To determine clinical signs that can predict pneumonia (confirmed by radiography) in infants under 2 months of age, 101 infants with pneumonia and 150 with an upper respiratory infection (but not pneumonia) were studied. Ten infants with pneumonia and 15 with an upper respiratory infection did not have the cough and/or difficult (or rapid) breathing that are recommended as 'entry criteria' by the World Health Organisation (WHO). The remaining infants met WHO entry criteria; in them sensitivity and specificity of respiratory rate ¢60/min and/or severe chest indrawing to diagnose pneumonia was 85% and 97% respectively. Addition of four non-specific signs (stopped feeding well, looked sick, temperature ¢'380C, and abdominal distension) to respiratory rate -60/min and/or chest indrawing for case identification resulted in a 7% gain in sensitivity but 22% loss of specificity. Addition of nasal flaring improved the sensitivity by 6% without loss of specificity. However, the non-specific signs were the only clue to diagnosis in five infants weighing £2500 g. At age <7 days, a weight s2500 g and cyanosis were associated with significantly higher risk of mortality. These findings support the use of a respiratory rate m60/min and/or chest indrawing for identification of pneumonia, and suggest addition of nasal flaring to the criteria for case identification in infants under 2 months with cough and/or difficult or rapid breathing.

Objective-To evaluate the respiratory rate as an indicator of hypoxia in infants < 2 months of age. Setting-Pediatric emergency unit of an urban teaching hospital. Subjects-200 infants < 2 months, with symptom(s) of any acute illness. Methods-Respiratory rate (by observation method), and oxygen saturation (SaO 2 ) by means of a pulse oximeter were recorded at admission. Infants were categorised by presence or absence of hypoxia (SaO 2 < 90%). Results-The respiratory rate was > 50/ min in 120 (60%), > 60/min in 101 (50.5%), and > 70/min in 58 (29%) infants. Hypoxia (SaO 2 < 90%) was seen in 77 (38.5%) infants. Respiratory rate and SaO 2 showed a significant negative correlation (r = −0.39). Respiratory rate > 60/min predicted hypoxia with 80% sensitivity and 68% specificity. Conclusion-These results indicates that a respiratory rate > 60/min is a good predictor of hypoxia in infants under 2 months of age brought to the emergency service of an urban hospital for any symptom(s) of acute illness. (Arch Dis Child 2000;82:46-49)

In a prospective study to determine simplified clinical signs predictive of pneumonia in children between 2 months and 5 years of age, and to test the validity of the signs recommended by the World Health Organization, clinical findings were correlated with X-ray evidence of pneumonia in 854 children, 400 with pneumonia and 454 with upper respiratory infections (no pneumonia). A respiratory rate of > or = 50/min in infants 2-6 months of age, > or = 40/min in children 7-35 months, and > or = 35/min in children > or = 36 months was the best discriminator of radiological evidence of pneumonia. Use of a respiratory rate of > or = 50/min instead of > or = 40/min resulted in a 14%, 19% and 32% loss of sensitivity with little gain in specificity in the age groups 7-11 months, 12-35 months and > or = 36 months, respectively. The age-specific respiratory rate (recommended by WHO) and/or chest indrawing, history of rapid or difficult breathing and/or chest indrawing, and nasal flaring were also sensitive and specific indicators of pneumonia in almost all the age groups studied.

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