected mortality = 50%) was 4 per cent and 97 per cent respectively. In conclusion, the original PRISM score underpredicted the mortality outcome in our patients with respiratory failure. This suggests that PRISM score is population dependent and should be modified before being used with our patients.

Clinical score and arterial oxygen saturation in children with wheezing associated respiratory illness (WARI).

OBJECTIVES: To determine the correlation between clinical score (based on respiratory rate, chest wall retractions, air entry, wheezing, consciousness and audible wheezing) and arterial oxygen saturation (SaO2: measured by pulse oximetry) as well as the most appropriate total score for predicting hypoxemia (SaO2 < or = 95%) in children diagnosed to have wheezing associated respiratory illness (WARI). SUBJECTS: 70 children (1 month-5 years old) hospitalized in the Department of Pediatrics, Chulalongkorn Hospital with the diagnosis of WARI from January 1, 1996 to December 31, 1996 were studied. Half of them were diagnosed to have acute lower respiratory tract infection (LRI) with wheezing while the remainder had reactive airway disease (RAD). DESIGN: Cross sectional, analytical study. METHODS: In each group of patients, the clinical score and SaO2 were assessed by the same pediatrician throughout the study. The correlation between the clinical signs and SaO2 as well as the cut off point of total score for predicting hypoxemia were analyzed. The sensitivity, specificity and accuracy of that total score in predicting hypoxemia were also calculated. RESULT: In both groups of patients (acute LRI with wheezing and RAD group), the clinical signs correlated with SaO2 were wheezing (rs = -0.67 and -0.47 respectively) and chest wall retractions (rs = -0.57 and -0.59 respectively). Total score was also correlated with SaO2 (rs = -0.68 and -0.5 respectively). The cut off point of total score in predicting hypoxemia was 4 providing 80 per cent sensitivity in both groups with accuracy 74.3 per cent and 80 per cent respectively. CONCLUSION: This clinical score may be used to assess the severity of hypoxemia in WARI patients. Wheezing, chest wall retractions and total score correlated well with SaO2. The total score > 4 was most appropriate in predicting hypoxemia in both children with RAD and wheezing associated with LRI.

Chlamydia pneumoniae infection in Thai children: serological diagnosis.

Recent Chlamydia pneumoniae infections were investigated in children with respiratory tract infections and in normal children. Four groups of sera were tested for C. pneumoniae antibody IgG and IgM serum fraction by the method of MIF test. A total of 7 cases of recent infection were detected, 3 of 116 with pneumonia, 3 of 123 with other respiratory tract infections, 1 of 263 normal school children and none in sera from cord blood. The cases with recent C. pneumoniae infection were as young as 24 days and 2 months old.

Risk factors of streptococcal colonization in school age children.

We studied the factors influencing the colonization of Streptococcus in school age children aged 6-11 years from 2 low socioeconomic schools of the Bangkok Metropolitan area. 4,055 throat swab cultures were performed. Beta hemolytic Streptococcus (BHS) and beta hemolytic Streptococcus group A (BHSA) were isolated in 1,747 (43%) and 744 (18%) respectively. 1,547 questionnaires were returned from the children. Of these, 750 and 570 were found to have BHS and BHSA in the throat, respectively. Among the risk factors, considered, teeth brushing of one time or none per day was significant for BHS positive in the throat as compared with the BHS negative group, while personal hygiene such as sharing glass with other, playing in dirty water, poor housing sanitation and low family income was significantly associated with the BHSA positive group. With the combination of certain clinical manifestations, these factors may increase the accuracy of predicting streptococcal infection.

Predictors of bronchodilator responsiveness in infants with wheezing associated respiratory tract infection.

The responsiveness to bronchodilator is variable in infants with wheezing associated respiratory illness (WARI). Factors for prediction of the response will lead to more rational use of the bronchodilator in these infants. We examined the possible predictive factors in 44 children under 2 years of age who had their first episode of WARI. All of them were treated with 0.15 mg/kg of nebulized salbutamol. Thirty patients (68%) with decreasing clinical score > or = 3 after treatment were considered as the responders while the remainder (14 infants) were non responders. By using Chi-square test, Fisher exact test and Mann-Whitney U test to compare the data of the 2 groups, the significant factors for the responders were older than 6 months and history of previous LRI (p < 0.01). The significant factors for the non-responders included concurrent diarrhea, patchy pulmonary infiltration and positive RSV in the nasopharyngeal secretion (p < 0.01). These results suggested effective bronchodilator therapy in infants older than 6 months or having a history of previous LRI. Those who had acute RSV infection or patchy infiltration in chest X-ray and associated diarrhea were less likely to respond.

Lymphomatoid granulomatosis with upper airway obstruction: a case report.

A case of lymphomatoid granulomatosis in a previously healthy 13-year-old Thai girl presenting with right sixth cranial nerve palsy and severe upper airway obstruction was reported. Cranial nerve palsy later disappeared spontaneously but the patient developed multiple pulmonary nodules and cavity leading to pulmonary insufficiency. Her course was complicated with septicemia which limited the use of corticosteroid and cytotoxic drugs. She finally expired with pseudomonas sepsis in addition to pulmonary and liver involvement. This is the first case of lymphomatoid granulomatosis in a child ever reported in Thailand. Lymphomatoid granulomatosis should be included in the differential diagnosis of upper airway obstruction with pulmonary nodules and cavity and multi-organ involvement in children.

Group A beta-hemolytic streptococcal type M11 sepsis and empyema: a case report.

A case of serious suppurative disease caused by GABHS in a previously well 2-month-old Thai female presenting with clinical features of sepsis and right pleural effusion was reported. Treatment was initially with cloxacillin and a right side intercostal drainage. When subsequent cultures of blood and pleural fluid grew GABHS; intravenous penicillin was substituted. She made an uneventful recovery. Typing of the GABHS revealed non typable T-antigen and M-protein 11 GABHS, although very sensitive to penicillin, can cause severe and rapidly progressive disease in a very young infant. This is the first case of GABHS type M11 causing pleural effusion and sepsis in an infant ever reported in Thailand. Epidemiologic study might be indicated if an epidemic should occur.

Afebrile pneumonia associated with chlamydial infection in infants less than 6 months of age: initial results of a three year prospective study.

During the year 1986-1988, 112 infants younger than 6 months of age with the diagnosis of afebrile pneumonia were studied at Chulalongkorn Hospital, Bangkok, Thailand. Thirty cases (26.78%) were caused by Chlamydia trachomatis. The clinical and laboratory findings which differed significantly from pneumonia caused by other organisms included longer duration of symptoms (greater than 1 week), younger age of onset (less than 12 weeks), history of conjunctivitis after birth, no wheezing detected, white blood cell count greater than or equal to 10,000 cells/microliters with eosinophilic count greater than or equal to 300 cells/microliters and reticulonodular infiltration on the chest x-ray.