Clinical algorithm reduces antibiotic use among children presenting with respiratory symptoms to hospital in central Vietnam.

OBJECTIVE: To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection. METHODS: The effect of an algorithm to guide the management of young (< 5 years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training. RESULTS: Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics. CONCLUSIONS: We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.

Evaluation of the Need for Intensive Care in Children With Pneumonia: Machine Learning Approach.

BACKGROUND: Timely decision-making regarding intensive care unit (ICU) admission for children with pneumonia is crucial for a better prognosis. Despite attempts to establish a guideline or triage system for evaluating ICU care needs, no clinically applicable paradigm is available. OBJECTIVE: The aim of this study was to develop machine learning (ML) algorithms to predict ICU care needs for pediatric pneumonia patients within 24 hours of admission, evaluate their performance, and identify clinical indices for making decisions for pediatric pneumonia patients. METHODS: Pneumonia patients admitted to National Taiwan University Hospital from January 2010 to December 2019 aged under 18 years were enrolled. Their underlying diseases, clinical manifestations, and laboratory data at admission were collected. The outcome of interest was ICU transfer within 24 hours of hospitalization. We compared clinically relevant features between early ICU transfer patients and patients without ICU care. ML algorithms were developed to predict ICU admission. The performance of the algorithms was evaluated using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and average precision. The relative feature importance of the best-performing algorithm was compared with physician-rated feature importance for explainability. RESULTS: A total of 8464 pediatric hospitalizations due to pneumonia were recorded, and 1166 (1166/8464, 13.8%) hospitalized patients were transferred to the ICU within 24 hours. Early ICU transfer patients were younger (P<.001), had higher rates of underlying diseases (eg, cardiovascular, neuropsychological, and congenital anomaly/genetic disorders; P<.001), had abnormal laboratory data, had higher pulse rates (P<.001), had higher breath rates (P<.001), had lower oxygen saturation (P<.001), and had lower peak body temperature (P<.001) at admission than patients without ICU transfer. The random forest (RF) algorithm achieved the best performance (sensitivity 0.94, 95% CI 0.92-0.95; specificity 0.94, 95% CI 0.92-0.95; AUC 0.99, 95% CI 0.98-0.99; and average precision 0.93, 95% CI 0.90-0.96). The lowest systolic blood pressure and presence of cardiovascular and neuropsychological diseases ranked in the top 10 in both RF relative feature importance and clinician judgment. CONCLUSIONS: The ML approach could provide a clinically applicable triage algorithm and identify important clinical indices, such as age, underlying diseases, abnormal vital signs, and laboratory data for evaluating the need for intensive care in children with pneumonia.

Children's pneumonia diagnosis system based on Mach-Zehnder optical fiber sensing technology / 国际生物医学工程杂志

Objective:To explore a fast and accurate method to diagnose children's pneumonia according to respiratory signals, so as to avoid the cancer induction caused by traditional X-ray examination.Methods:A Mach Zehnder optical fiber sensor was used to build a respiratory signals(RSPs) detection system, and the RSPs of the monitored children were extracted according to the vibration signal generated by the children's lung rales. Preprocessing methods such as the discrete cosine transform(DCT) were used to compress and denoise the RSPs. Multi-feature extraction of RSPs was conducted through signal processing methods such as the Hilbert transform and autoregressive (AR) model spectrum estimation. A support vector machine (SVM) classification model was constructed to classify the collected RSPs.Results:The accuracy rate of the proposed RSP classification of children with or without pneumonia was 94.41%, which was higher than the previous methods.Conclusions:The children's pneumonia diagnosis system based on an optical fiber sensor has a higher detection accuracy, and is expected to be widely used in clinical practice.

[Prescription and medication regularity of traditional Chinese medicine for treating child pneumonia based on data mining].

To analyze and summarize formulae of traditional Chinese medicine(TCM) in the treatment of pediatric pneumonia in CNKI based on the data mining method. CNKI was retrieved for literatures of TCM treatment of pneumonia in children in recent 20 years, which was taken the data source. After screening, a prescription database was established. Frequency analysis, association rules Apriori algorithm and complex system entropy clustering analysis methods integrated in TCMISS(V2.5) were applied in data analysis and mining. Core drugs and their properties and flavors, medication modes and new prescriptions were summarized and studied. A total of 408 prescriptions were screened out, involving 218 drugs, among which Chinese herbal medicines with the highest use frequency included Gancao(Glycyrrhizae Radix et Rhizoma), Xingren(Armeniacae Semen Amarum), Huangqin(Scutellariae Radix), Mahuang(Ephedrae Herba), Jiegeng(Platycodonis Radix), Banxia(Pinelliae Rhizoma), Sangbaipi(Mori Cortex), Chenpi(Citri Reticulatae Pericarpium), Fuling(Poria), Jinyinhua(Japonicae Lonicerae Flos). Flavors were mainly bitter, sweet and pungent; and the main medicinal property was cold. Most of these drugs entered lung meridian(LU), stomach meridian(ST) and spleen meridian(SP); and the association rules between drugs were established. Totally 6 new prescriptions were obtained through entropy hierarchical cluster analysis. Our results objectively presented, at present, TCM focuses on phlegm and heat in treating children's pneumonia, which targets at lung and also treats spleen and stomach. The main therapies aim to clear heat and resolve phlegm, ventilate lung and relieve cough and dyspnea, release exterior and dissipate cold, and relieve cough and eliminate phlegm. The results of statistical analysis are basically consistent with the consensus of experts, which can provide theoretical basis for clinical medication and drug development.

Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.

BACKGROUND: In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial). METHODS: Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm. RESULTS: Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03). CONCLUSION: Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen. TRIAL REGISTRATION: Clinicaltrials.gov NCT02484183 , June 29, 2015.

Paediatric use of antibiotics in children with community acquired pneumonia: A survey from Da Nang, Vietnam.

AIM: To characterise paediatricians' antibiotic-prescribing behaviour when managing community acquired pneumonia. METHODS: We conducted a knowledge and attitudes survey of paediatric doctors practicing at a regional provincial hospital in central Vietnam over a 2-week period (from 12 December 2017 to 29 December 2017). RESULTS: Of 79 eligible paediatric doctors, 69 (87.3%) completed the questionnaire, of whom 65 (94.2%) thought that antibiotics were overused in Vietnam. Thirty-eight doctors (55.1%) indicated that they routinely hospitalised children with pneumonia to provide intravenous antibiotics. Most doctors reported discharging children with non-severe pneumonia after 5 days (76.9%) and those with severe pneumonia after 7-10 days (88.4%); older doctors generally continued intravenous antibiotics for longer. The two most important factors driving discharge decisions were clinical assessment (95.6%) and completion of the full course of intravenous antibiotics (80.0%). Antibiotic prescription was influenced by local guidelines (62.3%), drugs used before admission (50.0%) and the opinion of senior clinicians (37.7%). Most doctors believed antibiotic stewardship was necessary (98.6%) and that over-the-counter use of antibiotics should be restricted (97.1%). CONCLUSIONS: Paediatricians recognised an urgent need for more effective regulation and antibiotic stewardship in Vietnam. Routinely completing a full course of intravenous antibiotics leads to unnecessary and prolonged hospitalisation.

Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: a mixed-methods study on caregivers' perceptions.

BACKGROUND: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers' perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. METHODS: There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children's caregivers. RESULTS: Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. CONCLUSION: According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.

Outpatient Management of Children With World Health Organization Chest Indrawing Pneumonia: Implementation Risks and Proposed Solutions.

This Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed.

The value of detecting mycoplasma pneumonia antibody and total serum IgE in patients with pneumonia in children / 国际检验医学杂志

Objective To discuss clinical value of the detection of Mycoplasma pneumoniae IgG with antibody (MP‐IgG) and the serum total IgE in child pneumonia .Methods Detected the serum M P‐IgG and total IgE in 480 cases of hospitalized children pa‐tients with pneumonia ,and grouped by the results of MP‐IgG .Results There was significantly difference between each category in study group and control group on the positive rate and concentration of serum total IgE(P<0 .05) ,comparison of the positive rate and concentration of serum total IgE between each category in study group had statistically significant differences(P<0 .05) .There was a positive correlation between the positive rate and concentration of IgE with the titer of MP‐IgG(R2 was0 .957 1 and 0 .917 7 respectirely) .Conclusion The combined detection of serum MP‐IgG and total IgE could provide reference for diagnosis of Myco‐plasma pneumonia and basis for clinical treatment .